Maybe we’re measuring the wrong problem

Yet another weekend spent staring at the screen: refilling prescriptions, approving prior-authorization requests, making specialist referrals, charting, reviewing faxes (aren’t those supposed to be gone by now?), and finally spending some time reviewing test results.

By Sunday evening, she felt like she’d worked an entire week. Only to arrive at the clinic Monday morning to a ton of emergent requests and some very sick patients on her geriatric panel.

This is a typical weekend for three of my current coaching clients, and the heartbreak is that they love their patients. They actually enjoy the practice of medicine. But none of their patients know that their physicians work seven days a week, only to receive warnings from administration that their RVUs are down and they need to be seeing more patients day-to-day. In fact, one of them is consistently threatened with fines for late charting. No strategic support or meaningful help, only punitive action layered onto an already impossible workload.

Conversely, I have a couple of coaching clients who are really sick right now with serious illnesses. What I hear from them is that the oncologist doesn’t really listen. They feel like a number in a practice that is too big. They wait months for MRIs and other tests. They are losing confidence in the healthcare system.

At first, these sound like complaints coming from opposite sides.

The physician says:

“I worked all weekend and administration says my RVUs are down.”

The patient says:

“My oncologist doesn’t listen to me and I feel like a number.”

Those appear to be competing complaints, but they’re not. They’re the same problem viewed from opposite sides of the examination room. The physician doesn’t haveenough time. The patient doesn’t get enough time. The physician feels commoditized and so does the patient. The physician feels nobody understands what it takes to provide good care. The patient experiences nobody understanding what it takes to receive good care.

Neither one is the villain.

We have somehow built a healthcare system in which the physician feels unable to provide the kind of medicine they trained to practice, while the patient feels unable to receive the kind of medicine they thought they were paying for.

And what is particularly interesting in the midst of all this is that physician burnout is decreasing.

The latest numbers show physician burnout declined for a fourth straight year, down to 41.9% in 2025. That’s good, right?

But in another poll, 44% of physicians said they had considered leaving medical practice in 2026, up sharply from 35% the year before.

So what exactly is going on?

Burnout really may be getting better. And physicians may still be leaving. Those two things can be happening simultaneously. That’s the paradox.

The interventions may actually be working. Physicians are establishing boundaries. They’re reducing hours. They’re changing jobs. They’re exercising. They’re getting coaching. They’re protecting themselves better.

But perhaps one of the consequences of physicians becoming healthier is that they’re also becoming less willing to tolerate an unhealthy system. Maybe we’ve been assuming that physicians leave medicine because burnout finally becomes unbearable. What if some are doing something different?

What if they aren’t leaving because they’re burned out? What if they’re leaving because they’re increasingly unwilling to become burned out?

They may also be becoming more certain that medicine as it is currently structured is incompatible with the life they want, or with the kind of medicine they want to practice.

And rather than continuing to complain, appeal to HR, wait for administrators to fix things, or hope the next organizational initiative will finally make things better, physicians are increasingly taking the problem into their own hands. From where I sit, job mobility has become one of the ways physicians are trying to solve what we continue to call burnout.

It can look something like this:

Hospital → private practice → employed group → concierge → telehealth → administrative medicine → another health system…

What I hear is:

“I tried telehealth and I don’t feel confident just viewing the patient on a screen. I can’t do the deeper physical dive that might be called for.”

“I tried a DPC or concierge practice and I still felt like I was on call 24/7. And the expectations don’t decrease, they increase! I couldn’t do it. Unsustainable.”

“I decided to throw my hat in the ring for a leadership role. I thought maybe that would help me be a change agent from the inside-out, top-side down. But instead I couldn’t get anything done between the constant meetings and politics.”

Different tradeoffs, but often the same underlying question: Can I actually practice medicine this way and still have a life? So…off to the next experiment.

At some point, changing jobs stops looking solely like career advancement and starts looking like an experiment: Maybe medicine will feel like medicine again over here.

And this is where I think we need to be very careful about what we celebrate. Let’s not throw a party just yet.

Declining burnout is good news. We want physicians to be healthier. We want them sleeping, exercising, setting boundaries, reducing unreasonable workloads, protecting their families and reclaiming lives outside of medicine.

But a healthier physician is not necessarily a physician who has become more willing to tolerate an unhealthy system. Perhaps it’s the opposite.

So, what do we do?

First, we need to talk about it. Explore it. And be willing to see and hear what is really going on. Because if physicians are becoming healthier while simultaneously becoming more willing to leave, then burnout scores alone won’t tell us what we need to know.

We need to ask different questions:

Do you still want to practice medicine?

Do you still recognize the profession you trained to enter?

Can you provide the kind of care you believe your patients deserve?

Does the structure of your work allow you to have a life outside of it?

And perhaps most importantly:

If your burnout disappeared tomorrow, would you still want this job?

Because the answer to that question tells us something a burnout inventory cannot.

These physicians may not have stopped loving medicine.

But they may have stopped loving what practicing medicine now requires of them.

And their patients may be telling us the same thing from the other side of the examination room.

Burnout is improving. But our healthcare system is not