Pearl, the author of “ ChatGPT, MD,” teaches at both the Stanford University School of Medicine and the Stanford Graduate School of Business. He is a former CEO of The Permanente Medical Group.
With a single ruling, the Federal Trade Commission removed the nation’s occupational handcuffs, freeing almost all U.S. workers from noncompete clauses that prevent them from taking positions with competitors for varying periods of time after leaving a job.
American medicine, especially, will benefit. The FTC projects the new rule will boost medical wages, foster greater competition, stimulate job creation and reduce health expenditures by $74 billion to $194 billion over the next decade. This comes at a crucial time for American health care, an industry where half of physicians report burnout and 100 million people (41 percent of U.S. adults) are saddled with medical bills they cannot afford.
The FTC’s final rule, issued in April, liberates not only new hires but also the 30 million Americans currently tethered to noncompete agreements. Scheduled to take effect in September — subject to legal challenges by the U.S. Chamber of Commerce and other business groups — the ruling will allow health care professionals to change jobs within the community rather than having to move 10, 20 or even 50 miles away to avoid breaching a noncompete clause.
Like all major rulings, this one creates clear winners and losers — outcomes that will reshape careers and potentially alter the very structure of U.S. health care.
Winners: Newly trained clinicians
Undoubtedly, the FTC’s ruling is a win for younger doctors and nurses, many of whom enter the medical job market in their late 20s and early 30s, carrying significant student-loan debt — nearly $200,000 for the average doctor.
Eager for a stable, well-paying position, young professionals join hospitals and health systems with the promise of future salary increases and more autonomy. But when these promises fail to materialize, noncompete clauses give clinicians little choice but to uproot their lives, move far away and start over. As one physician in rural Appalachia told the FTC, “Healthcare providers feel trapped in their current employment situation, leading to significant burnout that can shorten their career longevity.”
By banning noncompetes, the FTC’s rule will boost career mobility, spurring competition among health care employers to attract and, more importantly, retain top talent.
Currently, the rule comes with one notable asterisk: Nonprofit hospitals and health systems fall outside the FTC’s jurisdiction. However, the agency says these facilities might be at “a self-inflicted disadvantage in their ability to recruit workers.” Moreover, as Congress intensifies scrutiny on the nonprofit status of U.S. hospitals, those that reject the FTC’s guidelines may find themselves forced to comply through legislative actions.
Winners: Patients in competitive health care markets
The FTC’s ban on noncompete clauses will directly improve patient outcomes. For example, doctors and nurses who experience less burnout and greater job satisfaction are far less likely to make serious medical errors, studies show.
Further, clinicians who are now free to practice elsewhere in the community are likely to offer greater access, lower prices and more personalized service to attract and retain patients. Other doctors and nurses will join local outpatient centers, offering convenient and cost-effective alternatives to the high-priced diagnostic tests, surgeries and urgent care provided at nearby hospitals.
Losers: Large health systems
Made up of several hospitals in a geographic area, large health systems have traditionally relied on noncompete agreements to build market dominance. By preventing high-demand medical professionals such as radiologists and anesthesiologists from joining with competitors or starting independent practices, these health systems have managed to suppress competition while forcing insurers to pay more for services.
Currently, these systems demand high reimbursement rates from government and business payers. At the same time, they maintain relatively low wages for staff, creating a highly profitable model. Yale economist Zack Cooper’s research shows the consequence of the status quo: In highly concentrated hospital markets, prices go up and quality declines.
The FTC’s ruling will challenge those conditions, eroding health-system monopolies and shrinking their oversized bottom lines.
Losers: Hospital administrators
Individual hospitals have faced a unique challenge this past decade. Inpatient numbers continue falling nationwide, which makes it harder for hospital administrators to fill beds. This trend — driven by new technologies, evidence-based practices and changing insurance-reimbursement policies — have forced hospital administrators to adapt their financial strategies.
And adapt they did. Today, outpatient services account for half of all hospital revenue, reflecting aggressive acquisitions of local practices that offer physician consultations, procedures like radiological and cardiac diagnostics, chemotherapy, and same-day surgery.
Medicare and other insurers pay hospital-owned outpatient services more than local doctors and other facilities for identical services. By acquiring community outpatient practices, hospitals are paid higher rates without facing higher costs, thus generating large profits.
This strategy only works, however, if hospital administrators can prevent clinicians from quitting and returning to practice in the same community. If they do, their patients are likely to follow.
This is why the noncompete clauses are so essential to a hospital’s financial success. As expected, the American Hospital Association opposes the FTC’s rule, calling it “bad law, bad policy, and a clear sign of an agency run amok.”
