We entered medicine with a shared calling (to heal, to serve, and to make a difference). Yet somewhere along the journey, between the never-ending charting, late-night calls, and invisible emotional burdens, many of us forgot how to heal ourselves.

Every few months, another survey or report confirms what so many of us already sense in our bones: physicians are burning out at staggering rates. But what remains under-discussed, and perhaps even more revealing, is how strongly one’s specialty predicts the risk.

Emergency physicians, for instance, consistently rank at the top for burnout in both Canada and the U.S. But this isn’t simply a matter of chaotic schedules or high patient loads. From my perspective as a physician, speaker, and coach, burnout is not primarily a workload problem, it’s a relationship problem. To understand it fully, we must look beyond the hospital corridors and into the human heart of medicine itself.

The numbers don’t lie: burnout by specialty

The statistics are sobering. The Medscape 2024 Physician Burnout & Depression Report revealed the following:

• Emergency medicine: 63 percent reported burnout
• Obstetrics and gynecology: 53 percent
• Family medicine: 51 percent
• Oncology: 53 percent
• Pediatrics: 51 percent

In Canada, the CMA’s 2025 National Physician Health Survey reported that 46 percent of physicians met the criteria for burnout, a dramatic rise from pre-pandemic levels. Once again, emergency and family physicians were among those most affected.

The pattern is unmistakable: burnout tends to cluster within specialties that involve high emotional intensity, rapid decision-making, shift work, trauma exposure, and the constant weight of uncertainty. These are the specialties where medicine most resembles a storm (and physicians, the ones trying to hold steady in the wind).

Emergency medicine: where the rush meets the rubble

Having worked alongside emergency physicians, I’ve witnessed the unique combination of adrenaline, mastery, and compassion it takes to survive in that environment. The same qualities that make these physicians thrive in crisis, decisiveness, stamina, and focus under pressure, also make them vulnerable when the intensity never lets up.

So what makes emergency medicine such fertile ground for burnout?

1. The adrenaline trap

Each shift is a high-stakes performance under conditions of uncertainty. The body remains locked in a state of heightened vigilance (fight, flight, or freeze), often for hours at a time. This constant flood of cortisol and adrenaline may feel exhilarating at first, but over time, it corrodes both physical and emotional health. The body forgets what calm feels like.

2. Shift work and circadian chaos

Rotating night shifts, disrupted sleep, and missed family milestones all take their toll. The human body was never designed for perpetual jet lag. Chronic sleep deprivation doesn’t just cloud judgment; it erodes empathy, blunts emotional regulation, and weakens immunity.

3. Trauma exposure and emotional load

Emergency physicians bear witness to humanity’s most harrowing moments: sudden deaths, suicides, overdoses, domestic violence, and accidents. Each tragedy leaves a subtle imprint on the psyche. Over time, emotional detachment (or depersonalization) can emerge as a survival mechanism.

4. Systemic pressures and moral injury

Working in understaffed, overcrowded emergency departments is not only exhausting but also ethically painful. When physicians know what quality care should look like but are blocked by systemic barriers, they experience moral injury: the deep anguish of being unable to practice according to one’s values.

5. The culture of invulnerability

Medicine has long glorified endurance. We are trained to “push through,” to keep functioning despite exhaustion or grief. But this culture of stoicism has a dark side. What was meant to be resilience often becomes repression. And when emotions remain unacknowledged, they eventually surface, as irritability, withdrawal, depression, or worse.

It is no accident that emergency physicians have among the shortest life expectancies in the profession. Chronic physiological stress accelerates aging, increases cardiovascular risk, and slowly depletes the capacity for joy. Living in constant anticipation of crisis comes at a steep price, and too often, it’s the physician’s body and soul that pay it.

Why I see burnout differently

After years of practice and reflection (as a family physician, wellness coach, and woman who has walked through her own burnout) I came to understand that burnout isn’t merely about long hours or inadequate staffing. Many of my colleagues didn’t leave medicine because they couldn’t handle the work. They left because they lost their alignment.

