A colleague recently reduced her clinical schedule from full time to 0.8 full-time equivalent (FTE). She did not want to practice less medicine; she was trying to make the job sustainable. Afterward, she told me that 0.8 still felt like full time.
That is the part health care leaders need to understand. Reducing scheduled patient visits does not automatically reduce the work that surrounds them. Test results still arrive, patients still send messages, refills and forms still accumulate, and documentation still has to be completed. Some of the work falls with a lighter schedule, but much of it does not. The clinician gives up income and patient-care capacity, yet the workday remains nearly as long.
This is how health systems lose clinical capacity: not only through resignations, but one fraction of a position at a time.
Christina Mitchell and I examined the broader workload model in our National Academy of Medicine Perspectives commentary, “The Real Driver of Burnout: The 1.2-FTE Problem.” This essay asks a narrower question: How should leaders decide whether a burnout intervention is real? The answer begins with a simple test: What work does it remove from the clinician’s day?
Real physician voices, twice a week
Free, and one click to unsubscribe.
A meaningful intervention should change the workday in a way clinicians can feel and organizations can measure. It should reduce unnecessary inbox messages, simplify documentation, eliminate wasteful handoffs, shorten insurance delays, or move routine tasks away from clinicians when clinical judgment is not required. When work cannot be removed or reassigned, the intervention should create protected time to complete it.
If a program does none of that, it may still be worthwhile. Peer support can help clinicians recover after a traumatic event. Confidential mental health care may be essential. Food during a difficult shift is appreciated, and some clinicians may benefit from mindfulness resources. These supports can make a workplace more humane, but they do not create time or reduce demand.
That distinction is often lost when everything is placed under the broad heading of clinician well-being. A health system can offer valuable resources while leaving the underlying job unchanged. Leaders may point to what they have provided, while clinicians still face the same overflowing inboxes, inefficient processes, and unfinished work at the end of the day.
The limits of that approach become clear when the burden is made concrete. Last month, I covered a peer-to-peer prior authorization call while my colleague was seeing patients. These calls are supposed to allow a clinician to discuss a coverage decision directly with a medical reviewer at the insurance company. Instead, I spent about two hours being transferred among four people in four departments. At the end, I was told to upload documents through an online portal. The entire call could have been replaced by that instruction at the beginning.
Those two hours did not disappear when I hung up. They displaced patient care, documentation, messages, and results that still had to be completed. The insurer’s inefficient process transferred the cost of its failure directly into a clinician’s workday. No resilience module can repair that. The solution is not to help clinicians tolerate wasted time more calmly; it is to stop wasting it.
The work-removal test changes how burnout initiatives should be evaluated. Health systems often measure what they launch: a committee, a platform, a campaign, a workflow. Those things are easy to report, but they do not prove that the burden has fallen. The better measure is whether the workday changed. Are clinicians spending less time in the electronic health record after hours? Are fewer messages reaching them unnecessarily? Are authorizations completed with fewer calls and handoffs? Has documentation time decreased without simply shifting work somewhere else?
This is the same standard health systems apply to other operational investments. An intervention should address a defined problem and produce a measurable result. Success is not the introduction of a new process. Success is less unnecessary work.
Leaders must also answer a second question: If the work cannot be removed, where is the time to perform it? Some administrative work is necessary and requires clinical judgment. Results must be reviewed, complex messages answered, and certain coverage decisions challenged. But necessary work is not free work. If organizations expect clinicians to perform it, the time must appear somewhere in staffing, scheduling, or compensation. Patient visits are part of the job, and organizations allocate time for them. Work should not become invisible simply because it happens outside the exam room.
Many burnout programs fail because they begin with the clinician rather than the job. They ask how individuals can become more resilient before asking whether the workload is reasonable. Coping skills can help people through periods of unavoidable stress, but they cannot permanently reconcile a position that contains more work than there is time to perform.
Clinicians eventually correct that imbalance themselves. They reduce their schedules, limit their patient panels, leave demanding practice settings, or leave clinical medicine entirely. Those decisions may make the job sustainable for the individual, but they reduce access for patients and create new recruitment, vacancy, and turnover costs for the organization. That is the part leaders should take seriously. When unnecessary work is left in place, the organization pays for it twice: first through wasted clinician time, then again through lost capacity, turnover, and recruitment.
Health systems should not claim progress simply because they have offered another resource. They should be able to show that the job itself has become more manageable. Before calling something a burnout intervention, ask what work it removes. If the answer is none, the organization is not fixing burnout. It is preserving the conditions that drive clinicians to reduce their hours or leave, then paying to recruit their replacements.
Institutional self-harm is not a workforce strategy.
This essay is cited in the KevinMD record on physician burnout.
Amir Atabeygi is a family physician. Christina Mitchell is a clinic operations manager.
