Local opinion: It’s not burnout — it’s something worse

MA, my 66-year-old patient, was so happy with her Medicare Advantage plan. She could continue seeing me as her doctor and the premiums were ridiculously cheap. Then the unexpected — she developed lupus and her life changed. The referrals I made for various procedures, medications and work-up all required prior authorization. Hours were spent on the telephone trying to speak with someone who could authorize MA’s necessary care. This was all evidence-based, necessary care. Some might call this “cost-saving through the hassle factor". If you deny it often enough, maybe I’ll just give up.

These perverse profit motives are undermining my profession and making it challenging for me to practice medicine.

A new national study from Physicians for a National Health Program, conducted in partnership with the Robert Wood Johnson Foundation, surveyed over 1,200 physicians and found this experience isn’t rare, but rather the norm. 62% of physicians reported moderate or very high distress caused specifically by administrators’ or insurers’ cost-cutting priorities overriding their clinical judgment.

For years, we’ve been told that healthcare workers are “burning out.” That framing is wrong, and it's wrong on purpose. What we experience is not burnout, it is moral injury. It is the distress that comes from knowing exactly what your patient needs and being blocked from providing it by a system designed to extract profit. Burnout blames the worker. Moral injury names the system. Burnout implies clinicians can’t handle the job. Moral injury identifies that the job has been restructured to prevent ethical practice.

A landmark study on physician moral injury found that 69% of physicians had contemplated leaving or had actually left a position due to the experience of moral injury.

This is not the profession I entered when I finished my residency training as a family physician.

Imagine you’re the physician being overruled. You feel betrayed, and you are unable to realize the values that led you to this career.

44% of surveyed physicians said that lack of insurance approval or service availability often or always prevented them from delivering medically necessary treatment. In turn, physicians must make the impossible decision of choosing an inferior therapy or spending time and energy they often don't have on fighting what is frequently a losing battle; 35% of surveyed physicians reported being required to care for more patients than they could safely manage. This inevitably leads to risk of harm, a risk created by the system but imposed upon physicians, violating our moral codes.

This isn’t about physician feelings — it’s about patient harm. These aren’t just physician complaints. When clinicians are blocked from providing care, patients suffer, and the harm falls hardest on marginalized communities. The same study found that 41% of physicians felt complicit in structural racism perpetuated by their profession.

Patients in focus groups described the system as “convoluted,” “corrupt,” and “dysfunctional.”

We need structural change. Immediately, that means eliminating prior authorization barriers. Healthcare has been redesigned from promoting health to extracting wealth. Prior authorization, productivity quotas, and documentation demands are tools of financial control, not clinical quality. Ultimately, it means building a healthcare system where no insurer stands between a physician’s clinical judgment and a patient’s right to care.

If we can fix the structural problems in healthcare where profits are the main concern and institute a single-payer system removing the profit motive from care financing, MA can receive her necessary care, and I can practice the medicine I trained for to be singularly focused on caring for my patients.