Eleven physicians joined Becker’s to discuss the biggest threats physicians will face next year. Among the threats they cited were longstanding issues such as erosion of public trust to reimbursement declines. Yet, others saw more emergent ones stemming from workforce shortages and declining practice independence.
Editor’s note: Responses have been edited lightly for clarity and length.
Question: What’s the biggest threat to physicians in 2026?
James Cain, MD. Chair and Professor of the Department of Anesthesiology at University of Florida (Jacksonville): Among the greatest threats to physicians in 2026 is the erosion of trust in scientific expertise and evidence-based medicine. Trust in science is foundational to informed consent, public health and shared decision-making, yet the decline in that trust did not develop in isolation. The COVID-19 pandemic was a global crisis that imposed profound emotional, social and economic strain. Nearly every individual and family experienced some form of loss — whether of loved ones, livelihoods, stability or health — and the burden on clinicians, particularly those in safety-net hospitals, was unlike anything in modern times.
It is understandable that such an event would leave a lasting imprint on the expectations of our healthcare system. The pandemic exposed vulnerabilities, required rapid adaptation and demanded decisions under uncertainty. Many in the public emerged with grief, disappointment or doubt about whether medicine could provide the level of certainty and protection that society hoped for. That context matters when considering the skepticism we encounter today.
However, it is essential to distinguish between natural, experience-based questioning and the deliberate promotion of misinformation by individuals with influence who have access to the same data, yet advance narratives unsupported by scientific evidence. Scientific understanding evolves — that is its strength — but when evidence itself is dismissed as optional, the result is confusion rather than clarity, polarization rather than partnership, and delayed or declined interventions that could improve health outcomes.
Rebuilding trust is not simply a communication challenge; it is a cultural one. It requires acknowledging the hardship of the past several years, honoring the experiences of patients and families, and remaining steadfast in our commitment to science as the most reliable path to improved health. That work is essential to the future of patient care and to the social contract that underlies the practice of medicine.
Richard Chazal, MD. Medical Director of Heart Health at Lee Health Institute (Fort Myers, Fla.): The erosion of trust in science and in physicians is highly problematic. Clinicians and medical leaders who provide evidence-based advice regarding diagnosis, lifestyle changes and treatment rely on patient acceptance of knowledge and benevolent intent. Distrust in either or both undermines our ability to favorably influence health and healthcare outcomes.
Antonio Hernandez Conte, MD. Past-President of the California Society of Anesthesiologists: Financial viability for group practices for anesthesiologists and nurse anesthetists will be the biggest issue facing our specialty in 2026. The severe reduction in Medicaid funding via passage of H.R.1 (“Big Beautiful Bill”), aggressive insurance payer behavior forcing in-network contracts at reduced reimbursement rates and hospital financial solvency will significantly impact anesthesia practices. Practitioners and hospitals in both rural and urban areas will be most impacted. Additionally, due to the anticipated loss in ACA payment subsidies, millions of people will also likely cancel health insurance coverage due to exorbitant premiums — physicians and hospitals will be caring for more persons who are underinsured or un-insured.
Marsha Haley, MD. Clinical Associate Professor of Radiation Oncology at University of Pittsburgh School of Medicine: We have a shortage of physicians that is expected to worsen in the foreseeable future, particularly in rural areas. This is due to several factors — the need for physicians outpacing the supply, a shortage of residency positions, a lack of incentives for physicians to practice in rural areas, declining reimbursement in a setting of massive student loan debt, hostile malpractice environments and burnout.
The biggest threat to physicians is allowing these issues to continue and, in many cases, worsen. State-level policies have exacerbated the problems by passing scope of practice legislation allowing physicians to be replaced by nonphysician practitioners, enabling overly restrictive noncompete clauses and allowing abusive malpractice conditions.
At the federal level, Congress has been slow to act. The Resident Physician Shortage Reduction Act would increase residency positions.The Physician and Patient Safety Act would ensure professional due process rights for physicians.The [Specialty Physicians Advancing Rural Care] Act would offer loan repayment to specialty physicians serving in rural communities. The Restoring Rights of Physicians to Own Hospitals Act would repeal the ACA ban on physician-owned hospitals. It is critical for legislators to pass these and other pro-physician bills so that we can continue to recruit the best and brightest to the medical field. This would go a long way toward ensuring we have enough physicians to take care of our patients.
