Appointments booked months out. Overwhelmed specialists. ERs struggling to stay staffed. The physician shortage is not coming. It is already here.

The Association of American Medical Colleges projects a shortfall of more than 124,000 physicians by 2034. But that number does not capture the reality that doctors are leaving medicine quietly, every single day. Some retire early. Others step into nonclinical roles. Many more are simply trying to find a better way to practice medicine.

We should not be asking why they are leaving. We already know. We should be asking what we are doing to help them stay (or return) on their own terms.

Barriers, not burnout

Burnout gets most of the headlines. But the exodus from medicine is about more than exhaustion. It is about barriers that make sustainable practice impossible: restrictive contracts, rigid, volume-driven payment models, administrative overload, and a lack of physician autonomy.

The good news? This crisis is also an opportunity to reimagine what medicine could look like if we fixed these issues. Here is how we start:

Ban non-competes now

Non-competes do not improve care. They fracture continuity, limit access, and punish doctors for seeking better working environments. The FTC recently moved to ban non-compete clauses nationwide, but states should not wait for a federal ruling. South Carolina and others are already working to exempt physicians from these clauses. Ending non-competes is one of the fastest ways to stabilize access in underserved areas, keeping doctors in their communities, even if they change employers.

Let doctors break up with third-party payers.

Doctors across specialties are rethinking how they deliver care; and many want to move away from third-party payers altogether. From direct primary and specialty care memberships to hybrid models that mix insurance with cash-pay services, physicians are experimenting with approaches that align with what patients actually want: easier access, transparent pricing, and stronger relationships with their doctors. Some are contracting directly with self-funded employers or building telehealth-first practices that reach patients wherever they are. These models reduce administrative burden, restore autonomy, and keep care decisions between doctor and patient, not dictated by insurers. Policy should support these innovations with tax incentives and startup grants, making it easier for physicians to step outside broken reimbursement systems and design sustainable practices that truly serve patients.

Independent practice is not dead.

Independent medicine is not dead. In fact, physicians across the country are experimenting with hybrid practices, direct primary care, and cash-pay models that cut administrative burden and restore autonomy. Indiana recently passed a tax credit for independent practices, a simple but powerful way to encourage physician-owned care. Similar incentives nationwide could spark a revival of sustainable, community-based practices.

Legislation is finally catching up, barely.

States are finally making moves to dismantle outdated policies that limit physician-led care. Repealing Certificate of Need (CON) laws, for example, removes unnecessary barriers to opening new, doctor-owned facilities. Pair that with targeted tax credits for physicians who provide charity care (particularly in rural areas) and we create a path for mission-driven practice that is financially viable.

Train more doctors, smarter.

We cannot solve a physician shortage without training more doctors. But despite rising demand, federally funded residency slots have barely increased. We need to expand these slots strategically, focusing on primary care, rural medicine, and high-need specialties. And we should fast-track qualified, foreign-trained physicians who can help fill critical gaps.

An inflection point

This is not just about saving a profession. It is about transforming it. Doctors and patients are not asking for a return to “the good old days.” They are asking for a future where autonomy, sustainability, and patient care can coexist. Legislative shifts, grassroots innovations, and growing patient demand are already pointing the way. We just need policymakers to catch up.

We have spent years talking about burnout as though it is the problem. It is not. It is a symptom. The real problem is a system that pushes physicians out and makes coming back nearly impossible. We will not fix health care by talking about burnout. We will fix it by building a road back for the doctors we have lost.

Marcelo Hochman is a facial plastic and reconstructive surgeon.