As a young pediatric anesthesia attending, I would often roll my eyes at resident trainees who prioritized their personal needs and required mental health days. I may have even looked down upon them as lazy, weak, and lacking grit. I prided myself on my work ethic, sacrificing time with my two children and aging parents for the sake of my patients. Medicine is a calling, not just a job, I would repeatedly tell myself.

The stark reality is that physicians are leaving the workforce in droves. The cost of one in five physicians leaving the profession due to burnout is estimated to be four billion dollars annually in the United States. There is a growing national shortage of physicians, with a projected deficiency of 125,000 physicians by 2034. Following the COVID-19 pandemic, physicians are now subject to longer hours, higher patient volume, stagnant reimbursement, less autonomy, and systemic burnout fueled by unsustainable working conditions and lack of institutional support. How are we to enlist the best and brightest into health care without offering either financial incentivization or appropriate work-life balance?

The U.S. health care system is in crisis. Simply stated, although we are spending more, our outcomes are worse. When comparing the performance of health care systems of 11 high-income countries in regard to outcomes, administrative efficiency, equity, and access, the United States ranks last overall despite spending more of its GDP on health care.

The health care system accounts for the highest rates of personal bankruptcy nationally, with as many as 66.5 percent of patients declaring financial defaults, despite the institution of the Affordable Care Act. We are leading the world in a number of categories: higher mortality from preventable disease, higher maternal and infant mortality, higher suicide rates, and a higher chronic disease burden.

While medical school classes are comprised of 50 percent or more women, a JAMA study found attrition rates of nearly 300,000 physicians in academic medicine from 2014 to 2019, with women 25 percent more likely to leave academia than men. Yet, there is much research to support that health care outcomes are improved when patients are treated by female physicians. Losing female physicians to burnout reduces the overall quality of public health and adversely affects patient safety.

Potential strategies to recruit and retain physicians at the systems level include:

• Payment reform
• Addressing dire workforce shortages
• Harnessing artificial intelligence (AI) to reduce administrative burdens
• Returning to a culture of mission-driven health care

Health care overhaul may come in various forms. Still, it is worth taking a deep dive into Maryland’s unique Total Cost of Care (TCOC) model, a partnership between the state and the Centers for Medicare and Medicaid Services. The only one of its kind in the United States, it requires all insurance payers (private insurers, Medicare, Medicaid) to pay the same rates for hospital services. By shifting from volume-based to value-based care, it has reduced hospital spending, decreased readmission rates, and achieved $1.06 billion in net cumulative Medicare savings from 2019 to 2023.

The model created a shift from volume-driven, fee-for-service care to a focus on financial incentivization for reduced hospital complications, investment in preventive care, and improved health care access and equity. Not only does value-based care focus on outcome optimization and patient satisfaction, it harnesses the power of data analytics and digital tools to track patient progress.

Following the pandemic, health care workers are leaving their positions in what has been known as the “great resignation,” due to work overload, reduced work-life balance, toxic work culture, and unethical work environments. Tuition subsidies, loan forgiveness, and higher physician reimbursement could increase funding for medical education and attract the brightest to the profession. Expanding residency positions in marginalized communities and providing immigration pathways for international health care workers are actionable items that may be utilized to address workforce shortages. Health care systems remain limited in championing wellness initiatives as opposed to the technology sector due to high clinical demands, less access to remote work, and an underlying stigma regarding resilience training.

The automation of non-clinical tasks via AI is being utilized to streamline physician documentation and administrative burdens. AI-powered scribes can summarize and transcribe doctor-patient visits into the electronic health record, saving physicians hours of time each evening. By engaging in clinical decision support, AI can enhance a physician’s informed decision making without the doctor having to sift through a patient’s entire medical record. Frequently used in radiology and pathology, AI can pre-screen imaging and biopsy slides, highlighting abnormal results that require the physician’s attention.

After a 12-hour day in the operating room and my five-year-old daughter asking yet again when I will be home, it is difficult to recall the doe-eyed medical school graduate who set out to save the world. Physicians need a reminder of the passion and purpose-driven work they embarked upon at the start of their careers. A mission-driven health care culture fosters resilience by valuing patient-centered care, purposeful work, ethical responsibility, and physician autonomy.

Back in 2011, my fellow anesthesiologist Karen Sibert wrote an op-ed suggesting medicine should not be put aside if it becomes challenging or inconvenient. Instead, it is a life’s work. I would argue that although this is certainly true, the health care system has not kept pace with the demands placed on physicians and is failing both patients and health care workers. Change is urgently mandated. True health care reform is predicated on prioritizing patient outcomes while simultaneously valuing medical providers.

Irim Salik is a pediatric anesthesiologist.