By Ellie Kollme
Dr. Amir Barzin, a family medicine physician and the chief operating officer at UNC Health, starts each morning with a solitary run to clear his mind before the day begins. The routine, he said, helps him manage the daily pressures of working in health care — pressures that many physicians across the country face.
His approach reflects a growing awareness among medical professionals of the mental and emotional toll their work can take, which can contribute to widespread issues such as burnout and depression.
This year’s annual Wellbeing Survey conducted by the Physicians Foundation and sent to more than 1,000 U.S. physicians, found that of the physicians who answered the online survey, 55 percent reported having felt “levels of debilitating stress.” Fifty-four percent of respondents reported experiencing burnout, which is associated with poor mental and physical health.
The effects of burnout can also have direct consequences for patient care and health care outcomes.
“You can make errors in finance and what happens is people lose their money,” said Dr. Theodore Stamatakos, a urologist based in Charlotte who has been practicing for 31 years. “But when you make errors — and I’m talking about major errors — in medicine, people lose their lives or people suffer.”
‘They get grumpier, they get snappy‘
The research database maintained by the National Library of Medicine contains more than 36,000 articles published in the past five years examining the phenomenon of health care worker burnout.
The definitions of burnout in the studies vary somewhat, but in general it’s a work-related stress syndrome resulting from chronic exposure to job stress.
The National Institute for Health Care Management identifies three components of burnout: emotional exhaustion, which can lead to irritability; cynicism, which replaces empathy with negativity and emotional numbness; and a low level of professional effectiveness.
James Romanowski, a Charlotte orthopedic surgeon specializing in sports medicine, said he has seen these symptoms appear in colleagues through gradual changes in physicians’ attitudes.
“They get grumpier, they get snappy, they’re less connected, they’re less engaged,” Romanowski said. “The signs aren’t obvious, but they’re there.”
Similarly, Robert Seymour, an anesthesiologist in Raleigh, said physicians can become callous and lose empathy for their patients.
“It is unfortunate because a lot of times, these people are the ones that have a whole lot to give and are very talented and skilled physicians,” Seymour said.
Many physicians experience moral injury, the top cause of physician burnout, according to NIHCM. That’s what happens when someone knows the right course of action but is unable to carry it out, or when they witness events that contradict their moral beliefs or expectations. Health care policies that limit care for certain patients, insurance limitations and increasing costs can create situations where doctors find it difficult to do what’s best for patients – and for themselves.
The experience can lead to guilt, shame, a sense of betrayal, sadness and a loss of confidence. Physicians report that too many bureaucratic tasks, long hours and lack of respect from other staff contribute to their moral injury and burnout, the NIHCM found.
Increasing administrative challenges take a toll
Sindhuja Damodaran, a UNC Chapel Hill senior from Charlotte, shadowed doctors around the Triangle this summer to gain insight into the roles physicians play in health care. An environmental health science major at the Gillings School of Global Public Health, Damodaran hopes to go to medical school after graduation.
One of her biggest takeaways from the summer was that despite doctors’ best efforts, they cannot always achieve their goals.
“All these people work really hard and try very hard,” she said. “This is basically their entire life, and sometimes it just doesn’t work. And I think that can be very disheartening.”
Romanowski said that his subspecialist role as an orthopaedic surgeon often means he’s the final stop in someone’s care journey, which is difficult when there’s nothing more he can do. He said the patients he could not help weigh on him.
“You don’t remember all the people you helped; you remember the ones that you couldn’t help,” Romanowski said.
Many physicians point to increasing administrative challenges as another major driver of burnout. A 2024 study by Google Cloud and The Harris Poll showed that administrative work, like acquiring prior authorization for treatment, decreases job satisfaction and impacts patient care. The study found that administrative work contributes to feelings of burnout for 82 percent of clinicians and 81 percent of medical staff.
