No Margin, No Mission: Reframing the Business of Medicine

Rahul K. Shah, MD, MBA
AAO-HNS/F Executive Vice President and CEOI write this column each month with a genuine sense of optimism about where our specialty stands, and this month that optimism feels particularly well-founded. March gave us two meaningful moments to take stock of who we are and what we are capable of: Congressional Advocacy Day and OTO Forum. On the surface, these are very different gatherings. One takes place in the halls of Capitol Hill; the other in the halls of a hotel’s meeting space. But the more I reflect on both, the more I am struck by what they share.

In each case, our members made a choice. They stepped away from their practices, their patients, and their personal lives to invest time in something larger than any one of them. That is not a small thing, and I do not take it for granted. 

The results speak for themselves. As a direct result of our members' presence and advocacy on Capitol Hill, two members of Congress committed to sponsoring our legislative priorities around CMV and Ally's Act. That is tangible, consequential progress. At OTO Forum, attendance reached record levels, and the energy throughout the meeting was palpable, not just in the sessions but among the exhibitors and at the social events, including a well-attended ENT PAC* reception for our dollar-a-day donors. Our members showed up, engaged, and made an impact.

The Academy is working hard to match that energy with action of our own. We recently launched an inaugural Physician Leadership Institute. We are revamping the Bulletin to meet members where you are and reflect how you actually access content. We are refining our education offerings to ensure they remain relevant and high value. These are just three tangible examples of what your Academy is doing for you. These are not incremental gestures; they are deliberate investments in our collective future. At our most recent Boards of Directors meeting, we reviewed our Strategic Plan, focusing on ensuring that our goals and objectives are driving how staff allocate their time and use Academy resources. The analogy I use is simple: every oar in the water, pulling in the same direction. We are beginning to see what that alignment makes possible.

We are not yet where we aspire to be, and we are certainly not yet where we want to be. But we know that we go further together. That is true of our relationships with industry colleagues. It is true of our work with state and federal legislators. And it is most certainly true of our relationship with you, our members.

I have grown increasingly uncomfortable with the phrase "business of medicine," not because the underlying reality does not exist, but because the framing suggests a tension between two things that are, in practice, inseparable. At OTO Forum, our programming addressed how to build physician-led care models at scale, ensure our community and referring providers understand our expertise, and engage legislators and policymakers to drive meaningful change. None of that is geography-specific. None of it is practice-type-specific. It is not an academic-versus-private-practice conversation. It is medicine; medicine in 2026.

Sister Irene Kraus, founding President and CEO of the Daughters of Charity National Health System and one of the most consequential healthcare administrators of the 20th century, gave us the phrase, "no margin, no mission." It is well known for a reason. It is not a concession to commerce; it is an acknowledgment that serving patients at the highest level requires the resources and infrastructure to do so. The financial health of a practice and the quality of care it delivers are not competing values. They are the same value, expressed differently. If we continue to treat them as separate domains, we will keep having the wrong conversation. My hope is that we begin to think of them as one concept, because in practice that is exactly what they are. 

This column was drafted with AI assistance.

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