I recently attended a meeting where a focus group of randomly selected people was assembled to opine on a wide variety of topics of common public concern. A series of questions came up regarding their perceptions of the medical profession and the current American healthcare system. Alarmingly, almost to a person, the feedback was negative.

The people in attendance complained of the dehumanized features of corporate medicine where they felt like a commodity and a cold business transaction. They spoke of the outrageous wait times to get an appointment with a physician, the high physician substitution rates with extenders, and the outrageous costs of even minor medical care. They described the presence of an almost impenetrable administrative shield between them and their physicians, making needed contacts increasingly difficult. They complained about the over-referral to the ER as a common default for minor complaints that could easily be managed in the office. Finally, and most disturbingly, there was a general sense among the group that their doctors often had little but a superficial interest in them as a person.

A response to one question shocked and haunts me. When asked if they were serving on a jury in a medical negligence case would they be able to separate the emotion and the empathy for a bad result from the true facts of the case if they supported the doctor’s care. Two-thirds of them said no! They explained by saying that their previous unsatisfactory encounters and subsequent poor opinion of the profession would not allow them to be able to overcome negative bias. When asked how that made them feel, they reported they were sad, but that the profession was not what it used to be, and they didn’t trust or respect it anymore. Sadly, these opinions are very consistent with the feelings of so many patients, friends and colleagues with whom I interact from across the country concerning the current perception of our profession.

Years ago, when the American automobile industry was faced with a similar declining public perception problem, the Ford Motor Company hired a consultant skilled in public image restoration. He said in situations like this, the problem is generally not the people in the company, but in the system that they are working in. I believe in large part that fact pertains to the situation our profession faces today.

Much to our own fault, we have allowed our noble profession to become corporatized. We have struck a Faustian bargain with the merchant class, abrogating our responsibilities of leadership and the protection of our sacred guild in search of some type of false security. In consideration of this type of wager, Benjamin Franklin once said: “He who sells his liberty for security will end up with neither.” His comments were prescient and represent the situation that our profession and those that work in it face today.

I believe that the progressive and systematic corporate takeover of the American healthcare system represents the greatest threat to the future character of the profession as well as the sanctity of the previously accepted time-honored servant base covenant that has been the hallmark of our guild. The harsh application of the inherent profit-driven business model of shareholder equity is having a devastating effect on the medical profession as well as the cost, quality, accessibility and personal intimacy of healthcare in our country.

The profit-centric business school model of modern corporate practice, with its efficiencies of scale, just-in-time ordering, assembly-line methods and “market-bearing” pricing works very well for the production of inanimate objects such as refrigerators. However, it fails miserably and is not transferable to the nuanced complexities of clinical care, the inherent unpredictability of human nature, and effects of their societal environment. These harsh capitalistic principles are societally acceptable and, in many ways, beneficial for the production, marketing and pricing of the various commodities where one has choices of need or price, but are, in my opinion, blatantly immoral and completely countercurrent to the historical mission of our noble profession.

Consistent with the corporate principle of market control, such as territorial monopoly, is physician employment. Once employed, physicians are controlled by three-year contracts constructed with sophisticated one-sided legalese, arbitrary renewable and cancellation clauses as well as onerous wide territorial restrictive covenants. As the employment model grows (currently approaching 80%), many insidious and pernicious changes are occurring, relegating medical professionals to the base level of a commodity functioning simply as mere cogs in the corporate profit regime. Instead of the high and noble distinction of “physicians,” we have been denigrated to the level of hired “providers,” tasked with pushing assembly-line–type transactional care in the relentless mandate to feed the insatiable RVU [relative value unit]-hungry corporate machine—an ignominious activity representing a merchant philosophy that has heretofore been repellent to the noble creed of our sacred profession.

Also in this new demoted commodity designation, the system is being robbed of our needed leadership, influence and nuanced expertise essential to the safe and quality practice of complex modern-day medicine. This progressive attack on our professionalism is also resulting in declining morale, a shift-work mentality, burnout and early retirement with dangerous implications for the future fabric of our nation’s medical care.

In sum, I truly believe that the corporate financialization system of healthcare is threatening the very core values of our noble profession and seriously hampering its quality, access, safety and affordability that the patients entrusted to us so rightly deserve.

This truism was again reinforced to me the other day in a local drugstore. As I was standing in line waiting to fill a prescription, I struck up a conversation with a woman behind me. During the conversation, she asked me what I did for a living. I proudly answered that I was a physician. Her friendly countenance abruptly changed to one of near hostility as she harshly retorted: “You people are just terrible!” Momentarily caught off guard, I regained my balance and replied: “Ma’am, my profession has its problem people, like all professions do. However, we are not terrible—the system we are working in is terrible.”

It is time we take back our profession from the merchant class and return it to its rightful noble place—a place well described by paraphrasing Robert Louis Stevenson’s “Eulogy of the Doctor”—as one that, when the stage of man is done, will be marveled at in history as to have shared in little of the defects of the period and to have most notably exhibited the virtues of the human race.

I believe this to be our solemn charge!

Dr. Elsey is a professor of surgery at the Medical University of South Carolina, in Charleston, and the past vice chair, Board of Regents of the American College of Surgeons.