The truth is not hiding. We have known for decades what allows physicians to thrive and what erodes their well-being. The science has been published, the interventions described, and the solutions tested. What we face is not a crisis of knowledge; it is a crisis of action.

I was reminded of this recently when an emergency physician preparing a talk on wellness asked me for help. She wanted to share with her colleagues what actually works—what is rooted in evidence, not simply what is available, easy, or photogenic. Her request was simple and urgent: strip away the noise and name what is real. After more than two decades in physician wellness, my answer has not changed.

The most powerful remedies for burnout are structural, not personal. Systemic change is not a luxury; it is the evidence-based intervention we keep choosing not to enact. Reasonable patient volumes, thoughtful schedules, responsive and compassionate leadership, and reduced clerical burden are not extravagant wishes. They are the baseline requirements for sustainable practice. Without them, no number of yoga classes or gratitude walls will make a dent in the rising tide. Yet systemic change is often deemed “impossible” in the face of financial pressures and political headwinds. The truth is that what is truly impossible is to keep practicing medicine as we have been—relentlessly and inhumanly—and expect those who carry it to remain whole.

There is another layer that cannot be ignored: lifestyle medicine. We know that sleep, movement, nourishment, mindfulness, and human connection are essential to optimal brain function, sound decision-making, and long-term health. We prescribe these to our patients with conviction. And yet, in the culture of medicine, these same practices are treated as optional indulgences for physicians. A profession that demands peak performance under high stakes should be the last to tolerate chronic sleep deprivation, physical stagnation, and disconnection.

Mindfulness and coaching have also been quietly and persistently proving their worth. Both have been studied in randomized controlled trials and shown to reduce burnout, strengthen purpose, and improve quality of life. They are not fringe tools. They are effective ones, helping physicians align their choices, reclaim their clarity, and engage with their work in a way that sustains rather than depletes. Physicians who are mindful, intentional, and well-coached are the ones who will lead the change to a healthier culture in medicine. Until each of us changes the expectations we have of ourselves about self-sacrifice, being a martyr, taking responsibility for what is not ours, and practicing toxic independence, nothing will change in medicine. We must stop being so judgmental and have reasonable human expectations of ourselves and our colleagues. The only intervention I have encountered in 20 years of leading physician wellness that helps with this ongoing is a blend of mindfulness and coaching.

What does not work is pretending optics are impact. Wellness dashboards, ski weekends, and spa gift cards may offer momentary relief, but they do not change the lived reality of medicine. Nor does “medicalizing burnout” as though it were an individual pathology to be treated rather than a cultural distress signal calling for transformation.

Sustainable wellness is layered. It requires institutional accountability, personal responsibility, and cultural evolution—interdependent, not siloed. It means creating space for decompression and debriefing, fostering consistent teams and authentic connection, and reclaiming healthy boundaries as a professional norm. This will not happen overnight. Institutions may not rush to make it happen for us.

That is why, in the meantime, we must care for ourselves from a place of strength, not depletion. We must lead change from within, remembering that wellness is not a checklist to complete but a way of living and leading. When physicians are well, medicine itself will begin to heal. Not because we are working harder, but because we are working whole.

Jessie Mahoney is a board-certified pediatrician, certified coach, mindfulness and yoga teacher, and the founder of Pause & Presence Coaching & Retreats. After nearly two decades as a physician leader at the Permanente Medical Group/Kaiser, she stepped outside the traditional medical model to reimagine what sustainable well-being in health care could look like. She can also be reached on Facebook and Instagram.

Dr. Mahoney’s work challenges the culture of overwork and self-sacrifice in medicine. She helps physicians and leaders cultivate clarity, intention, and balance—leveraging mindfulness, coaching, yoga, and lifestyle medicine to create deep and lasting change. Her CME retreats offer a transformative space for healing, self-discovery, and renewal.

As co-host of the podcast, Healing Medicine, she brings self-compassion and presence into the conversation around modern medical practice. A sought-after speaker and consultant, she partners with organizations to build more human-centered, sustainable, and inspired medical cultures.

Dr. Mahoney is a graduate of Dartmouth College and the University of California, San Francisco, School of Medicine.