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Palliative care physician and certified physician development coach Christie Mulholland discusses her article “5 things health care must stop doing to improve physician well-being.” Christie challenges the pervasive narrative that younger physicians lack work ethic and argues that their boundary-setting is a rational response to an untenable system. The conversation explores why well-being initiatives fail when they are treated as volunteer hobbies without budget or authority. Christie explains the double standard where new technology is an investment but physician wellness is expected to prove immediate financial return. She also critiques the rigid employment models that punish part-time work and warns against implementing new tools without considering the downstream impact on doctor workload. Learn how true cultural change requires shifting the focus from individual resilience to institutional accountability.

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Transcript

Kevin Pho: Hi, and welcome to the show. Subscribe at KevinMD.com/podcast. Today we welcome back Christie Mulholland, palliative care physician and physician development coach. Today’s KevinMD article is “Five things health care must stop doing to improve physician well-being.” Christie, welcome back to the show.

Christie Mulholland: Hi, Kevin. Thanks for having me. Great to be back.

Kevin Pho: All right. So tell us what led you to write this article and then talk about the article itself for those who did not get a chance to read it.

Christie Mulholland: I was doing my end-of-year reflections, and I was thinking about these patterns that I noticed that keep coming up in my conversations with well-being leaders and other doctors around the country. They seem to be trends. So these are five things that I think we need to leave in 2025 if we want to get serious about really improving physician well-being.

Kevin Pho: All right, so tell us about those five things that you are seeing.

Christie Mulholland: All right, so I am going to start with thing number one. This is: we must stop blaming younger physicians for not wanting to work as hard. I have been hearing this narrative come up. I hear it talking with more senior faculty members. I hear it from well-being champions that I work with. I see it in the news media. There is just this idea that this generation is different. They feel more entitled to having work-life balance.

There was an article in the Wall Street Journal that summed it up. The article is called “Younger Doctors Want Work-Life Balance. Older Doctors Say That’s Not the Job.” But I think that this narrative is often couched in concern. Older doctors are saying that younger doctors are missing out on their own learning and their own development because they just want to get their work done and go home. I hear faculty members who are really frustrated. They want to provide teaching to residents or mentorship, and the residents are not showing up. Younger faculty are declining committee work and they are not building their CVs.

But I think that the narrative that this is a younger generation and the generation is different gets it wrong. The reframe that I offer is that medicine has changed. You and I talked on another episode about how the space to do good work in a bad system is narrowing over time as health care has become more corporatized. I really think this is what is happening with younger doctors. They are having a rational response to these changes in the system. The administrative work, the hoops, the hurdles that younger doctors are jumping through, and the time that that is taking away from actual patient care make them feel less rewarded by the job.

So the response to be very protective about their own boundary setting is a rational response because the system is not going to protect their boundaries. They are setting boundaries for themselves. I think that we need to stop this narrative. We need to stop blaming the younger doctors because we should pay attention to their behavior and what it is telling us about this system. How we respond as a profession to this new generation is really going to inform what medicine looks like going forward and making sure that we have enough doctors staying in medicine for the long haul.

Kevin Pho: So I am hearing that when these older physicians bemoan younger physicians wanting work-life balance, medicine was different back then when older physicians were training and practicing. Now medicine is beset by so many things that are non-clinical, like you mentioned, administrative burdens, pre-authorization, and so many things that prevent physicians from applying their best clinical work. So today’s medicine is different from medicine of a generation past.

Christie Mulholland: It is different. Once in a while, I actually have heard some older doctors kind of admit that. They say, “We didn’t have to see as many patients back in the day. We had time to sit down and have a journal club or have a water cooler conversation.” Nowadays those water cooler conversations just are not happening because there are too many patients to see, number one. And number two, the water cooler space probably got repurposed for something else generating revenue.

Kevin Pho: How can we balance the concerns the older physician has with the changing expectations we should have for younger physicians? Is there a middle ground?

Christie Mulholland: Well, I think so. My general approach that I would recommend is let’s make space for people that care about being a doctor and want to continue being a doctor. Let’s listen. I think that Wall Street Journal article sparked a lot of discussion online. And in comment threads, and I admit I participated in some of that, this debate came up about medicine. Is medicine supposed to be a calling or is it just a job?

My tendency is to say that both answers are valid. I think that this is actually a really rich coaching question: What is medicine for me as an individual doctor? Is it a calling for me or is it just a job? Maybe it is a job that I really care about. I want to do a good job. I have invested a lot in it, but I also have other parts of my identity that deserve some space and time. If we listen and encourage people to get clarity on that for themselves, I think there is space for everybody. So my answer to that is yes. And let’s keep doctors in medicine, even the ones that do not find a spirituality in making all the sacrifices that it involves to be a doctor.

