It is 3 a.m. and you are wide awake, not because of your overnight shift or a surgery you are prepping for, but because the stress you have been carrying for months will not let you sleep. You know you need help. You also know you probably will not ask for it. Somewhere in the back of your mind, a fear: that a mental health diagnosis could surface in your next review or quietly follow you into a credentialing decision.

That scenario is more common than most of us in medicine want to admit. Physicians routinely work 40 to 55 hours a week and make decisions every day that affect entire families. The authority that comes with that responsibility is real and it makes vulnerability feel like a professional liability. The therapist your hospital offers might work two floors above you. The platform your employer provides may share data with a parent company. So you say nothing.

That silence does not stay individual, it compounds across the system. I am not surprised to hear nearly half (46 percent) of health workers report feeling burned out often or very often. What surprises me is how mental wellness is still considered an afterthought instead of a business priority. Burnout costs the health care system an estimated $4.6 billion annually, and the Association of American Medical Colleges (AAMC) already projects a shortage of 86,000 physicians by 2036. We are burning through a workforce we cannot afford to lose.

The core fear: Who will see this and what will they do with it

In my experience, the hesitation usually comes down to one question: Who will see my vulnerability, and what will they do with it? That fear is not hypothetical; it is structural, and especially acute for physicians in smaller or rural health care systems. In fact, large regions of our country are mental health deserts, where psychiatrists are scarce, wait times are long, and the few therapists available are often affiliated with the same hospital network. In that environment, truly anonymous care is almost impossible.

At the same time, accreditation is often not designed with a physician’s privacy in mind. Credentialing forms typically include questions about past and present mental health conditions and drug usage; physicians who acknowledge such conditions and usage are often asked to share more details or be subjected to monitoring and drug tests. It is no surprise, then, that many physicians stay silent.

Three hurdles we need to break down

I believe there are three things standing between where we are and a system where seeking mental health care is genuinely career-safe.

The first hurdle is institutional. Licensing, credentialing, and compliance requirements were built for a different era. Improving access requires updating these systems to support virtual and cross-state care, along with interstate compacts, streamlined credentialing, and team-based models. Only then does accessible care become a realistic option rather than an aspirational one.

The second hurdle is technological. Too many hospital systems still rely on legacy employee assistance programs that are neither confidential enough nor designed with clinical staff in mind. Telehealth has real potential to reach physicians. Moving toward virtual-first, always-available mental health support is not a nice-to-have employee benefit. It is infrastructure, no different from electronic health records or clinical communication systems.

But neither of those changes will matter much if we do not address the third hurdle, and it is the hardest one.

The culture we need to challenge

There is a culture of stoicism in medicine that I watched play out in real time during my coronavirus disease 2019 (COVID-19) frontline experience. I have worked alongside colleagues who were exhausted, grieving, but stayed brave because they were meant to be authority figures in a time of crisis. The culture of stoicism comes from the same place as the dedication to service that draws people to this profession. But it is doing real and lasting damage. Until we treat help-seeking as a sign of good judgment rather than weakness, better policies and better platforms will only reach the people who were already willing to use them.

The good news is that the culture is shifting. More clinicians are speaking openly about stress, burnout, and mental health.

What we can all do now

If we get this right, the benefits reach further than physician well-being. Clinicians who receive support show up more present and more resilient, and that manifests in better patient outcomes, better retention, and better overall health of the institutions we work within.

But it requires action at every level. If you are a physician, start with your immediate circle, check in on your colleagues, and be open to asking for help when you need it. If you are a chief medical officer, audit the mental health resources your system offers and ask whether they were actually designed with clinician confidentiality in mind. If you are a chief people officer, push for platforms built specifically for clinical staff: virtual-first, confidential, and accessible regardless of where a physician practices.

Namit Choksi is a physician-entrepreneur, health care executive, and investor focused on building scalable, high-integrity health care platforms. He serves as chief executive officer of Tend Health, a national behavioral health company supporting clinicians in high-stress environments, and as executive director of The Asclepian Group, a health care investment firm. Dr. Choksi combines frontline clinical experience with operating and investment expertise to scale care delivery and health technology businesses.

Previously, he led growth and strategy for India and the Asia-Pacific region at Perfect Day and worked with Northern Light Venture Capital, where he advised and invested in health care startups. His global health experience includes collaborations with the World Bank and India’s Ministry of Health. He holds an MD., an MPH from Harvard, and an MBA from MIT Sloan, and is a Schwarzman Scholar at Tsinghua University.

His commentary and thought leadership have appeared in Authority Magazine, MedCity News, Becker’s Hospital Review, Health IT Answers, New India Abroad, Citybiz Portland, and Life Sciences Times. He shares professional updates on LinkedIn.