Collective Hive November 2026

November 01, 2026

The Time of Monsters

Nobody really trusts you anymore. The insurer assumes you are padding the bill, Medicare has an algorithm that holds your payment on suspicion, and when KFF asked voters this summer who was mostly responsible for fraud in Medicare, 53 percent said doctors' offices and hospital systems. The deference you were promised when you signed up for this career is gone, and the one thing you were trained to do about it, which is keep your head down and work hard to do a good job, is the one thing that no longer works.

Antonio Gramsci, writing from a fascist prison in 1930, had a phrase for a moment like this: The old is dying and the new cannot be born, and in between, a great variety of morbid symptoms appear. Slavoj Zizek later added his own flair with, Now is the time of monsters. 

The old world is the one Paul Starr described in The Social Transformation of American Medicine in 1982: a sovereign profession that had struck a bargain with the country. Physicians would police themselves and put the patient's interest ahead of their own, and in exchange they got autonomy over their work, a deference nobody else in the economy enjoyed, a steady and prosperous living, and the right to be left alone. Three years after Starr, two sociologists named John McKinlay and Joan Arches published a paper in response called, Towards the proletarianization of physicians, and predicted that the bargain would not survive the corporation. They were right, and it took forty years, but the last ten have come fast and hard.

What has happened in those forty years since? Physicians continued to absorb the myths and never really examined them: sacrifice as commitment, prestige as compensation, autonomy as selfishness, exhaustion as the price of admission. These are what Gramsci would have called morbid symptoms, the habits of an old order that persist after the order has stopped prioritizing them. Consolidation, power grabs by insurance companies, corporatization of healthcare, and most recently AI being used to determine outcomes and payments. The deference has largely gone out the window as well - from the public and the institutions meant to safeguard it. But physicians have kept performing their half of the contract, even while the other parties tore theirs up. 

So what has the younger generation of physicians been doing? They have started to treat being a doctor like any old job. They ask about duty hours. They talk about mental health. They want to see an equitable call schedule. And they have been vilified for it. What happened to “the calling,” people ask them. “If they didn’t want this job, they shouldn’t have signed up for it,” goes the tired refrain. And of course, the “it’s just a job,” is only another “morbid symptom.” This version of the doctor is simply the proletarianized physician predicted by McKinlay and Arches, a line worker with an elevated title. And the system is frankly happy to accept it for the most part. So what’s the middle ground?

“The Monster” is the doctor who is done being pious. She still cares, yes; patients should not be collateral damage in any of this. The teeth are reserved for the administrators and the payers who make decisions on her behalf without ever seeing a patient. She learns about fee schedules and how reimbursements work, in contrast to her older attending who brags about having no idea what this surgery costs. She pushes back against insurance companies denying claims and stays involved in political movements. She does not accept a contract with a brutal non-compete clause or one that will vastly underpay her. And she says the private things out loud in the workroom, discussing compensation and unionization with her staff and peers. 

“The Monster” is a matter of perception. The key is to be perceived as such by the wrong people, while only being perceived as slightly ahead of the curve by the right people. And right now, doctors have a perception problem. Large swaths of the general population blame physicians for the sins of others and may even think they are committing some level of fraud. Institutions think doctors are easy marks and regularly attempt to take advantage of them. And even amongst physicians, there is such a stark divide in opinion on what it means to be a modern physician that presenting a united front within the profession has become increasingly difficult. 

This is where the profession’s worst habit shows up. Doctors are slow. Not at practicing medicine (we’ve become incredibly efficient at the practice of medicine itself), but at everything else. Every change to our working conditions comes as a reaction to something else, not something spearheaded by physicians demanding change. Libby Zion died in a New York hospital in 1984, in part blamed on an understaffed hospital and overworked residents, and it took 20 years for medicine to agree that residents should only work 80 hours per week. Private practice collapsed over decades and hardly a discussion occurred to try and combat it. This spring, 4 out of 5 doctors told the AMA that they already use AI at work, and yet have you seen any policies adopted to formalize or control this trend? 

The terms of what happens next are being written right now, and it's mostly being done by actual monsters. The pious doctor who keeps the old contract in place will be left behind, and the line-worker will get exactly what she asks for, which is nothing. But the slightly Monstrous Doctor? That doctor becomes the morbid symptom, on purpose. It’s much harder to ignore a collective of doctors who go on strike than one who grumbles to themselves in the hallway. If the wrong people already think physicians are monsters, why not own it? Nobody has ever been argued out of that opinion, and they certainly won’t be influenced by apathy. They’ve only been outvoted, outlasted, or outnegotiated. 

The monster on screen is rarely the thing the film is actually afraid of. Nobody in a boardroom is afraid of a physician who stops caring or doesn’t even understand the rules of the game to begin with: they have a plan for them. The one they haven’t planned for is the one who keeps caring, but stops deferring. Halloween might be over, but the Monsters are here to stay.

Artist in Residence Update

Quick note about the Fall 2026 Artist in Residence. We have officially chosen our winner and will be announcing the results this week! Thank you to the over 200 people that applied. We were floored by the quantity and quality of applications and the sheer variety of interesting things that you all are doing. We hope to showcase as many of you as possible in the coming months.

And a reminder to keep sharing these parts of you! Don’t keep them hidden away beneath your white coat. A well-rounded, fulfilled doctor is a better doctor. And the more you can light the way, the easier it becomes for the next person.

A Few Of Our Favorite 'Progress Notes' From October

The Horror Issue

By Sacha McBain, PhD

We cannot recommend Sacha and what she is doing with Pathologizing Pop Culture enough! If you haven’t gotten your fill of Halloween horror yet, The Horror Issue is here to provide the real scares (plus it’s fun and interactive!). Sacha McBain uses stories from film, television, literature, and art to explore the psychology of illness and healthcare. This October, we pulled the darkest ones. Eleven entries, three movements, arranged in the order they will hurt you.

I Want The Residency My Attendings Had

By Catherine Read, MD

Once I started listening more closely I heard my faculty say things like, “As a third year resident I ran every trauma on my own without an attending in the building,” “As a second year, I did most cases while the attending watched without scrubbing in,” and “I did my first appendectomy alone with a textbook on the mayo stand.” 

Financialization of Health Care: Parts I & II

By Liz Malphrus, MD

To put it in medical terms so we all feel safe here, financialization is a syndrome. Administrative bloat, CEO pay, hospital closures: these are symptoms across a lot of different organ systems with a common underlying cause. And we all know there are two ways to tackle a syndrome. You can treat the symptoms, or you can address the underlying cause, and the second is always going to be more effective.

Non-Medical Spouse Nightmare Journal

By Latha Panchap, MD

Then, as I’m trying to figure out the logistics of Argentinian school enrollment and the presence of veterinary care in Africa, a call comes in from a debt collector telling us Jackie’s ten year fellowship is against loan deferment rules. If we didn’t start paying right away, the new interest rate would make our $200k debt from her school loans double in the next two years. I start panicking and looking for Jackie to explain, but when I ask Kelly where she is, she says “Mommy is already matched to Vietnam, we’re supposed to meet her there this afternoon!”

Halsted Is Dead: The Resident Perspective

By Catherine Read, MD

An introduction to a new series from Catherine Read, MD. Surgical residents are driven, gritty, and determined. We have never met a problem we can’t solve, except when it comes to the conditions under which we train. It is time to change that. To do so, we need the attending surgeons on our side.

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Until next month,
The HC Team

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