Romanowski said medical school did not teach him much about the administrative or financial aspects of medicine, which he encountered only after entering the workforce. Barzin agreed, adding that few doctors pursue the profession for those parts of the job.
“If you’re thinking about what allures you to medicine, no one ever says, ‘I’m really excited about going to work and arguing with insurance companies about a prior authorization,’” Barzin said. “What excites them and gets them really happy about going to work is providing care for the patients.”
Romanowski said the financial side of health care can be difficult to overlook, because administrators are focused on bringing in revenue.
“The more efficient you are, the more revenue you bring in,” Romanowski said. “But the price to pay is your ability to deliver high-quality care.”
Less connected to patients, coworkers
As burnout intensifies for doctors, its effects can impact patient safety.
“If the provider is burnt out, not thinking clearly because they’re so out of it, I would not want that,” Damodaran said. “It’s scary, especially if you’re in a vulnerable position where you have a super serious condition. It takes away from the provider being able to give proper health care advice.”
Barzin said doctors have to be on their game all the time because their decisions affect human lives. When physicians are not performing at their best, he added, patients notice and can lose trust in their physicians and in the overarching health care system.
“The impact of you not being on your game is really important for society as a whole,” he said. “The second we lose trust in medicine and the way that we provide care for patients, that’s the second our society sees worse outcomes from health care.”
In addition to burnout influencing decision-making, it also interferes with physicians’ efforts to connect with others. Romanowski said the physician-patient relationship is special and is essential to care quality and outcomes.
“They’ll feel like you care, they’ll feel like you’ve connected and, more importantly, they’ll believe in your treatment plan,” Romanowski said.
Barzin said teamwork in hospitals is equally important, as collaboration fosters trust and a shared purpose.
“You have to show humility and let everyone speak and have their voice heard so you can do what you’re there to do, which is provide the best care possible for patients,” he said. “There’s this tight, connected weave in how we interact at work.”
Charlotte urologist Stamatakos said mistakes in medicine are inevitable, but that weakness is looked down upon. He said there is not as much camaraderie as there should be.
Resources and coping strategies
Hospitals are beginning to address burnout more systematically. At the UNC School of Medicine, Barzin said physicians have access to a peer mentoring program and the Taking Care of Our Own program, which promotes well-being.
At Novant Health, where Romanowski practices, the American Medical Association recognized the organization in 2023 as a Joy in Medicine health system for its commitment to physician wellness. Novant also launched the Leadership Development Program in 2013 to help remove barriers to professional fulfillment.
Nationally, the American College of Physicians offers online resources focused on wellness and burnout prevention.
Aside from institutional resources, physicians have developed personal coping strategies by focusing on what is important to them.
“If you can focus on those key things, then the rest is just noise,” Romanowski said.
Seymour said compartmentalization is essential to maintaining balance between work and home.
“If you let it consume you, you will always find something to take your time, take your attention, away from the things that are really important in life, like your spouse or your family,” Seymour said.
The coping mechanism of compartmentalization is important not only for difficult situations, but also for tough conversations. Damodaran said when she shadowed an oncologist, breaking difficult news seemed like a major burden. She witnessed him preparing to tell a patient that he did not have much longer to live.
“I think it’s something that’s going to dwell,” she said. “He just kept shaking his head, upset.”
A meaningful profession
Despite the challenges, each physician interviewed said they do not regret going into medicine.
“I don’t think that a single doctor or a nurse walks into the job saying that they’re doing it because they want to receive praise,” Barzin said. “We genuinely love the aspects of providing care.”
He said he still gets birthday cards from a patient he has been caring for for over 13 years — a reminder of the meaningful work he has done.
Stamatakos said the profession is rewarding because it allows him to play a role in people’s lives and gain insight that few other jobs offer.
“Who’s there when you’re born?” Stamatakos said. “A doctor’s there when you’re born. Who’s there when you die? Usually a doctor. And who’s there when you most critically need them, at least from a psychological or physical point of view? A physician.”
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