Kevin Pho: So I see the same conversation as well regarding whether medicine is a calling versus a job. One thing I want to ask you is that for those who see themselves where their identity is more than just being a physician and maybe see clinical medicine as a job, can they still be good physicians?

Christie Mulholland: Absolutely, they can still be good physicians. They can do that by showing up with integrity. The first step of integrity, of having integrity and acting with integrity, is being really clear on what you value and why you are showing up to be a doctor every day. Now, if your clarity is that you are showing up to be a doctor every day for the money and that is it, that might tell you some important information. If you value living your life with integrity or living aligned with your values, maybe you shouldn’t be staying in medicine, and that is OK too.

But yes, I think it is absolutely possible to see medicine as just a job. It is a job that you care about, a job that you are going to set some boundaries around for yourself, but you are very in touch with your why. Why are you showing up? I am a palliative care physician and I want work-life balance, but I also know that when I show up for my shifts, I want to be fully present with my patients and their families and provide the best care possible because they are meeting me at the most difficult moments of their lives. I need to show up fully for that. Part of how I show up the best way I can as a doctor is to have balance in my life.

Kevin Pho: How do you coach younger physicians who may be a little bit conflicted? Because all through training, they have probably been taught by the older generation that medicine is a calling and medicine should be the overwhelming priority at the expense of other parts of their identity.

Now you and I were talking, and I am in the same space, that physicians are more than their degrees. Not everyone wants their identity to be purely a physician. Some physicians want to be known as husbands and wives and fathers and mothers through their children. Sometimes that is going to come at the expense of the resources spent traditionally on clinical medicine. How do you coach younger physicians who may be a little bit conflicted? Now we are telling them something that may be a little bit different from what they have been previously taught.

Christie Mulholland: Well, it is a lot of untraining. It is untraining of everything that they have been told over and over again by that older generation. It is retraining that what they are feeling inside and what they know about themselves to be true is OK. And it is valid. I think it is also getting people out of their silos.

There is a world outside of that ivory tower of academic medicine or medicine in general. If you are spending all of your time and energy being a doctor, being around other doctors, and working all the time, then you are not going to have an opportunity to make connection and community outside of medicine. You won’t talk to people that work in other fields. Spend time with people that have non-traditional career paths. There are people who take sabbaticals. There is a whole community called the Retire Often Community. This is professionals who believe that it is natural and healthy for a career to take extended breaks.

So I think those would be the two things. What you are feeling inside is OK. In coaching we can make some space for that and really talk about it and normalize it. And then also get out of your silo and find like-minded communities outside of your silo.

Kevin Pho: How about within the academic medicine space, and I know that you have involvement there. Do you see the tide changing away from the prior generation’s mindset and maybe giving space that there is a life and identity outside of clinical medicine?

Christie Mulholland: Well, I see a lot of work happening there and a lot of culture change. As you know, culture change happens slowly. The way that it happens is by bringing people together to talk about these ideas. The Wellbeing Champions Committee that I oversee is a great example of that. I do see that glimpse of culture change.

Actually, this is a nice segue into the next of my five things. I am not sure if we are going to have time to talk about all five of them, but we will talk about my favorite ones for today. If you want to know about the other ones, read the article.

Another thing that I think we need to stop doing in health care is asking doctors to run well-being programs without resources and asking them to be volunteers in this role. We have done an amazing job in health care of shining a light on physician well-being, why it is important, and even having most institutions have a chief wellness officer and a wellness committee. But a lot of the well-being champions that I talk to around the country are volunteering and they do not have a budget for any wellness activities. So there is a disconnect there.

I think where this touches on the work-life balance issue is that the people that are most passionate about well-being end up doing extra work on top of their regular jobs. The work of a well-being champion is very prone to burnout actually because they are hearing a lot of the problems every day. They are hearing the things that are distressing the physicians they work with. People come to them with complaints and challenges, and then they do not have any money necessarily to actually address the things that are really at the core of the problem. So the work of a well-being champion is prone to burnout. That could be a real dichotomy. These well-being champions really care about changing the culture to make it a gentler culture. But on the other hand, there are so many obstacles that they are up against, and they find themselves kind of pulled in all those different directions.

Kevin Pho: And when you say resources, it is not just money, but of course, as you alluded to, time as well, right?

Christie Mulholland: Time is so valuable for cultivating your own work-life balance. Time is really needed to do the work of physician well-being, which a lot of the time is changing workflows in clinics and making clinics run more efficiently. That takes concerted effort. You need to do things like having a daily or a weekly huddle to make sure that the continuous improvement is happening. That does not happen when it is just a volunteer effort and there is no dedicated time to make those programs work.