They could no longer see themselves in the mirror of their profession. That realization inspired my framework: The Anatomy of Alignment.

Introducing the Anatomy of Alignment framework

I developed this framework after studying burnout patterns, coaching hundreds of professionals, and analyzing the human side of performance. Think of your well-being as a three-legged stool, representing three essential relationships that must remain balanced for you to stand tall:

1. Relationship with self

• How you see yourself (your values, boundaries, and capacity for self-compassion).
• Whether you can pause long enough to listen to your inner signals before they become screams.

2. Relationship with significant other

• This might be your partner, a trusted friend, or a confidant who truly knows you.
• The person who reminds you that you are more than your title, more than the letters after your name.

3. Relationship with work and society

• This includes your connection to your calling, your sense of contribution, and the meaning behind your work.
• When this leg weakens, purpose is replaced by performance (and fulfillment by fatigue).

Two invisible forces hold these legs together:

• Faith: Your guiding belief system or moral compass.
• Stress: The constant testing ground that reveals where cracks are forming.

When all three relationships are strong, you feel grounded and whole. But when one leg weakens (say, your personal relationships fray or you lose your sense of purpose) the stool wobbles. When two legs fail, collapse is inevitable. Burnout, in this model, is not simply the product of overwork; it is the outcome of relational misalignment.

The Harvard connection: relationships and longevity

The Harvard Study of Adult Development, one of the longest-running studies on human well-being, offers profound insight here. It has followed participants for over 85 years and found that the quality of our relationships, not wealth, fame, or achievement, is the strongest predictor of health, happiness, and longevity.

Strong relationships act as a buffer against life’s storms. They protect both mind and body. Conversely, loneliness and disconnection carry health risks equivalent to smoking 15 cigarettes a day.

Physicians, ironically, are among the most vulnerable to relational disconnection.

• With self: We push past fatigue, suppress emotions, and measure our worth by productivity.
• With significant others: Irregular schedules, trauma exposure, and emotional depletion make intimacy harder to sustain.
• With work and society: Bureaucracy, moral injury, and dehumanizing metrics sever the connection to our original “why.”

When these relationships break down simultaneously, no mindfulness workshop or corporate “resilience training” can restore balance. Healing must start from within, and with reconnection.

Burnout isn’t weakness, it’s a signal

When the body sends pain signals, we investigate. When an organ system fails, we intervene. But when the soul begins to ache, many of us minimize it, rationalize it, or bury it beneath more work.

Burnout is not failure. It’s feedback. It’s the body and spirit saying, “You’re out of alignment.”

When viewed through this relational lens, burnout is not about a lack of strength. It’s about losing connection, to self, to others, to purpose. The most resilient physicians are not those who push through pain, but those who pause, reflect, and reconnect.

Rebuilding the stool: from breakdown to alignment

1. Strengthen the relationship with self

• Audit your beliefs. Examine the scripts running in your mind: “I can’t say no,” “I have to be perfect,” “Self-care is selfish.” Outdated beliefs quietly sabotage well-being.
• Prioritize rest. Sleep is not indulgence; it’s the foundation of cognitive and emotional health.
• Choose reflection over distraction. Journaling, coaching, therapy, prayer, or time in nature reconnects you to your center.

2. Nurture the relationship with significant other

• Be present, not just available. Your loved ones need your full attention, not the exhausted remnants of your energy.
• Communicate honestly. Let them in. Share what you’re feeling, even when it’s uncomfortable.
• Create shared rituals. Regular dinners, walks, or moments of laughter re-establish intimacy.

3. Repair the relationship with work and society

• Revisit your “why.” What called you to medicine in the first place? What moments remind you that your work matters?
• Advocate for alignment. Speak up for systemic reforms that humanize care, for both patient and provider.
• Set boundaries. Saying no to what depletes you is saying yes to what sustains you.

