Skip to content
Search

Latest Stories

Top Stories

Three surprising lessons for U.S. medicine from around the world

Doctor treating a patient

A doctor treats a patient in an East African village.

hadynyah/Getty Images

Pearl is a clinical professor of plastic surgery at the Stanford University School of Medicine and is on the faculty of the Stanford Graduate School of Business. He is a former CEO of The Permanente Medical Group.

During my residency at Stanford, I traveled to Mexico with a group of surgeons to operate on children with cleft lips and palates. On the first day, I watched in awe as the team leader meticulously realigned the tissues of the lip, mouth and nose of a 3-month-old boy, leaving behind nothing but a faint scar — all in just 90 minutes.

I immediately fell in love with plastic and reconstructive surgery. As a surgeon, I visited over a dozen countries to repair the cleft lips and palates of children. But later, in my leadership role as CEO at Kaiser Permanente, extended travel proved impossible. And I missed those trips dearly.

Last month marked my first global surgery mission in many years. Not only did our time in the Philippines reignite my passion for global surgery, but it also left me with three surprising lessons for American health care:


Without mission and purpose, medicine proves exhausting

Surgical trips are physically and emotionally demanding. Far from the sterilized corridors of American hospitals, you are plunged into environments where resources are scarce and the needs overwhelming. In remote towns and underdeveloped cities, you operate in tight spaces with erratic electricity and limited clean water. The days stretch long, with five to seven surgeries in a 12-hour day.

Sign up for The Fulcrum newsletter

Each child you treat carries a story of hardship and hope, their families’ eyes filled with a mix of fear and optimism. And just as you start to tire from the heat and yearn for a good night’s sleep, another mother arrives. She has walked for two days through the mountains with a child in her arms, praying her baby can be added to the surgical schedule. There is no saying “no” to this. You immediately become reinvigorated.

After a physically trying week, you return to the United States not exhausted, but emotionally replenished. Nearly every clinician who has participated in a surgical mission feels the exact same way.

American health care today obscures the fundamental mission and purpose that motivates clinicians. Physicians find themselves ensnared in a web of administrative tasks and insurance disputes. For many doctors, this noble calling has become just a job.

To revive the profession and address the burnout crisis that affects more than 60 percent of clinicians, a renaissance of purpose is imperative.

To get there, we must pivot away from the transactional “fee for service” financial model that rewards doctors for the sheer quantity of services rendered. In its place: a reimbursement model led by clinicians who are paid based on the quality of clinical outcomes achieved.

Inherent in the privilege of healing is the duty to lead this transformation. Taking on that accountability — and thereby eliminating the care restrictions that insurance companies impose — will rejuvenate, not further fatigue, health care professionals.

American doctors are excellent but so are physicians around the globe

U.S. physicians believe that training outside the States is a second-rate education. It’s time to alter that perspective.

During my week in the Philippines, I had the pleasure to work alongside five local physicians, often at adjoining operating room tables. They’d trained in residency and fellowship programs all around the world to maximize their expertise. To a person, their results matched the leading pediatric hospitals in the United States.

Although American doctors have access to the best facilities, machines and materials, physicians in other nations have a competitive advantage that comes from higher volume. The best way to hone any medical skill is through repetition and experience. American surgeons lag their global colleagues in this area.

U.S. clinicians bring a wealth of knowledge that can greatly benefit doctors worldwide, yet there are equally rich lessons to learn from the experiences and practices of physicians abroad.

In the U.S. today, doctors adhere to minimum surgical volume standards. Patient outcomes would improve tremendously if, instead, our nation set benchmarks for superior performance. Combining high-volume surgical experience with our advanced technologies and top-notch facilities would produce superlative clinical outcomes.

But first, America’s health care professionals need to embrace humility and be open to learning from our global colleagues.

U.S. resources are vast but access is still scarce

In countries like the Philippines, health care challenges are magnified by economic constraints. Despite government coverage, per capita health care spending remains low, under $200 annually. This financial reality forces difficult choices, leaving significant gaps between the health care needs of the population and the services available.

Witnessing these disparities firsthand is a poignant reminder of the abundance the United States enjoys, with health care spending now exceeding $13,000 per American. And yet, despite our nation’s wealth, independent studies reveal that U.S. health care ranks last among a dozen wealthy nations and near the bottom of 38 OECD countries in more than a dozen health measures.

