I recently enjoyed reading Peggy Noonan’s new book “A Certain Idea of America.” It is a wonderful collection of her essays on a variety of thoughts and ideas inspired by seminal events and national struggles. Her central belief is that America is the “shining city on the hill,” the “last great hope” for a free humankind. She rightly points out that America is a grand idea and aspirational in its essence—an anti-feudal ongoing experiment in government that aspires to create a world of equality and meritocracy, where anyone can reasonably become anything they want given their talent, their desires and their acceptance of hard work.

Noonan laments and warns, however, that America’s aspirational motif of the greater good is slowly becoming financialized where the quality of the country’s soul and measure of the experiment’s success is defined by houses, cars, trips, clubs, bank accounts and other materialistic metrics. This change in national aspiration is leading to rapacious greed, great wealth disparities, destabilizing societal polarization, rampant individualism, generalized anxiety, institutional distrust and alienation of so many of our disenfranchised citizens. This change from the noble inclusive mantra of “out of many, one” to the selfish “out of one, many” is threatening the very social fabric of our nation.

Sadly, I see this slowly happening to the great profession of medicine. We have struck a flawed Faustian bargain with the merchant class. We are slowly surrendering the pure aspirations of our noble calling and allowing ourselves to become minions of the corporate machine. In this sad state we are turning patients into profit-and-loss statements, denigrating care to cold transactions, turning a blind eye to the evils of private equity takeovers, and establishing the RVU (relative value unit) as the “new coin of the realm.” All of these changes are defined by the profit-centric cabals of our corporate masters and the medical industrial complex.

In this corporate indoctrination, we have been renamed as simple providers instead of physicians and healers. As we tolerate this demoted mantle, many are changing their career perspectives, looking at the practice of medicine as “just a job” rather than through the lens of the aspirant values of a grand and noble calling.

Inherent in this recasting of the professional’s ethos are the progressive attempts of self-preservation and protectionism, ideologies that have been historically countercurrent to the time honored, accepted and heretofore gladly embraced guild’s requirements of personal sacrifice. The historic servanthood covenant that has been emblematic of our central identity is slowly being eroded by the progressive search for the nebulous concept of work–life balance, shift-work mentality, handoffs, excessive use of extenders, ER default care and increasing communicative barriers between patients and their doctors.

Like the current threats to our exceptional grand national experiment of self-determination, these dangerous ideologies and their resultant fallout will undermine the time-honored Hippocratic principles of servitude and professionalism that are deeply inherent in our grand and noble art. These are the bedrock principles that make up the core values of who we are and what we do as healers.

I truly believe medicine is different. It is not, nor can it ever be, just a job or trade. It is truly aspirational in its essence. It is a noble idea that transcends the routine and mundane. It is a grand aspiration that should existentially change all of those that take up its calling: the aspirations to selflessly enter the sick room; to participate in the mystical miracle of healing; to place the needs of our patients above our own; to help bear the often unbearable; to protect the most intimate confidences; to dispense hope wherever and whenever possible (and harsh truth when needed); and to act always as servants, never merchants.

These aspirant qualities are the North Star of our grand profession. We must never lose them!

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