4. Reinforce the struts: faith and stress

Faith (whether spiritual, philosophical, or ethical) gives meaning to struggle. It reframes chaos as growth. Stress, when understood, becomes a teacher rather than an enemy. It exposes weaknesses in the stool, revealing where balance needs restoration.

The cost of misalignment

The toll of physician burnout extends beyond the individual.

• Higher rates of depression and suicide: Emergency physicians are particularly at risk; one Canadian study found that 14 percent had experienced suicidal thoughts during their careers.
• Compromised patient care: Burned-out physicians are more prone to errors and less capable of empathy.
• Systemic instability: Turnover, absenteeism, and early retirements deplete the health care workforce, undermining the continuity of care.

But perhaps the most significant loss cannot be measured, the quiet erosion of meaning. The joy that once came from healing begins to fade, replaced by numbness. That loss of joy is the real crisis.

Redefining success in medicine

Our profession measures success by metrics: patient outcomes, procedures completed, and publications earned. Yet rarely do we measure alignment.

If The Anatomy of Alignment teaches anything, it’s that success without alignment is unsustainable. A thriving physician is not one who never tires but one who recognizes when to pause, recalibrate, and return to center.

We are not machines built to perform indefinitely. We are relational beings operating within a system that too often forgets that truth.

A call to my colleagues

To my colleagues (especially those working the night shifts, juggling trauma and chaos while trying to preserve a piece of themselves) I see you.

You are skilled, compassionate, and deeply committed. But you are also human. Humans are wired for connection, not perpetual depletion.

It’s time to redefine burnout not as a personal failure, but as an invitation to realign. When we heal our three core relationships (with ourselves, with our loved ones, and with our sense of purpose) we don’t just survive medicine; we rediscover its soul.

In closing

The Harvard Study proved it scientifically. I’ve seen it firsthand. Relationships, not resumes, determine health, fulfillment, and longevity.

Burnout, then, is not the end of the story; it’s a mirror reflecting where we’ve drifted from our truth. The cure is not found in working harder or faster, but in reconnection.

Because the real medicine (the kind that heals both doctor and patient) begins not with another checklist, but with a simple principle: The quality of our relationships determines the quality of our lives.

Until medicine heals its own relationships (with itself, with one another, and with the systems it inhabits) this hidden epidemic will persist.

I, for one, refuse to accept that as our future.

Tomi Mitchell is a board-certified family physician and certified health and wellness coach with extensive experience in clinical practice and holistic well-being. She is also an acclaimed international keynote speaker and a passionate advocate for mental health and physician well-being. She leverages over a decade of private practice experience to drive meaningful change.

Dr. Mitchell is the founder of Holistic Wellness Strategies, where she empowers individuals through comprehensive, evidence-based approaches to well-being. Her career is dedicated to transforming lives by addressing personal challenges and enhancing relationships with practical, holistic strategies.

Her commitment to mental health and burnout prevention is evident through her role as the host of The Mental Health & Wellness Show podcast. Through her podcast, Dr. Mitchell explores topics related to mental fitness and stress reduction, helping audiences achieve sustainable productivity while avoiding burnout.

Dr. Mitchell is also an author. Her book, The Soul-Sucking, Energy-Draining Life of a Physician: How to Live a Life of Service Without Losing Yourself, addresses the unique challenges faced by health care professionals and provides actionable solutions for maintaining personal well-being in demanding careers.

Dr. Mitchell’s expertise and advocacy have been recognized in her role as an executive contributor to USA Today, Thrive Global magazine, KevinMD, OK! Magazine, and Brainz Magazine, as well as across various television and radio platforms, where she continues to champion holistic wellness and mental health on a global scale.

Connect with her on Facebook, Instagram, and LinkedIn, and book a discovery call to explore how she can support your wellness journey. For those interested in purchasing her book, please click here for the payment link. Check out her YouTube channel for more insights and valuable content on mental health and well-being.