Physician Stewardship: A Timeless Ethic in a High-Stakes Healthcare Market

TUCSON, AZ – June 02, 2026 – In an era defined by rapid consolidation and the growing influence of corporate finance in healthcare, a call for a return to first principles is gaining resonance. Dr. George L. Smith, III, President of the Association of American Physicians and Surgeons (AAPS), has articulated a compelling framework for physician stewardship, urging his colleagues to anchor their practices in the enduring values of patient-first care. In a recent article for the Journal of American Physicians and Surgeons, Dr. Smith argues that the long-term health of both patients and the profession depends not on chasing the latest management trend, but on a disciplined commitment to ethical and professional integrity.

His message serves as a critical touchstone as physicians navigate a landscape fraught with administrative burdens, technological disruption, and unprecedented financial pressures. It raises a fundamental question for the 2026 landscape: can the traditional ethos of the independent physician survive the powerful forces of commercialization?

The Three Pillars of Practice

At the heart of Dr. Smith's guidance are three deceptively simple principles he calls the “3 A’s”: affability, ability, and availability. While these concepts have long been part of the implicit contract between doctor and patient, he argues for a more conscious and balanced application. “Physicians need to,” he explains, “1) Have the ability to do what you say you can do. 2) Be affable with your patients, but also your staff and above all with your family. 3) Be available with reasonable office hours without overwhelming yourself, your family, and your staff, while making it easy for your patients to access your care for their well-being.”

This framework is not a call for physicians to be endlessly accessible or universally charming, but rather a strategic guide to building a sustainable and trustworthy practice. The emphasis on “ability” underscores the necessity of rigorous, continuous medical education—a commitment to competence that builds the foundation of patient trust. Affability extends beyond a pleasant bedside manner to encompass respectful and supportive relationships with staff and family, recognizing that a physician’s stability directly impacts their capacity to care for others. Finally, availability is framed with a crucial caveat: it must be balanced against the risk of burnout, a condition now rampant in the medical field. By creating reasonable access without sacrificing personal well-being, physicians can ensure they provide high-quality care over the long term.

A Cautionary Tale: Lessons from the Past

To illustrate the life-and-death stakes of professional diligence, Dr. Smith invokes a powerful historical example: the case of Selacryn. This cautionary tale serves as a stark reminder of the dangers of uncritical adoption of new treatments. Approved by the FDA in 1979 as a novel drug for hypertension, Selacryn was aggressively marketed and quickly adopted by physicians.

Less than a year later, in January 1980, its manufacturer, Smith Kline & French, voluntarily pulled it from the market. The reason was a wave of reports linking the drug to severe hepatotoxicity, or liver damage, which in some cases was fatal. Subsequent investigations revealed that the manufacturer had failed to promptly report these adverse reactions to the FDA. Dr. Smith recounts his personal experience as a family medicine resident at the time, having to urgently contact every patient who had been prescribed the drug. The incident was a searing lesson in the fallibility of regulatory systems and the ultimate responsibility of the physician to act as the patient’s last line of defense. This decades-old case remains profoundly relevant, highlighting the physician’s duty to maintain a healthy skepticism and prioritize empirical evidence over marketing enthusiasm.

Beyond the Highest Bidder: Morality in an Era of Consolidation

The most pointed part of Dr. Smith’s message addresses the economic realities of modern medicine. As independent physicians face mounting pressures, the temptation to sell their life's work is immense. Here, Dr. Smith offers a stark warning: “Make sure the highest bidder is not bereft of morality or principles!” This counsel lands directly in the center of one of the most significant trends reshaping healthcare: the acquisition of physician practices by private equity firms and other large corporate entities.

The motivations for selling are clear. Physicians are grappling with declining reimbursement rates, overwhelming administrative tasks, and widespread burnout. Private equity offers a lifeline in the form of capital, sophisticated management, and a lucrative exit strategy. However, this trend brings profound ethical questions. Medical ethicists have long expressed concern that a business model predicated on maximizing short-term returns is fundamentally at odds with a physician's fiduciary duty to act solely in the patient's best interest. When profit becomes the primary driver, clinical decisions can be subtly—or overtly—influenced.

Research and industry reports confirm these concerns are not merely theoretical. Studies have shown that private equity acquisition in specialties like dermatology and gastroenterology can lead to significantly higher prices for patients. There is a palpable fear among many practitioners of losing their clinical autonomy, facing pressure to increase patient volume, shorten appointment times, and favor more lucrative procedures. While corporate ownership can bring efficiencies, Dr. Smith’s advice challenges physicians to look beyond the dollar figure and scrutinize the values of any potential partner, safeguarding the integrity of their practice for the patients who depend on it.

A Call for Autonomy and Legacy

Ultimately, Dr. Smith’s article is a rallying cry for physicians to reclaim their agency. This extends beyond the walls of the clinic and into the public square. “The importance of your contributions to your local, state, and national governments cannot be overstated,” he writes. “We must stay vigilant and contribute to the dialogue that affects our profession, our practices, our patients, our families, and our country.” This call to civic action reflects the long-standing philosophy of the AAPS, which has advocated for physician independence from what it views as governmental and corporate overreach since 1943.

For the independent physician, such engagement is no longer a choice but a necessity for survival. It is a strategy to ensure that the rules governing medicine are shaped by those on the front lines of patient care, not just by bureaucrats or investors. This sense of stewardship also includes a duty to the future. Dr. Smith emphasizes the responsibility to pass these core principles along to the next generation, ensuring that future patients will have “the luxury of having a physician who is dedicated to their medical needs first and foremost.” In a rapidly changing world, this commitment to mentorship is perhaps the most critical strategy for preserving the soul of medicine.