06/25/2026
Who Shaves the Barber? Reflections on 180 Years of Organized Medicine
From our OSMA President:
In 1901, philosopher and mathematician Bertrand Russell described a famous paradox. It asks a deceptively simple question: if there is a singular barber who shaves everyone who does not shave themselves, who shaves the barber?
The paradox forces us to think about systems that depend upon themselves for their own existence.
I find myself contemplating a related question: if physicians do not speak up, who will protect the patient-physician relationship?
Through the 180-year history of the Ohio State Medical Association, Ohio’s physicians have come together to advocate not only for our profession, but for the patients and communities we serve. During that time, medicine has changed dramatically.
Independent practice ownership has steadily declined as healthcare has become increasingly consolidated. According to the American Medical Association’s Physician Practice Benchmark Survey, physician-owned practices have fallen to just 35% as of 2024, while the percentage of physicians identifying as employees has risen to nearly 60%. For many physicians entering practice today, employment is simply the norm.
This evolution has brought some benefits. Larger organizations often provide resources, technology, administrative support, and operational capabilities that would have been difficult for many independent practices to achieve on their own. Some of these changes have even enabled patients to be more active participants in their own decision making.
Today’s physicians work within systems dedicated to improving care for the patients and communities they serve. Yet the realities of modern healthcare can create competing pressures that are not always easily reconciled.
Yet one thing has not changed: the patient-physician relationship remains at the heart of medicine, and physicians need an independent voice to protect and strengthen it.
Hospitals, health systems, employers, insurers, regulators, and physicians all help shape healthcare policy. Their interests frequently align, but they are not always identical. Physicians occupy a unique role because our first responsibility is not to a balance sheet, a quarterly report, or a regulatory framework. It is to the patient at the bedside.
That perspective matters.
According to the AMA, 95% of physicians report that prior authorization delays patient care, and nearly 1 in 3 physicians report that prior authorization has led to a serious adverse event for a patient in their care. Physicians see the impact of these policies every day; delayed treatments, postponed procedures, and unnecessary barriers to care are not abstract debates but result in real disability and harm.
That is why independent physician representation remains important.
The physician perspective is distinct because it begins and ends with the patient-physician relationship.
Recent advocacy successes in Ohio demonstrate the value of that voice. Most recently, Senate Bill 162 established reasonable limits on how long insurers may seek recoupment of payments and prohibited insurers from charging physicians fees simply to appeal those determinations. These reforms may sound technical, but they address a fundamental principle of fairness. Physicians should spend their time caring for patients, not defending years-old claims or paying fees to challenge administrative decisions. For some practices, these recoupment demands arrived years after care had been delivered, forcing physicians and staff to divert time and resources away from patients and toward administrative disputes.
OSMA’s advocacy extends beyond legislation. Whether addressing prior authorization, workforce shortages, scope-of-practice issues, liability reform, or the growing administrative burdens that contribute to burnout, organized medicine works to strengthen the environment in which physicians care for patients.
That work includes supporting physicians themselves. Medicine is a demanding profession, and no healthcare system can succeed without healthy, engaged physicians. Through peer support, wellness initiatives, leadership development, and educational resources, OSMA invests in helping physicians build long, meaningful, and healthy careers. Strengthening physicians ultimately strengthens the care we provide to our patients and communities.
One of the great strengths of organized medicine is that its benefits extend far beyond its membership. When advocacy succeeds, all physicians benefit. More importantly, so do patients.
Yet that success creates its own challenge.
When physicians are buried in administrative burdens, it can become easy to hope that someone else will carry the responsibility of engagement, advocacy, leadership, and stewardship. Someone else will testify before a legislative committee. Someone else will review regulations. Someone else will advocate for reform. Someone else will defend the physician-patient relationship.
History suggests otherwise.
| For 180 years, generations of Ohio physicians chose not to rely on hope alone. They invested their time, expertise, and resources to ensure that medicine remained a profession guided by physicians and dedicated to patients. The challenges they faced were different from ours, but the principle remains the same: the physician-patient relationship is strongest when physicians are willing to stand up and speak for it. |
That is why I believe every physician should participate in organized medicine. The pathways are many, including through a county medical society, a state medical association, a specialty society, a national organization, or ideally all of the above. Participation may look different for each of us. Some physicians volunteer their time. Some contribute expertise. Some mentor future leaders. Yet even with these many avenues for engagement, membership remains one of the most important ways physicians strengthen the collective voice of our profession. Membership is not simply a benefit physicians receive. It is an investment physicians make in the future of medicine and the patients they serve. We cannot expect a strong physician voice while treating advocacy as someone else’s responsibility.
Advocacy is something created by physicians.
It requires volunteers, expertise, engagement, and financial support.
The physician-patient relationship is strengthened when physicians are willing to invest not only in their own practices, but in the profession’s ability to advocate for the patients and communities who depend upon it.
We can continue to ponder Bertrand Russell’s barber and ask questions with impossible answers. Who shaves the barber?
I’d prefer we start with organized medicine’s more practical one: who speaks for physicians?
The answer has always been physicians themselves.
The physician-patient relationship does not protect itself.
The profession does not govern itself.
The future of medicine is not shaped by someone else.