Twice a week, in the evenings, I cheat on one of the greatest loves of my life.

I sneak away from my friends, slip out of the library, and leave the responsibilities of medical school strewn across my desk. I don’t respond to texts. I ignore emails. I miss meetings.

I’m exhausted because of it. It’s all I can do to keep up with my work, and let’s not talk about the bags under my eyes. The ladies at Sephora have told me that covering those up is a lost cause.

Twice a week, I go to my accounting and managerial statistics classes. You see, I may be a medical student, but I am also pursuing my masters in business administration.

Medicine is my passion. I have known since I was a child that I wanted to be a physician. It was the only thing that I ever felt viscerally drawn towards. I want to diagnose and heal, listen to and learn from, care for and nurture my patients. But that doesn’t mean I can’t see the big picture.

The healthcare system in America is itself sick. A cash guzzling, inefficient, broken behemoth, it is failing our patients every single day. The system is wracked with horrific inefficiencies and inane complexities, exorbitant prices, and ludicrous bureaucracy. Patients suffer its unerring dehumanization. Healthcare providers suffer the unending pressure to stay fiscally afloat, yet still pursue their moral obligation to heal and help. And every day, that becomes harder and harder to do.

Private practices are closing, as they become less and less financially viable. Physicians are overwhelmed with high patient demand. There is an enormous deficit of physicians in inner city and rural areas, especially in primary care. Schools that train physicians or nurses get more and more expensive, leaving our providers hundreds of thousands of dollars in debt just as salaries for healthcare workers are declining nationwide.

True, there are, in fits and starts, attempts to cure the woes of American healthcare. Well intentioned activists and politicians pass laws. New guidelines are regularly brought down from on high, meant to overhaul a decrepit system. Yet so often these harm rather than help. Without profoundly understanding the healthcare system as only an insider can, there is no curing its sickness.

Physicians and nurses, assistants and technicians, these are who should be running hospitals, setting guidelines, and advocating for all parties in the healthcare system. I fundamentally believe that maintaining patient centered care, on a systemic level, can only be achieved by those who have actually delivered patient centered care.

And that core belief is why I know I will advocate for my patients in the exam room and the boardroom, why I push myself to the brink of exhaustion studying wildly disparate disciplines, why I am pursuing this MD/MBA.

Claire McDaniel is a medical student at Georgetown University School of Medicine, and an MBA candidate at Georgetown University McDonough School of Business, in Washington, DC.

Competing interests: I have read and understood BMJ policy on declaration of interests and declare the following interests: None.