Let me start with a truth many of us sense long before we ever speak it aloud. We whisper it to ourselves on post-call mornings. We feel it in the drive home after another shift that took more than it gave. We carry it into our kitchens, into our bedrooms, and into the quiet moments where no pager or EMR alert can compete with what’s happening inside us.

The elephant in the room isn’t only the system. Yes, the system is flawed. Yes, the bureaucracy can drain even the most hopeful among us. Yes, medicine has become a place where we attempt to heal inside environments that feel held together by unstable scaffolding.

We know this story well. We live it. We have the scars, the sleepless nights, and the internal negotiations that keep us pushing through one more shift, one more week, one more year.

But there is another elephant we talk about far less. It isn’t loud, though its presence is unmistakable. It lives inside us, and it lives inside the relationships we return to after the hospital doors close behind us.

Burnout is not simply a workplace phenomenon. Burnout is a relational phenomenon.

In my TEDx talk, Redefining Burnout, I said: “Burnout is a relationship problem, a problem rooted in our relationships with ourselves, our significant others, and our work and society.”

That line wasn’t theoretical. It came from lived experience. It came from witnessing patient suffering, carrying the unseen burdens of physicianhood, navigating motherhood, facing loss, rebuilding my life, starting over, and learning one step at a time what alignment actually feels like. Today, I want to go deeper into that truth. Not in a philosophical way, but in a practical, human way that physicians rarely have space to explore.

The myth of external fixing

When we talk about burnout in medicine, our eyes naturally look outward. We see:

• Hospital culture
• Staffing shortages
• Documentation demands
• Inboxes that never stop multiplying
• Electronic medical records designed without an understanding of patient care
• Leadership strategies that speak wellness but reward overextension
• A psychological environment where safety often feels negotiable

All of this is real. All of it is heavy. But if we place every ounce of our distress on external factors alone, we miss the deeper fracture. It is like treating chest pain with antacids because looking at the EKG feels too vulnerable.

[Image comparing systemic burnout factors versus internal relational factors]

We cannot heal what we refuse to examine. Some of the most potent contributors to burnout aren’t found on staffing schedules, compensation grids, or administrative flowcharts. They exist inside us, not as blame, but as awareness.

Because here is a truth that medicine rarely names out loud: We learn to abandon ourselves long before the system ever finishes the job. We learn to ignore our needs. We learn to outrun exhaustion. We learn to wear suffering as a badge of honor. We learn to silence emotion until we forget how to hear it.

By the time the system harms us, we’ve already been conditioned to participate in our own depletion. That conditioning is the quiet elephant few physicians want to look at.

The Anatomy of Alignment™

I call it the Anatomy of Alignment™, a three-legged stool that sustains our ability to thrive in medicine and beyond:

1. Relationship with self
2. Relationship with significant others: the inner circle of our lives
3. Relationship with work and society

When all three are aligned, we feel grounded and capable. When two weaken, we start compensating in ways that aren’t sustainable. When only one remains, we collapse under the weight of what life demands.

The third leg, the system, is the one we talk about most often. But the first two are where burnout actually begins. They are the most intimate, the most vulnerable, and the easiest to neglect in the name of professional duty. It is more comfortable to critique a broken system than to face the ways we have neglected ourselves. It is easier to point to policies than to admit the strain in our closest relationships. It is simpler to talk about workflow redesign than to say out loud, “Somewhere along the line, I forgot how to care for myself.”

Relationship with self: the forgotten discipline

Medicine teaches us to override our humanity. We are trained to ignore the very needs we tell our patients to honor. We skip meals and call it efficiency. We push through fatigue and label it dedication. We bottle emotions and call it professionalism.

We ask patients to tune into their bodies while ours whisper, then weaken, then break under the weight of chronic self-abandonment. Wellness isn’t missing from physicians’ lives because we lack information. It is missing because the culture trains us to treat our own needs as distractions from patient care.

This self-disconnect starts early:

• In medical school, rest is optional.
• In residency, sleep becomes currency.
• In early career practice, saying no feels dangerous.
• In mid-career, identity and worth become intertwined with productivity.

Somewhere between training and practice, we internalize the belief that we are only as valuable as our output. That belief is the beginning of burnout. Not the inbox. Not the EMR. Not even the administrative overload.

Burnout begins when we fracture the relationship with ourselves. Rebuilding that relationship requires:

• Boundaries
• Self-trust
• Emotional honesty
• Respect for our limits
• Permission to have needs

These are not luxuries. They are the foundation of longevity in medicine.

Relationship with significant others: Where we bleed quietly

The people closest to us often feel our burnout before we consciously recognize it. They see the fatigue we try to hide. They notice the withdrawal. They experience the irritability we rationalize as being “just tired.” They receive what’s left of us after we give our best energy to the clinic, the hospital, or the call room.

Burnout is not private. Burnout is relational.

Partners begin carrying more than their share. Children sense a heaviness they cannot describe. Friends drift because connection requires energy we no longer have. Community becomes something we will “return to later.” Isolation settles in quietly. It looks like self-sufficiency, but it is really a protective shell built around exhaustion.

Here is the truth physicians rarely say aloud: Burnout is not only painful for the physician. It is painful for the people who love the physician.

Rebuilding this relationship leg takes humility. It takes intentional conversation. It takes acknowledging the weight our loved ones have been carrying. It also takes learning how to let ourselves be supported, which does not always come naturally to people trained to be the helper, the fixer, the strong one.

We cannot thrive in relationships where we refuse to be vulnerable. And we cannot heal burnout without rebuilding the connection that sustains us outside of medicine.

Relationship with work and society: the leg we talk about

Let me be clear: The system matters. Workplaces matter. Policy matters. Moral injury is real and pervasive. I have experienced this personally, and I would never minimize it.

But even as we advocate for change, we cannot wait for systems to transform before we begin healing. If we do, we hand away our agency and delay our well-being indefinitely.

When we rebuild the first two relationships, with ourselves and with our meaningful connections, we show up to work differently. Not superhuman. Fully human. Grounded. Clear. Boundaried. Resistant not because we are hardened, but because we are anchored.

A physician who is aligned internally is incredibly difficult to break. That is a radical stance in a culture that benefits from physician self-neglect.

The hard truth

We can create wellness programs, redesign schedules, and rewrite policies. We can push for systemic change, and we should. But none of that will matter if the internal fractures remain unaddressed.

The real wound is the disconnection from self and the disconnection from the relationships that steady us. Until we heal those fractures, no amount of external improvement will bring sustainable well-being. This is not defeatism. It is empowerment. It is the invitation to reclaim the parts of ourselves that medicine taught us to suppress.

The call forward

To my fellow physicians: You were never meant to endure medicine simply. You were meant to live within it. You were meant to thrive outside of it. You were meant to experience joy, connection, purpose, rest, and humanity.

Burnout is not an identity. Self-abandonment is not professionalism. Sacrificing your life for a system is not legacy.

Your life matters. Your needs matter. Your relationships matter. Your joy matters. Your alignment matters.

We do not rise from burnout by becoming more productive. We rise through presence. Through truth. Through restoration of the relationships that make us whole.

The system may take time to change. But healing does not have to wait for that day. We begin today. Not by doing more. By returning to ourselves first.

That is where flourishing begins. That is where medicine heals.

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.