We Can't Keep Asking Physicians to Be More Resilient

What if physician burnout isn't just a physician problem? What if it's also a work design problem?

I recently came across a discussion among physicians about a woman practicing full-scope OB/GYN who was struggling with overnight obstetric call.

The sleep deprivation and the time it takes to recover from the sleep deprivation was having a significant impact on her mental health. She still loved medicine. She wanted to continue practicing. But she was reaching the point where she couldn't continue practicing in the same way.

She explored moving to GYN-only practice within her organization, but her group couldn't easily cover the GYN call that would remain. She approached administrators and was essentially told that physician call arrangements weren't something they would solve.

The discussion that followed highlighted something I think we need to talk about much more openly.

Who is responsible for making medicine sustainable for the physicians who practice it?

The physician is not the only part of the system

Of course, physicians have responsibility for their own careers. We have to recognize when something isn't working. We have to advocate for ourselves. We have to set boundaries. We have to negotiate. And sometimes, we have to make the difficult decision to leave.

But there is a difference between personal responsibility and personal blame.

If a physician is working a schedule that is fundamentally unsustainable, telling her to meditate, exercise, sleep more, or become more resilient doesn't address the underlying problem.

At some point, we have to ask whether the environment itself is part of the problem.

And I think health systems have a responsibility to ask that question too.

We need to stop making physicians negotiate with each other over who gets to be more or less exhausted

One of the responses to this discussion made an important point. If one physician stops taking overnight call, someone else has to cover it.

Those physicians have families. They have their own health concerns. They have limits. We can't simply tell colleagues to absorb more work and call that a solution.

But the answer also shouldn't be:

"Your colleagues can't cover it, so there's nothing we can do."

That's where health systems need to get creative. Could shifts be shorter? Could there be a night-float system? Could some physicians provide daytime coverage while others are compensated for overnight coverage? Could the organization hire a nocturnist? Could the physician move into a different clinical role? Could a part-time arrangement work? Could compensation be structured differently? Could the physician move into another position within the health system? Could the organization create a role that allows a valuable physician to remain while eliminating the part of the job that is no longer sustainable?

And sometimes the answer will be no.

Sometimes the economics don't work.

Sometimes the staffing isn't available.

Sometimes the practice truly can't accommodate what a physician needs.

But "we can't do that" should be the conclusion of a thoughtful exploration of possibilities, not the starting point.

Because if the organization wants to retain physicians, it has to be willing to think creatively about what retention actually looks like.

The research that made me stop and think

This issue became even more compelling to me when I read a 2025 study published in JAMA Internal Medicine examining mortality among more than 3.6 million U.S. workers ages 25 to 74. 

The researchers used national death certificate data from 2020 through 2022 and compared mortality among physicians and other health care workers with people in non-healthcare occupations. They specifically included high-income occupations such as lawyers, engineers, and scientists as comparison groups because of their similarities in education and income.

The overall finding was reassuring in one respect: physicians had substantially lower overall mortality than the general population and high-income non-healthcare workers.

But the findings by sex were striking.

Among high-income non-healthcare workers, women had a mortality rate about 40% lower than men. The female-to-male mortality rate ratio was 0.60.

Among physicians, the female-to-male mortality rate ratio was 0.97.

In other words, the mortality advantage women generally have over men was essentially absent among physicians. The researchers found a similar pattern when they restricted the analysis to working-age adults ages 35 to 64.

The study does not tell us why.

It does not prove that burnout causes this difference.

It does not prove that overnight call causes it.

It does not prove that the healthcare system causes it.

This was a cross-sectional observational study, and the authors acknowledge that factors such as income, marital status, immigration history, and other characteristics weren't available in the mortality data.

But I think the finding should make us uncomfortable enough to ask questions.

Why does the survival advantage women have in other high-income professions essentially disappear among physicians?

What are women physicians being asked to sacrifice in order to succeed? Sleep? Time with their families? Their own healthcare? Exercise? Relationships? Recovery?

And what happens when those sacrifices accumulate over years and decades?

We don't have all the answers.

But I don't think we can continue ignoring the question.

Health systems need to own their part of the problem

For years, much of the conversation around physician burnout has focused on what the individual physician needs to do differently.

Be more resilient. Set better boundaries. Practice self-care. Take a vacation. Meditate. Exercise. Get enough sleep.

And yes, those things matter.

But there is something fundamentally wrong with telling someone to "get more sleep" while requiring them to work a schedule that makes adequate sleep nearly impossible.

There is something wrong with telling physicians to set boundaries while creating staffing models that depend on them consistently crossing those boundaries.

And there is something wrong with treating every physician who reaches a limit as an individual problem to be managed rather than asking whether the way the work is designed is part of the problem.

Health systems employ physicians. They depend on physicians. They need physicians to stay healthy enough to continue doing the work.

That creates a responsibility.

Not responsibility for every aspect of a physician's wellbeing. Not an obligation to accommodate every individual request.

But a responsibility to create working conditions that are reasonably sustainable and to seriously consider creative alternatives when a valuable physician says:

"I want to stay. But I can't keep doing the job this way."

That should be an invitation to problem-solve. Not an invitation to tell the physician to become more resilient, or to figure it out themselves because "we won't get involved in the call schedules."

Maybe the question needs to change

We often frame career decisions as: Should I stay or should I go?

But there is another question that may be more useful: What would medicine have to look like for me to want to stay?

Maybe the answer is a different schedule. A different practice model. Different call responsibilities. A different role. A different organization.

Or maybe the answer is that the organization you're currently in simply isn't capable of creating the career you need.

That's important information too. Physicians shouldn't have to sacrifice their health to prove their commitment to medicine. And colleagues shouldn't have to sacrifice theirs to keep an unsustainable system running.

The goal isn't to figure out which physician should absorb the cost. The goal is to build a system where fewer physicians are being asked to absorb it in the first place.

And when an organization has a physician who wants to stay but is telling them, "I can't continue like this," I think the first response should be: "Let's see what we can build."

Not: "That's your problem."