“Doctors need to develop resilience against burnout!”

After 20 years in medicine, every time I hear this, my jaw tightens, and my TMJ reminds me I have a very limited tolerance for nonsense.

Let’s call this what it is: not burnout, exploitation.

You cannot “resilience” your way out of systemic extraction. You cannot mindfulness your way out of an industry built on squeezing more and more labor out of you for less and less compensation. You cannot yoga your way out of a system that treats physicians as endlessly renewable resources rather than human beings. You cannot out-meditate an environment designed to break you.

Physicians are the product the system sells

Everyone makes money off physician labor, except physicians. Insurance companies sell access to us. Hospitals sell our work. Administrators monetize our CPT codes. Brokers negotiate contracts on our behalf, often without our input.

Patients pay for “coverage,” and then we beg insurance clerks for permission to do something the patient already paid the insurer for the right to receive. Then we wait months to be partially paid, and months later the insurer may recoup the payment entirely. This isn’t health care. This is a business model dependent on physician guilt and compliance.

The workload has doubled; autonomy has evaporated

Since the 1990s, the value of an RVU has barely risen in nominal terms and has dropped by nearly half in real terms. Meanwhile:

• Patient complexity increased
• Documentation is heavier
• Inbox management metastasized
• Appointment slots have shrunk to the point of parody

We see 25-30 patients a day at 12-15 minutes each, chart deep into the night, and then get blamed when patients wait months for appointments or feel unheard. The system offloads as much administrative burden onto the physician as possible (prior authorizations, denials, appeals, coding corrections), all unpaid, all uncounted.

This is not burnout. This is turning doctors into machines and patients into commodities. This is extraction.

The frog in the pot

Modern medicine is like putting a frog in a pot of cold water and turning on the heat. At first, residency feels warm. Challenging, but familiar. “I can handle this,” the frog thinks.

Then the water gets hotter. The frog tries to climb out. Immediately, it gets yelled at by the other frogs in pots: “You’re weak. You’re not resilient. You’re abandoning your patients.”

Ashamed, the frog sinks back into the water. The temperature rises. The frog dies.

As its spirit floats to the Heavenly Swamp, it wonders, “But, I went to resilience training.”

The other hot frogs shake their heads sadly. “Just not resilient enough, I guess.”

Burnout is the wrong diagnosis.

Language matters. If you name the problem incorrectly, you solve it incorrectly. Burnout implies a lack of personal coping capacity. But the data say otherwise:

• A 2018 JAMA Internal Medicine meta-analysis of 47 studies found that burnout doubles the risk of unsafe care, unprofessional behavior, and low patient satisfaction.
• A Mayo Clinic national study found that physician burnout and fatigue independently predict major medical errors, even after adjusting for specialty and environment.
• The National Academy of Medicine calls physician burnout a threat to patient safety and system integrity, not a personal failing.

In any other industry, doubling error rates would trigger a federal safety investigation. In medicine, we get a PowerPoint on resilience.

Look at who we’re doing this to

Medical students and physicians are not average workers. Studies show they are disproportionately high in conscientiousness, responsibility, persistence, and resilience. Admissions committees explicitly select for these traits. Training strengthens them further.

This is one of the most resilient cohorts in the entire labor market, and over half are now classified as “burned out.”

If a population preselected for resilience, trained in resilience, and culturally conditioned to sacrifice themselves is collapsing, the diagnosis is not “insufficient yoga.” The diagnosis is a toxic industrial system applied to humans.

Why exploitation is the real word

Medicine has been reshaped into a production-line business where:

• Physicians are cogs
• Patients are throughput
• Decisions are made by people who never touch patients
• Every minute of your day is optimized for billing rather than healing

Burnout is what the system calls it when its cogs start to seize. Calling it exploitation is just saying the quiet part out loud.

When doctors jump out of the pot

We shame physicians who leave traditional systems (those who move to direct primary care, concierge care, or low-volume practices) accusing them of abandoning patients or colleagues.

This is exactly how abusive systems function: The people who remain attack those who escape, because the escapee forces them to confront the reality they are not yet ready to face. It’s not quite Stockholm syndrome, but the emotional mechanics are the same.

Jumping out of the pot isn’t a failure.

Physicians who walk away from exploitative systems are not failing the profession. They are not selfish. They are not abandoning anyone. They are doing what every frog should have done the moment the water got hot: They are jumping out of the pot.

Tina F. Edwards is an emergency and integrative medicine physician.