A doctor with a small office, a receptionist and a couple of nurses used to be a common sight in American neighborhoods. Nicholas Mukhtar, a management consultant whose background includes a Bloomberg Fellowship in public health at Johns Hopkins University, points to that vanished model as evidence of how regulatory complexity reshapes an entire industry over time.
“The family doctor who ran his own small practice with a receptionist and a couple of nurses, that model doesn’t exist anymore,” Mukhtar said.
A Slow Accumulation, Not a Single Rule
Mukhtar’s explanation avoids blaming any one policy. Solo practices didn’t close because of neglect or a sudden regulatory change, he argues, but because requirements piled up year after year until small-scale medicine stopped being financially workable.
Insurance verification, prior authorization and government reporting requirements arrived one at a time, each defensible on its own, but their combined weight fell hardest on practices with the fewest staff to absorb it.
Physicians reported a 57.8-hour average workweek in 2024, including 7.3 hours on prior authorization and insurance forms and 13 hours on documentation and order entry – nearly 20 hours a week that never touch a patient directly. A solo practitioner absorbs all of that personally, while a hospital network spreads it across a compliance department.
A Public Health Lens on a Business Problem
Mukhtar’s public health background, including years running the Detroit nonprofit Healthy Detroit before it was named the American Public Health Association’s Organization of the Year in 2017, shapes how he frames the issue. Programs fail the people who need them most when access becomes burdensome, he says, whether the barrier is an intake form at a clinic or a stack of insurance paperwork in a doctor’s office.
That instinct traces back to Healthy Detroit’s own design. Rather than requiring residents to seek out a clinic, the nonprofit built health screenings and wellness services directly into city parks, removing the step that usually causes people to disengage from care.
Consolidation driven by the same compliance pressure has already thinned out primary care access in some underserved communities, and it tends to raise prices rather than lower them once fewer independent practices remain to compete on cost.
That framing treats friction itself as a measurable cost, one that determines who can still get care and who gets priced out of it entirely.
