There’s a version of Mexico’s public healthcare system that looks great on paper.
Universal access government-backed coverage. A safety net that, in theory, ensures nobody is left without care.
And to be fair, that version isn’t completely false.
But like many things, the real story isn’t found in policy announcements or official statements. It’s found in the day-to-day experience of the people inside the system—especially the doctors.
Recently, an orthopedic surgeon shared a candid account of his time working within Mexico’s public healthcare system. Not as an outsider looking in, but as someone who lived it for years. His story wasn’t political. It wasn’t exaggerated. It was simply honest.
And that honesty says a lot.
The System Looks Good on Paper
If you’ve been following recent changes or discussions around public healthcare in Mexico, you’ve probably seen headlines suggesting expanded access and improved coverage.
The idea is simple: a system where more people can receive care, regardless of income.
That sounds reassuring—especially for expats coming from countries where healthcare is either extremely expensive or publicly funded.
But there’s a difference between having access to a system and the actual experience of using it.
And that gap is where things start to get complicated.
What It’s Like to Work Inside the System
According to this surgeon, his routine was something many doctors in Mexico would recognize immediately.
Public hospital in the morning. Private practice in the afternoon. Surgeries when possible. Long days that stretched well into the evening.
At first glance, it might sound like ambition or even financial optimization. But over time, it becomes something else entirely.
It becomes survival.
Working inside the public system often means dealing with high patient volume, limited resources, and long waiting lists. It’s not uncommon for doctors to juggle multiple roles just to maintain both income and professional growth.
This creates what you could call a “dual system reality.”
The same doctor, operating in two completely different environments—one defined by constraints, the other by possibility.
The Moment It Stops Making Sense
At some point, the surgeon sat down and did something simple: he ran the numbers.
What he found changed everything. One private surgery paid him roughly the same as an entire month working in the public system.
A full month of early mornings, long shifts, administrative friction, limited supplies, and little incentive to go beyond the minimum.
It wasn’t just about money. It was about alignment.
The system didn’t reward effort. It didn’t reward efficiency. It didn’t reward better outcomes. Over time, that misalignment starts to wear people down.
Why Doctors Stay (Even When It Doesn’t Work)
If the imbalance is so clear, why don’t more doctors leave? The answer isn’t as simple as you might think.
For many, the public system represents stability. A fixed paycheck. Benefits. A sense of security that’s hard to walk away from.
There’s also a strong cultural component. In Mexico, having a permanent position in a public institution is often seen as an achievement—not just professionally, but socially.
Families take pride in it. Colleagues respect it. Walking away from that can feel less like a career decision and more like abandoning something valuable.
And then there’s the part that’s harder to quantify: meaning.
Public hospitals often see cases that don’t appear in private practice. Complex trauma. Delayed treatments. Situations that challenge doctors in ways that routine cases don’t.
For some, that’s a reason to stay… At least for a while.
When Even the Learning Stops
What ultimately pushed this surgeon to leave wasn’t the workload or even the pay.
It was the realization that he had stopped learning.
Over time, the gap between public and private care had widened. Equipment became outdated. Techniques lagged behind. Procurement decisions prioritized cost over quality.
In his words, it no longer felt like practicing medicine under constraints—it felt like practicing medicine from another era.
Residents, the next generation of doctors, were being trained under those same limitations. Learning methods that were already considered obsolete elsewhere.
That’s when something shifted. Because for many doctors, teaching is one of the last reasons to stay. And once that loses its value, there’s not much left holding things together.
The Hidden Cost Nobody Talks About
The physical toll.
Long hours on your feet. Repetitive strain. Poor sleep. Back-to-back shifts that leave little time for recovery.
By his mid-30s, this surgeon had already developed multiple spinal issues—ironically, the kind of conditions he treated in his own patients.
It’s a detail that doesn’t show up in official reports or system evaluations.
But it matters. Because when the people providing care are physically and mentally exhausted, it inevitably affects the care itself.
The Reality Most Patients Never See
From the outside, patients interact with the system in short, isolated moments — a consultation, a procedure, a hospital stay.
What they don’t see is everything happening behind the scenes.
Doctors balancing multiple jobs. Choosing where to invest their energy. Deciding, often subconsciously, how much they can realistically give in each environment.
This isn’t about negligence. It’s about incentives.
In a system where effort isn’t rewarded and resources are limited, doing the minimum becomes a rational response.
And over time, that behavior becomes normalized.
A Doctor’s Story — In His Own Words
Here’s a condensed version of how this surgeon described his experience:
I quit Mexico’s public healthcare system (IMSS) when I realized how much it was costing me to stay.
For years, I worked in public hospitals in the morning and private practice in the afternoon, ending my days exhausted. When I ran the numbers, one private surgery paid what an entire month in the public system did.
I stayed for the teaching and the complexity of cases, but over time even that disappeared. The system fell behind—outdated equipment, old techniques, and no real incentive to improve.
Eventually, I realized I wasn’t learning anymore, and what I was teaching wasn’t useful outside. Meanwhile, my body was paying the price.
When I left, my income didn’t drop—but my time and quality of life improved dramatically.
I’m not saying everyone should quit. But if you’ve done the math and keep saying “next year,” it’s probably not the numbers holding you back.
Original post: Renuncié al IMSS cuando entendí cuánto me costaba
What This Means If You Live in Mexico
None of this means the public system “doesn’t work.”
It does—within certain limits.
For many people, it provides essential care that would otherwise be inaccessible. It plays a critical role in the country’s healthcare ecosystem.
But it’s important to understand what it is—and what it isn’t.
If you’re used to healthcare systems in countries like the U.S. or Canada, the experience can feel very different.
Not necessarily worse in every case. But different in ways that matter, especially when timing, access, and resources become critical.
It’s Not About “Good or Bad” — It’s About Tradeoffs
Public healthcare offers accessibility and broad coverage, but often comes with limitations in speed, resources, and personalization.
Private healthcare offers more flexibility and comfort—but at a cost.
Understanding those tradeoffs ahead of time changes how you navigate the system. Because most people don’t think about this until they need it and by then, the decision is no longer theoretical—it’s immediate.
If there’s one takeaway from this doctor’s story, it’s this: The system you rely on isn’t just defined by policy. It’s defined by the people working inside it—and the conditions they work under. And those conditions shape everything else.
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