In 2026, consolidation is a common reality across industries, from education and healthcare to law and finance. While there will always be interesting new start-ups, smaller institutions — such as colleges, companies, law firms and hospitals — are increasingly becoming relics of the past.
And sometimes, bigger is truly better; for example, at a large university, students may have access to a wider variety of subjects, research opportunities, and programming that a small school would be less likely to provide. In healthcare, consolidation and mergers have produced positives like increased access for patients, and a wider range of opportunities for collaborative research and education.
But scale also changes how work gets done. While many hands should make for lighter work, the reality of hyper-specialization is that it can create more work that didn’t previously exist.
In the physician’s experience, dividing roles very specifically across groups, locations, and vendors can create an entirely new layer of coordination requirements that didn’t previously exist. This phenomenon manifests as a type of invisible labor where physicians navigate a ‘Who’s on First’ maze, figuring out the right person responsible for getting specific things done.
As consumers, most of us have experienced calling an airline or bank, navigating a phone tree only to end up at a dead end or be transferred repeatedly to people who cannot help. That experience increasingly mirrors what the era of consolidation can feel like in healthcare and should be our next target as we work to relieve the administrative burdens that lead to physician burnout.
Historically, physicians often worked with one assistant and perhaps an office manager, and they worked closely with those individuals. Assistants knew the physician’s schedule — which days involved surgery and what research projects were underway — and often knew patients and their families, as well as the physician’s own family. Strong professional working relationships were developed, and physicians were able to trust their assistant to know which patients truly needed appointments immediately, which might need reassurance and which calls likely represented true emergencies.
That one person might act as scheduler, manager, correspondence and content creator, receptionist, billing coordinator, while also taking on dozens of other tasks each day. Whether a question involved billing, scheduling, or insurance, the assistant knew who to call. And because of the close relationship, physicians trusted that when something needed to be done, it would be — and it would be completed properly and on time.
Post consolidation and corporatization, that one role can be split across a dozen different people in different departments in different locations. A single assistant has morphed into multiple departments: one that does scheduling, one for cancellations, one for clinic changes, one for vacation management, one for prescriptions and a separate one for refills, one for prior authorizations, one for infusion coordination.
Keeping track of who is doing what — and whether they have done — can become its own full-time job. This is the professional version of ‘invisible labor’: the unrecognized mental energy required to track tasks, fill gaps, find relevant information and coordinate work. And like the invisible labor many people carry at home, this cognitive load is now being carried by physicians.
What can make this labor particularly exhausting in a large organization is lack of agency. Often, the people performing tasks like scheduling, billing, and authorizations are not in a physician’s department or under their direction. Physicians may not even know who these individuals are. They haven’t been introduced, and it’s often unclear who the ‘right’ person is to move a specific task forward.
So while consolidation and corporatization have delivered real economies of scale by grouping functions together, the irony of our modern “efficiency” is that a taxing part of the work has been quietly offloaded. By dismantling the one-assistant model, systems have effectively imposed a new, uncompensated coordination tax on physicians.
And if this is what physicians experience, it’s not difficult to imagine what patients experience.
What might a better model look like? Other complex, consumer-facing industries have learned that when systems become too fragmented, people need fast access to a knowledgeable human who can orient them — someone who understands the system well enough to get an issue to the right place without endless handoffs.
Healthcare needs an equivalent who handles this invisible labor for both physicians and patients. Not another phone tree or ticketing system, but either a reduction in complexity or a return to integrated support roles — navigators whose job is to simplify the “Who’s on First”problem. It would also help if physicians were supported by clear documentation that outlines the correct path to get to any given endpoint.
Healthcare has spent years building scale. Now it needs to rebuild clarity, accountability and human connection. And while this dynamic is especially visible in medicine, the underlying challenge of “invisible labor” is increasingly familiar across large professional organizations of all kinds. If this work isn’t acknowledged or planned for, it becomes the hidden cost of consolidation. In the process, we risk trading efficiency for the relationships and daily interactions that make work sustainable for the people doing it and improve the patient experience.
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