The United States has earned its distinction as home to the most expensive and least effective health care system in the developed world. This isn’t just because of our 30 million uninsured citizens (and tens of millions who are underinsured). It’s the result of decades of underinvestment in primary care, tolerance of inefficient hospital systems and exorbitant drug prices.

The challenge of transforming American health care is daunting, and it requires a willingness to embrace change and confront uncomfortable truths. Observing the efficiency and ingenuity of less affluent nations inspires a reevaluation of our own care-delivery practices and health care finances.

The biggest problem in our health care system isn’t a lack of money. It’s the deficit in leadership and innovation.

Volunteering on global missions offers invaluable perspectives that could catalyze change in the United States. I’m optimistic that by learning from countries that achieve remarkable outcomes with modest means, we can enhance clinical outcomes, reduce clinician burnout, and make quality health care accessible and affordable for all Americans.

Read More

Trump’s Executive Orders: Bold Governance or Dangerous Precedent?

President Donald Trump signs two executive orders and speaks to the press in the Oval Office of the White House on January 30, 2025 in Washington, DC.

Getty Images / The Washington Post

Trump’s Executive Orders: Bold Governance or Dangerous Precedent?

No sooner did President Donald Trump resume his occupancy of the White House than he signed more than 200 executive orders in rapid succession. These directives radically shifted federal policies on issues ranging from immigration enforcement to energy production. While their full impact remains to be seen, many of these will face inevitable legal challenges, leading to prolonged court battles that will likely shape their outcomes and determine their long-term viability.

Executive orders instruct federal agencies on how to act or refrain from acting in specific ways. They do not grant new powers to the president—only Congress can do that—but instead rely on authority already granted by the Constitution or Congress. Importantly, these orders apply only to federal agencies and employees, meaning they do not directly govern private citizens or state governments.

Keep ReadingShow less
Two Minutes . . .

For This and Future Generations

Sunset over cracked soil in the desert. Global warming concept

Getty Images//Anton Petrus

Two Minutes . . . For This and Future Generations

I want to offer you a different lens through which to better understand the climatological and environmental crises that we—indeed all of humanity—are facing. I would like you to view these crises through the long lens of our planet’s geologic and evolutionary history.

From the beginning of our planet’s formation, some 4.6 billion years ago, to the present there have been five major extinction events which destroyed anywhere from70% (during the Devonian Period) to 95% (at the end of the Permian Period) of all living things on earth. These extinctions were natural events: caused by some combination of rapid and dramatic changes in climate, combined with significant changes in the composition of environments on land or in the ocean brought on by plate tectonics, volcanic activity, climate change (including the super cooling or super heating of earth), decreases in oxygen levels in the deep ocean, changes in atmospheric chemistry (acid rain), changes in oceanic chemistry and circulation, and in at least one instance, a cosmological event—the massive asteroid strike inChicxulub, near what is now the Yucatan peninsula.

Keep ReadingShow less
The Power of Outrage and Keeping Everyone Guessing

Question marks on a stack of small blocks.

Getty Images / Sakchai Vongsasiripat

The Power of Outrage and Keeping Everyone Guessing

Donald Trump loves to keep us guessing. This is exactly what we’re all doing as his second term in the White House begins. It’s one way he controls the narrative.

Trump’s off the cuff, unfiltered, controversial statements infuriate opponents and delight his supporters. The rest of us are left trying to figure out the difference between the shenanigans and when he’s actually serious.

Keep ReadingShow less
Trump’s executive orders can make change – but are limited and can be undone by the courts

The inauguration of Donald Trump.

Getty Images / The Washington Post

Trump’s executive orders can make change – but are limited and can be undone by the courts

Before his inauguration, Donald Trump promised to issue a total of 100 or so executive orders once he regained the presidency. These orders reset government policy on everything from immigration enforcement to diversity initiatives to environmental regulation. They also aim to undo much of Joe Biden’s presidential legacy.

Trump is not the first U.S. president to issue an executive order, and he certainly won’t be the last. My own research shows executive orders have been a mainstay in American politics – with limitations.

Keep ReadingShow less