Is Healthcare Too Efficient? The Cost to Patient Care

At 5:30 AM this morning, I was half-awake, listening to my daughter talk in her sleep—not quite awake, but not fully asleep either—and I found myself thinking about something that's been gnawing at me for months: can we be too efficient?

I've written nearly 100 Inefficiency Insights articles by now, and in almost every single one, I include a solution to make the inefficiency more efficient—often involving AI, sometimes involving workflow redesign, but always focused on doing more with less. And to be honest, I'm exhausted by it. AI this, AI that. I feel like I've covered it relentlessly throughout 2025, and if I'm feeling this way, I imagine you are too.

So after some deep reflection this morning—fueled by sleep deprivation and the strange clarity that comes with it—I came to a conclusion that might sound heretical coming from someone who writes about inefficiency every week: yes, there is such a thing as being too efficient.

To explain what I mean, we need to talk about the difference between two fundamentally different concepts that healthcare systems constantly confuse: efficiency and effectiveness. I've discussed this distinction before in my course, How to Problem Solve in Healthcare, but it's worth revisiting here because it cuts to the heart of what's broken in medicine today.

You can be incredibly efficient and not effective at all. You can also be inefficient and incredibly effective. The goal, obviously, is to be both—but in healthcare, doing both is often impossible because the system has decided that efficiency is the only thing that matters.

One area where this tension plays out every single day is in the physician-patient relationship. This is supposed to be a prized, cherished, delicate bond built on trust—and decades ago, it probably was. I spoke with a retired pediatrician the other day, and his advice to a young trainee like me was disarmingly simple: "Listen to your patients."

Simple. But almost impossible in a system that's trying to maximize efficiency by seeing as many patients as possible in a given day.

Because of the emphasis on efficiency—on throughput, on RVUs, on keeping the schedule moving—the goal of building rapport with patients and sustaining these physician-patient relationships has taken a back seat. We are not being effective if the goal is to build these relationships. And building such relationships cannot be efficient. If a patient feels rushed, that damages trust, and therefore damages the relationship. If a patient feels heard but not listened to, that also damages trust, and therefore the relationship.

I've written about this before when I talked about how corporatization is eroding the physician-patient dynamic. The drive to improve bottom lines has turned care into a throughput problem, where the metric that matters most is how many people we can see, not how well we can care for them. But as I argued in that piece, if patients don't have trust in their physicians, or if physicians don't have trust in their employers because of the relentless drive to maximize revenue, there won't be a bottom line left to protect.

Imagine breaking terrible, life-altering news to a patient—news that will fundamentally change the trajectory of their life—in short, succinct sentences, without any empathy, without any space for them to process what you're telling them. Sure, you're efficient. You delivered the information quickly, checked the box, moved on to the next patient. But effective in the context of fostering the physician-patient relationship? Absolutely not.

It sucks, this system emphasis on efficiency to improve bottom lines. And listen, if the goal we're trying to accomplish is to improve bottom lines—if that's the effectiveness metric we've decided matters—then so be it. But you'll have no bottom line if patients don't have trust in their physicians, or if physicians don't have trust in their employers, or if the entire system collapses under the weight of burnout and turnover.

What worries me most is that we've now reached the point where we, as physicians, need to remind ourselves that we're not pegs in a cogwheel—even though it might feel that way most days. We're humans with years of incredibly rigorous medical training, and we have the privilege of building relationships with patients through the work of healing them, whether that's with our brains (shout out to the medicine doctors) or with our hands (shout out to the surgeons).

I explored this tension before in The Three T's of Excellent Patient Care, where I argued that Time, Trust, and Transparency are the foundation of good medicine. But all three of those things require space to breathe. None of them fit neatly into a 15-minute visit that's been reverse-engineered to maximize RVUs while minimizing labor costs.

So what do we do about this? Because I can't just end this piece by saying "efficiency is bad" and leaving it at that—that's not helpful, and it's not how I usually operate in this newsletter.

The answer is that we need to stop pretending that efficiency is the only goal worth pursuing. If the goal is to improve bottom lines—if that's the effectiveness metric that matters—then the strategy needs to account for the fact that trust, relationships, and long-term care quality are what sustain the system in the first place. Short-term revenue gains built on the backs of burned-out physicians and distrustful patients are not a sustainable business model.

We don't need more AI tools to make visits shorter or documentation faster. We need solutions that address root causes, not just symptoms—solutions that redesign workflows to protect the parts of care that must remain inefficient. Building rapport takes time. Listening takes time. Delivering bad news with empathy takes time. These aren't bugs in the system. They're features of good medicine.

In summary, efficiency is not the enemy—but when it becomes the only goal, we lose what makes medicine meaningful. The system needs to stop optimizing for throughput and start optimizing for trust, for relationships, for the long-term effectiveness that actually keeps patients coming back and physicians from burning out.

If we don't, we'll end up with a very efficient system that no one wants to be part of—not the patients, not the physicians, and certainly not the next generation of trainees watching from the sidelines, wondering if this is really what they signed up for.