Cynthia Thurlow: ‘The business of medicine has gotten a little bit ugly’

Nurse practitioner and author Cynthia Thurlow said modern healthcare is increasingly shaped by insurance-driven decision-making, declining reimbursements, and administrative burdens that limit time with patients, during an appearance on the Health Policy Podcast.

“The constraints of reimbursement…people want to spend more time with their patients, but the constraints of reimbursement…reimbursement is going down,” Thurlow said, describing how clinicians are often forced to see more patients to sustain their practices.

Listen to this episode:

• Apple

• Spotify

Thurlow, who spent more than 20 years in ER medicine and cardiology before launching a lifestyle-focused practice, said these pressures are contributing to consolidation across the healthcare system, with hospital networks increasingly acquiring private practices. She added that clinicians are also navigating growing interference from non-medically trained decision-makers in insurance systems, which can affect approvals for treatments and procedures.

She said the rise of concierge medicine and cash-based practices reflects an effort by providers to regain control over patient care and time. At the same time, she noted that technology, including electronic medical records, has created efficiency but also reduced face-to-face interaction with patients.

“I think technology is both a blessing and a curse…we are so dependent on technology that it kind of lends itself to a degree of depersonalization with patients,” Thurlow said.

Thurlow also addressed artificial intelligence in medicine, calling it a “dual-edged sword.” While AI can streamline tasks and assist with research, she cautioned against relying on it to replace human judgment.

“I get concerned when I think that AI has the potential to replace human beings…we never want to take the human interest side out of medicine,” she said.

In addition to system-level concerns, Thurlow discussed the expanding role of nurse practitioners, noting there are now more than 460,000 in the United States helping fill care gaps amid physician shortages, particularly in primary care and underserved areas.

She also highlighted her book, The Menopause Gut, which explores how hormonal changes during midlife affect the gut microbiome and overall health. The book outlines a framework for addressing these changes through lifestyle, nutrition, and targeted therapies.

Thurlow said her work reflects a broader shift toward more holistic, patient-centered care models that aim to address root causes rather than symptoms alone.