By James L. Whiteside and Dmitry Tumin

Jan. 2, 2026

Whiteside serves as the chair of the Department of Obstetrics and Gynecology at the East Carolina University Brody School of Medicine. Tumin serves as research professor of pediatrics at the East Carolina University Brody School of Medicine.

In 2026, Medtronic plans to launch a new robot to compete with a legacy market leader. This new robot is reportedly cheaper both in startup and sustained costs. That’s a welcome direction for any new medical technology, but it ignores a problem that hospitals, especially rural ones, face relating to technology and physician training.

Sometimes, rational decisions made in isolation lead to irrational outcomes for everyone involved. This is the lesson of the prisoner’s dilemma, a classic game theory puzzle demonstrating how cooperation and self-interest often clash. In the puzzle, two prisoners are each offered a deal: Inform on the other and go free, or stay silent and face a lighter sentence together. Fearing betrayal, both inform and both lose.

Hospitals today face a similar dilemma. To attract and retain physicians, hospitals invest in expensive technologies like the robot, not because they improve patient outcomes but because physicians have become reliant on them. This self-interested behavior, driven by how we train doctors, leads to a system where costs rise, rural hospitals fall behind, and the public pays the price.