Looking ahead
Today’s hospital systems are divided between haves and have-nots. Facilities in affluent areas enjoy higher reimbursements from private insurers, with greater financial success and higher administrator salaries (but not necessarily better patient outcomes). Rural hospitals grapple with low patient volumes while facilities in economically disadvantaged, high-population areas face greater financial difficulties.
None of these models are working for everyday Americans. The ultimate measure of health care policy should be its effect on patients. Based on the FTC ruling, the evidence is clear: Eliminating noncompete clauses will benefit patients greatly.
image of U.S. President Donald Trump is displayed on a digital billboard in Times Square in New York on April 8, 2026.
Trump is stuck between two realities. Neither serves the American people
Normally, I worry that events may overtake a column. But not so with the Iran war.
I don’t worry about running afoul of a headline or Truth Social post from the president because what is said about the situation is no longer very relevant to the reality.
On April 8, Nick Catoggio, my Dispatch colleague, dubbed an earlier stoppage with Iran “Schrödinger’s ceasefire.” This was a reference to the famous thought experiment by the physicist Erwin Schrödinger, who was trying to explain the weirdness of “superpositionality” in quantum physics. A cat in a box is both dead and alive at the same time until you open the box. Schrödinger meant to illustrate the absurdity of the idea that particles aren’t any one thing, but a “cloud of probabilities.”
The Trump administration is stuck in a word cloud of probabilities of his own making. The war is over. The war is on. The war isn’t a war. We have a deal, but we don’t have a deal, but we’re about to have a deal. We destroyed Iran’s military. No, we left it intact. We want regime change. No we don’t. We already accomplished it. We “obliterated” Iran’s nuclear program a year ago. We had to go to war in February to prevent nuclear war. The Strait of Hormuz is open, closed, or something in-between. No deal without “unconditional surrender.” Let’s make a deal!
This everything-all-at-once vibe can be disorienting, particularly since most Americans didn’t have a war with Iran on their bingo cards until the shooting had already started. President Trump didn’t prepare the country or consult with Congress beforehand because he thought it would all be a smashing success in a matter of weeks.
The miscalculation that started it all: killing Iran’s Supreme Leader, Ayatollah Ali Khamenei, and much of Iran’s senior leadership, on the first day of the war. To “the great proud people of Iran, I say tonight that the hour of your freedom is at hand,” Trump announced on Feb. 28. “When we are finished, take over your government. It will be yours to take. This will be probably your only chance for generations.”
I support regime change in Iran and shed no tears for Khamenei or his goons. But when you start a war by killing the regime’s top leaders, it’s not unreasonable for the remaining ones to conclude that you really intend regime change.
Khamenei was a murderous fanatic, but he was a fairly cautious one. He liked to threaten closing the Strait of Hormuz or attacking our regional allies, but he was reluctant to actually do it, fearing it would invite a regime change war. The mullahs and IRGC goons believed, not unreasonably, that if they lost their grip on power, they’d be lynched by the Iranian people they’ve brutalized for decades.
By starting with a regime change war, Trump removed any reason for the regime not to go for broke. When you have nothing to lose — particularly when you are a millenarian religious fanatic — a Persian Alamo strategy makes a lot of sense.
So Iran closed the Strait of Hormuz and attacked its neighbors.
But it turns out this wasn’t the Alamo. In the contest of wills, Trump blinked. The Iranian regime’s tolerance for punishment proved — so far — to be greater than Trump’s and that of our gulf allies. Militarily we could finish the job, but that would require ground troops and much greater economic turmoil. In a conflict Trump launched unilaterally without the prior support of Congress, NATO or the American people, Trump doesn’t have the political capital for that.
But that’s only half the problem. Trump wants the war over, but he doesn’t want to pay — militarily, economically, politically — what that would cost. So he wants to make a deal that ends it. But there is no deal available that wouldn’t come at an equally undesirable cost. Any deal that looks like what President Obama struck with the Iranians would be too embarrassing to bear. But the Iranians are convinced that they can get just such a deal, and they’re willing to drag things out as long as it takes.
The result: Trump’s in a box of his own making. He thinks he can talk his way out by simply asserting a reality that doesn’t exist. When the financial markets get nervous, he announces a breakthrough that is, at best, a possibility. When the Iranians agree to a deal that looks similar to one Obama might negotiate, Trump goes back to his threats.
It can’t go on forever. But I’m sure it’ll last until long after this column is forgotten.
Jonah Goldberg is editor-in-chief of The Dispatch and the host of The Remnant podcast. His Twitter handle is @JonahDispatch.