Our US healthcare system is a complex world of moving parts. Like the game of Jenga, each piece (physician, hospital, payer, patient) is interdependent on the other. We are all carefully balanced, almost tipping over but then correcting.

The US spends $3.6 trillion dollars on healthcare or for every $5 spent within the US; $1 is spent on healthcare.

About $1 in every $3 spent on healthcare goes to the nation’s 5,100 acute care hospitals. Around 3,000 of these are not-for-profit, 1300 are for-profit, and the rest may be local, county, or federal government run. Today, most hospitals are part of large health systems, which may also own physician offices, home health providers, urgent care centers, and ambulatory care facilities, among other health care providers. This vertically integrated model enables hospitals to keep patients in its “system” whether that’s lab and imaging tests, physical therapy, or outpatient work up or treatments.

Around $1 in $4 healthcare dollars may go to hospitals employing the physicians or directly to the physician. Within our nation we have an estimated 500,000 primary care physicians and slightly more specialists.

Long term and rehabilitation facilities as well as prescription drugs round up the rest of the healthcare costs.

The Covid pandemic has upended patient’s expectations and created an opportunity for new disruptors vying to provide patients services in the setting that consumers want. Startups and other industries (e.g. Amazon, Walmart, Walgreens) are entering this lucrative healthcare market, and patients are willing to abandon traditional care for more affordable and convenient options.

What will happen if these new entrants successfully move into the healthcare world of Jenga replacing traditional medical practices (physicians or hospitals) with at-home, online or retail diagnostics or therapeutics? Retail, technology, telecommunication and even automakers are looking for ways to help consumers track chronic care data. Today, we have heartbeat monitors in our watches, can get vaccinations at grocery stores, and can call a “doc in a box” (for transparency, these are often non physicians answering your call).

UnitedHealth Group purchased digital health start up Audax and its Optum unit owns several hospitals and physician practices within our state. Temple University Health System operates “ReadyCare” retail clinics.

For patients, will this make access to healthcare more transparent, more Amazon.com style? Physicians need to be curious, good communicators and listeners, conscientious and empathetic. As physicians, we need to advocate for our patients. Will the ease of a retail clinic

promote overutilization or over prescription of antibiotics etc.? These are all complex questions even while our healthcare house of Jenga remains intact. I have enjoyed debating the pros and cons of these changes with colleagues during my roles within the AMA Council on Medical Service, as Chair of the WA State Health Technology Committee for state funded programs (including Medicaid), and as Chair of the Board of Chancellors at the American College of Radiation Oncology. The past few years has brought some hope that we are recognizing that our patients want more from us, and we must collaborate to deliver!