Ahad Mahootchi, MD. Cataract Surgeon at the Eye Clinic of Florida (Zephyrhills): Medicare “dis”Advantage and the hodge-podge coverage for things that have been used for 20 years. Many also say they cover something but at ASCs they intentionally set facility fee reimbursement about $150 less than the device cost — hence a disincentive to do a procedure advertised to enrollees as covered, if the reimbursement won’t even cover the hard cost of one part of the surgery. Talking to these big insurance companies is impossible.
Mary Meyer, MD. Emergency Medicine at Kaiser Permanente Westside Medical Center (Hillsboro, Ore.): Going forward in 2026, I think physicians need to recognize the importance of meeting patients where they are in order to practice good healthcare. This might mean going over their ChatGPT research with them. Or explaining the evidence base underlying certain recommendations and addressing distrust or misinformation. Or giving patients time to think about treatment options and ask a lot of questions. All of this requires a ton of intellectual humility and patience and, often, a shift from the way we may have practiced in the past. My concern is that if physicians don’t adapt to the new expectations of our patients, we will continue to see an erosion of trust in healthcare organizations.
Udaya Padakandla, MD. Past President of the Texas Society of Anesthesiologists: I believe among the significant threats to physicians in 2026, the most important is, and will continue to be, loss of independent practice model. With physicians increasingly coming under the employment umbrella of health systems or insurance companies or private equity companies without physician ownership/ governance, there is a rapid and steady decline in the numbers of physicians engaged in the advocacy for the patients and for the profession.
Among the other threats to physicians in 2026 are No. 1, vertical integration models which also contribute to the loss of physician practice autonomy; No. 2, ever-decreasing payments from the payors, both commercial and Medicare/Medicaid; and No. 3, a steady increase in the numbers of locum tenens physicians.
Aparna Padiyar, MD. Nephrologist at University Hospitals (Cleveland): The ongoing workforce shortage and rising care complexity. Organizations must continue to streamline operations and support team-based workflows in the face of growing administrative demands.
Amit Singh, MD. Cardiologist at Cayuga Health (Lansing, N.Y.): The biggest threat is continued reimbursement cuts.
Prince Singh, MD. Nephrologist at Allina Health Faribault (Minn.) Clinic: Declining reimbursements from Medicare and practice creep by non-MDs.
Mark Thoma, MD. Chair of Anesthesia at Kaiser Permanente Northern California (San Francisco): The biggest threat to anesthesiology in 2026 is the financial destabilization of hospitals following the failure to renew ACA subsidies. When subsidies lapse, more patients become uninsured or underinsured, sharply increasing uncompensated care and bad debt. Because many hospitals already operate on thin margins, this revenue loss forces hiring freezes, delayed backfills, reduced per-diem and traveler budgets and consolidation of service lines. Anesthesiology is uniquely exposed to these pressures because it depends on stable surgical volumes, protected staffing ratios and investment in essential equipment, monitors, and medications. As operating room schedules contract and capital budgets tighten, anesthesia groups face reduced resources, fewer supported roles and pressure to shift toward lower-cost staffing models impacting patient safety.
This will translate across multiple adjacent services too. Trauma centers may struggle to maintain on-call specialist coverage and 24/7 readiness. Labor and delivery units — already financially vulnerable — face heightened risk of consolidation or closure, reducing access to obstetric anesthesia. Elective surgical services, which normally greatly subsidize hospital operations, may be limited as hospitals cut block time, close ORs on low-volume days, or reduce postoperative bed availability. Each of these changes directly impacts anesthesia workload, staffing stability and the ability to maintain high-quality, patient centered perioperative care.
Although underserved and rural areas will feel the impact first and most acutely, these effects are not geographically limited. Rural and safety-net hospitals, with high proportions of Medicaid and uninsured patients, may face rapid service-line contraction, trauma downgrades, and OB closures. Urban community hospitals will also experience increased financial strain, reduced elective surgical volume, and staffing cuts. Even academic medical centers — despite stronger resources — remain vulnerable as uncompensated care rises, regional networks destabilize, and fixed complex-care costs remain high. In short, while the crisis begins at the margins, the economic pressures created by the loss of ACA subsidies can extend system-wide, affecting anesthesiology departments in hospitals of all types and sizes.
