The document discusses physician entrepreneurship and the prognosis is guarded. It notes that the US healthcare system ranks last among 11 high-income countries in quality and accessible care. However, the US entrepreneurial ecosystem is ranked first globally. It examines various vital signs that impact physician entrepreneurship like education, funding, networks and regulations. Social spending is negatively linked to entrepreneurship at the country level. The document questions why the US healthcare system ranks last if the entrepreneurial ecosystem is first.