Kevin Pho: So give us an example of maybe a successful medical institution that did invest the requisite time and money to really take well-being seriously. Because one thing I find when it comes to physician well-being is that the resources that they need to make a difference are going to come at the expense of making money. It is going to come at the expense of revenue, and not all medical institutions are willing to make that sacrifice.

Christie Mulholland: I think my response to that question is that it is heterogeneous where we are at right now. There is a wide range. There are some programs that are genuinely trying their best to get it right. I guess what I will say is you might be surprised that some of the well-being programs that you hear about nationally, which have a high profile and are doing a lot of work or publishing a lot of research about burnout, might not necessarily be the institutions that are doing the most investing of resources and having the biggest impact on their physician well-being.

Then anecdotally, I hear stories about physician groups that are run by private equity. Somebody at the top was moved by a story they heard and they just made the decision to allocate the resources and build a great wellness program. So, I think you might be surprised which programs are getting it right, which ones are getting it right by accident, and which ones are falling short still.

Kevin Pho: So I think we have time for one more of your five that you would like to see in 2026. So why do we go with that?

Christie Mulholland: All right. I am going to go with thing number five on my list, which is timely. In 2026, health care needs to stop rolling out every shiny new technology without properly vetting it and planning for the downstream effects. This is where we are at with AI right now and ambient AI scribing clinical decision support. That is all happening faster than any of us can really process.

We have seen this movie before with other technologies. The example that I will give is the patient portal messaging, MyChart messaging, if you use Epic. It was rolled out and all of a sudden patients could send the doctors messages anytime. The promise of that technology, of course, was that the doctors were going to be empowered to provide better patient care. But what wasn’t planned for was the impact of the burden, the task burden and the cognitive burden on doctors. The outcome that wasn’t planned for was the increase in “pajama time.” This is the time spent doing work outside of work hours.

Over the past several years, we have been seeing some really horrifying trends about work outside of work or pajama time. Only just now are we starting to see this kind of retrofitted solution where health systems are starting to explore and implement billing for that time that is spent in MyChart so that it doesn’t have to be uncompensated work anymore.

I worry that the same tendency exists to roll out the AI-driven technologies. The promise there is these things are going to help physician well-being. And I hope that they do. I am cautiously optimistic. But I actually heard another guest on your podcast who spoke about AI as a medical device. He said we should not roll out any new medical device that can impact patient outcomes without properly vetting it and doing trials. I argue that if we are serious about physician well-being, we need to try our best to think a few steps ahead in anticipating what the new technologies driven by AI are actually going to do and how they are going to impact doctors and well-being.

Kevin Pho: Who would be responsible to monitor those downstream effects of these shiny new objects specific to AI? How can we go about doing that?

Christie Mulholland: Well, I imagine it has to be some kind of multidisciplinary institutional committee. It should have people that know how to do science. So it should have some researchers, it should have some physicians, it should have the IT people, the ethics, legal. It should really be a multidisciplinary committee with physician voices. And those people need to stay around as the technologies are implemented in waves and continuously monitor the impact on physicians.

I fear that that is not necessarily going to be the standard way that it happens. It seems that the technologies might be dropped on doctors. It will be left to doctors to sort of point out the frustrations and difficulties as they come up. I hope I am wrong, but this is how I think about and prepare for this AI rollout.

Kevin Pho: And I want to underscore what you said. We need physician voices when it comes to evaluating these tools. One of my other guests on my podcasts mentioned that the last time there was a technological revolution, it was with the electronic medical records, and physicians didn’t have a voice at the table. We can see how that turned out in terms of upending our lives to our own detriments. So I think it is super important, as you said, to have physician voices when it comes to the vetting of new AI tools because I do think that this is a technological revolution that may surpass that of the electronic medical records.

Christie Mulholland: Absolutely.

Kevin Pho: We are on to Christie Mulholland. She is a palliative care physician and physician development coach. Today’s KevinMD article is “Five things health care must stop doing to improve physician well-being.” Christie, as always, we will end with some take-home messages that you want to leave with the KevinMD audience.

Christie Mulholland: So my take-home message is that these are five trends in health care that are counterproductive. If we are serious about clinician well-being, we need to stop doing them. We should continue pushing for the system to change for the better. And in the meantime, there is individual work that doctors can do, clarifying their values, their boundaries, what they are willing to accept, and what they need to negotiate for. That is the work that I help doctors with through coaching as well.

Kevin Pho: Christie, as always, thank you so much for sharing your perspective and insight. Thanks again for coming back on the show.

Christie Mulholland: Thanks for having me. Happy New Year.

Kevin Pho: Happy New Year.