Healthcare operates with back doors for some.
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The phrase “make the call” is well understood in healthcare circles.
Consider a scenario where a family member is unable to secure a specialist appointment for months, a friend is denied a necessary medication that all doctors agree is appropriate, or a colleague is trapped in a cycle of prior authorizations and appeals. Instead of relying on the system, someone picks up their phone, sends a text to the right person—a department chair, a hospital CEO, an insurance executive, or a former residency classmate—and suddenly, doors open. The appointment is booked, the authorization granted, and the issue resolved.
We often perceive these actions as acts of kindness, professional courtesy, or simply people helping each other. While that may be true to some extent, such moments also reveal a deeper issue: the system itself is not trusted to consistently deliver the correct outcome.
The presence of a back door in healthcare indicates something significant about the front door.
I’ve personally used this back door. Like many in the healthcare sector, I’ve reached out to colleagues to assist family and friends in navigating the healthcare maze. When a family member faced administrative hurdles in accessing a vital medication, I knew who to call. A single conversation resolved an issue that had persisted through standard channels.
Her medical condition hadn’t changed, nor had the evidence supporting her treatment. The only difference was our connection to someone with the authority to resolve the issue.
While I was thankful for the result, it left me questioning why such intervention was needed.
This experience made me confront a troubling reality: many healthcare leaders do not have faith in the systems they oversee when personal stakes are involved. If our spouse fell ill, would we wait in line like everyone else? Would we accept a lengthy wait for an appointment or navigate endless phone menus and fragmented referral systems? Most healthcare leaders know the answer.
We’d make the call.
This isn’t out of entitlement or impatience, but out of an understanding of where the system falters. We know which departments are overburdened, which authorization processes frequently fail, which clinics are inaccessible, and which bureaucratic hurdles require personal intervention.
Ironically, those most knowledgeable about the healthcare system are often the least inclined to rely on it without leveraging personal connections.
This issue should concern us.
The healthcare system has quietly evolved into two parallel access paths. The first is the one most patients see, governed by scheduling systems, referral pathways, insurance mandates, and administrative protocols. The second is less visible, operating through relationships, reputation, influence, and professional networks, accessible to physicians, executives, board members, donors, and those fortunate enough to know someone with the power to escalate their issue.
Many who use this informal system do so with good intentions. They aren’t seeking unnecessary care or special treatment but rather trying to secure care that should have been accessible from the start. They believe they’re rectifying an isolated failure, not seeking preferential treatment.
However, from a patient’s perspective, this distinction is negligible.
If access depends on who you know rather than your ability to navigate a broken system, the system is inherently unfair, even when clinical needs are the same.
Healthcare organizations often celebrate stories of outstanding employees solving seemingly impossible problems. The nurse who finds a specialist, the medical director who overturns a denial, the executive who arranges an urgent appointment. These stories are uplifting because they highlight exceptional dedication.
Yet, they should also raise concerns.
Each time extraordinary effort is needed for routine care, it highlights a design flaw rather than excellence. Heroic employees can become a substitute for reliable systems. Over time, organizations may celebrate heroism rather than addressing the underlying issues.
Healthcare leaders might miss this distinction because their leadership roles create distance. Senior executives rarely experience healthcare as ordinary patients do. They know department chairs, have direct access to specialists, assistants to book appointments, and doctors who return their messages. Even when they use their own services, they encounter a different version of the system.
This isn’t due to bad intentions. Many healthcare leaders joined the field to improve lives. The issue isn’t a lack of compassion but a growing disconnect from the experiences of those their organizations serve.
Over time, this separation alters perceptions of what is normal.
Waiting months for a specialist becomes a statistic rather than a personal ordeal. Prior authorization becomes an operational metric rather than a source of stress. Call center wait times become data points rather than frustrating moments. The system becomes something managed rather than a personal experience.
This is why I believe a simple question is revealing for any healthcare executive: “If someone I loved needed care today, would I trust the standard process, or would I seek a back door?”
The answer reveals more about our organizations than any quality metric.
This isn’t an argument against helping loved ones. If my mother fell seriously ill, I’d make every necessary call. Most would do the same. Family loyalty isn’t the issue.
The problem is the quiet acceptance of two access systems and mistaking the ability to circumvent dysfunction as proof that the dysfunction is manageable.
It isn’t.
Each executive intervention, physician favor, or expedited appointment through personal connections should be seen as valuable data. Each instance highlights where the formal system failed to meet reasonable patient expectations. Rather than celebrating the rescue, we should examine what process needs change to prevent future rescues.
This, ultimately, distinguishes management from leadership.
Managers address today’s exceptions. Leaders eliminate tomorrow’s exceptions.
The goal shouldn’t be to close the back door to medicine. Compassion, relationships, and professional generosity will always be part of healthcare. The aim is much more ambitious: to create a front door so reliable, humane, and responsive that no one feels the need to seek another way in.
When that day comes, the most powerful person in healthcare won’t be the executive with everyone’s contact details. It will be the patient who trusts the standard path is sufficient.
