The Managerialist Revolution in Medicine

According to Pew research, the number of US adults who place confidence in medical scientists to act in the best interests of the public declined from 40% in 2020 to 29% in 2022. A 2021 survey by the American Board of Internal Medicine likewise found that one in six people—including physicians—no longer trust doctors, and one in three do not trust the healthcare system. Almost half the population does not trust our public health agencies to act in our interests.

Doctors are leaving the profession in droves, prompting worries of a worsening physician shortage. According to the American Medical Association, one in five doctors plan to leave medicine in the next two years, and one in three plan to reduce their work hours in the next year. Why is medicine today failing many of its brightest students and pushing large numbers of its best-seasoned practitioners into early retirement?

The answer is complex and multifactorial, but a major contributing factor is the managerial revolution in medicine. Medicine, like many other contemporary institutions since World War II, has succumbed to managerialism—the unfounded belief that everything can and should be deliberately engineered and managed from the top down. Managerialism is destroying good medicine.

The managerialist ideology consists of several core tenets, according to N.S. Lyons. The first is Technocratic Scientism, or the belief that everything, including society and human nature, can and should be fully understood and controlled through materialist scientific and technical means, and that those with superior scientific and technical knowledge are therefore best placed to govern society. In medicine, this manifests through the metastatic proliferation of top-down “guidelines,” imposed on physicians to dictate the management of various illnesses. These come not just from professional medical societies but also state and federal regulatory authorities and public health agencies. […]

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