The reset: A conversation with Shannon Sims, M.D., Ph.D., FAMIA, and Matthew Bates, M.P.H.

Patients are older, sicker and showing up with more chronic conditions than they were before the pandemic. Costs are rising faster than revenue. The physician workforce is stretched, and advanced practice providers (APPs) are filling gaps that aren't going away. Artificial intelligence (AI) has moved from conference-room conversation to daily clinical workflow.

That's the backdrop for Vizient's 2026 State of the Industry Report, which frames this moment as a "reset" for U.S. health care — a collision between old volume-based assumptions and new operational realities.

Shannon Sims, M.D., Ph.D., FAMIA, chief product officer at Vizient, and Matthew Bates, M.P.H., managing director at Kaufman Hall, joined Medical Economics Associate Editor Austin Littrell to unpack what that means for physicians on the ground.

On AI, both said the hype cycle is giving way to something more concrete.

Ambient listening is going mainstream, reducing after-hours documentation, and early gains in billing, prior authorization and medication refills are already visible.

Sims was direct about the stakes for physicians who haven't engaged yet: "If they do not, they risk falling behind and losing some of the relevance and ability to practice in the way they would like to."

The APP conversation is just as pressing.

At 40% of the employed clinician workforce today and projected to reach roughly half within a decade, APPs are no longer a supplement — they're a structural feature of how care gets delivered. Bates called building effective physician-APP teams "a must-do, not a nice-to-do."

Sims added a note of caution: having physicians focused exclusively on the most complex cases is the goal, but that concentration carries its own cognitive load, and practices have to be thoughtful about it.

On finances, Bates offered a number that cuts to the core of what many physicians are feeling: direct expense per employed provider is up roughly 6% since late 2023, while reimbursement per unit of work hasn't kept pace.

Physicians are seeing more patients and doing more, but what they earn per wRVU is effectively declining. The subsidy required to support an employed physician, he said, is growing exponentially.

Access runs through everything. Coming out of the pandemic, staffing was the top concern health system leaders raised. Now it's access.

Bates said that commercially insured patients, who are critical to financial sustainability, will go wherever they can get seen within a few days. If a practice can't get them in, someone else will.

For smaller practices looking for concrete moves, Sims pointed to group purchasing coalitions and procurement software as ways to reduce supply costs without adding clinical pressure. Bates flagged governance as the key question for physicians considering partnerships with surgery centers, urgent care networks or corporate entities — specifically, whether clinical decision-making authority will remain with the physicians or shift to a distant corporate partner.

"Physicians go to medical school to do good, not to do paperwork," Sims said.