There is a tacit “deal” in American medicine. The “deal” was necessary because of how our education system evolved. In addition, the “deal” was created in partnership with the federal government as a method of providing healthcare to our population and our society. Social programs were adjunctive to the “deal,” and the costs for these programs have grown exponentially over time. The foundation of the “deal” was a trust that there was a shared mission-based integrity. However, there is also the gritty reality of economics behind the “deal.” How should a profession respond when trust is eroded and components of a long-standing relationship are parsed in such a way as to create an undue burden that ignores tenets of goodwill?
