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.
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.



















photo courtesy of Michael Varga.
An Independent Voter's Perspective on Current Political Divides
In the column, "Is Donald Trump Right?", Fulcrum Executive Editor, Hugo Balta, wrote:
For millions of Americans, President Trump’s second term isn’t a threat to democracy—it’s the fulfillment of a promise they believe was long overdue.
Is Donald Trump right?
Should the presidency serve as a force for disruption or a safeguard of preservation?
Balta invited readers to share their thoughts at newsroom@fulcrum.us.
David Levine from Portland, Oregon, shared these thoughts...
I am an independent voter who voted for Kamala Harris in the last election.
I pay very close attention to the events going on, and I try and avoid taking other people's opinions as fact, so the following writing should be looked at with that in mind:
Is Trump right? On some things, absolutely.
As to DEI, there is a strong feeling that you cannot fight racism with more racism or sexism with more sexism. Standards have to be the same across the board, and the idea that only white people can be racist is one that I think a lot of us find delusional on its face. The question is not whether we want equality in the workplace, but whether these systems are the mechanism to achieve it, despite their claims to virtue, and many of us feel they are not.
I think if the Democrats want to take back immigration as an issue then every single illegal alien no matter how they are discovered needs to be processed and sanctuary cities need to end, every single illegal alien needs to be found at that point Democrats could argue for an amnesty for those who have shown they have been Good actors for a period of time but the dynamic of simply ignoring those who break the law by coming here illegally is I think a losing issue for the Democrats, they need to bend the knee and make a deal.
I think you have to quit calling the man Hitler or a fascist because an actual fascist would simply shoot the protesters, the journalists, and anyone else who challenges him. And while he definitely has authoritarian tendencies, the Democrats are overplaying their hand using those words, and it makes them look foolish.
Most of us understand that the tariffs are a game of economic chicken, and whether it is successful or not depends on who blinks before the midterms. Still, the Democrats' continuous attacks on the man make them look disloyal to the country, not to Trump.
Referring to any group of people as marginalized is to many of us the same as referring to them as lesser, and it seems racist and insulting.
We invite you to read the opinions of other Fulrum Readers:
Trump's Policies: A Threat to Farmers and American Values
The Trump Era: A Bitter Pill for American Renewal
Federal Hill's Warning: A Baltimorean's Reflection on Leadership
Also, check out "Is Donald Trump Right?" and consider accepting Hugo's invitation to share your thoughts at newsroom@fulcrum.us.
The Fulcrum will select a range of submissions to share with readers as part of our ongoing civic dialogue.
We offer this platform for discussion and debate.