American Health Care is Sick

The deterioration of the Doctor-Patient relationship is important in the development of physician burnout; The solution begins with education in Medical School.

August 1, 2026

American Health Care is Sick

The American health care industry is ill. Medical expenditures are at record levels. The American health care industry spends far more per capita than every other developed nation yet has poorer outcomes. Why is this?^[1]

Poor health of the American patient is a factor, with aging and obesity making their care difficult. Our delivery system and financial underpinnings are not efficient. While these and other factors contribute to the poor health of the health care industry, the primary cause, in my opinion, is the deterioration of the doctor-patient relationship.

The Doctor-Patient Relationship — Effects on Health Care Outcomes and Burnout

Today's practicing physician has entered an era of declining quality in the health care industry. The physician today has less control over their practice than ever before. The doctor-patient relationship has been gradually eroded to the point that big business, government, drug companies, non-physician committees, and many other institutions make the day-to-day decisions regarding patient care. This lack of control directly contributes to the process of physician burnout.

Physician Burnout — An Epidemic and a Plague on the Health Care System

A very important factor that contributes to poor health care outcomes is the adverse health of physicians and other clinicians. The primary contributing cause is the widespread incidence of physician burnout.^[2]

It has crippled the physician community, directly leading to an epidemic of physician suicides and suicide attempts, widespread early retirement, and physicians flocking away from medicine, resulting in shortages of these important members of the health care industry.^[3]

The Culture of Overwork

The cause of physician burnout is multifactorial. One common thread, in my opinion, is that nearly all burned-out physicians are overworkers — victims of what I call the Culture of Overwork.

Physicians are essentially bred to be overworkers. Nearly all overwork in undergraduate settings to get into medical school, then continue this culture in medical school itself, in part to secure a good post-graduate education. It only makes sense that this lifetime pattern would spill over into medical practice.

While every burned-out physician is different — some carrying mental illness, financial burdens, malpractice litigation, or health issues of their own — I believe essentially all of them share an element of overwork.

Healing the Health Care Industry

What are the solutions for an ailing health care industry and widespread physician dysfunction secondary to burnout? I see two directions: repairing the doctor-patient relationship, and educating physicians, starting in medical school, on the prevention of burnout.^[4]

Repairing the Doctor-Patient Relationship

Any attempt to repair the health care industry will fail unless we address the deterioration of the doctor-patient relationship. Physicians have lost clinical control slowly over the last twenty to thirty years. Non-physician institutions — government, drug companies, other big businesses — have stepped in and begun making clinical decisions that should be made in the exam room. Physicians, perhaps to ease their own burdens, have allowed this to happen. Only if physicians claw back this control can the health care industry be repaired.

Physicians need to take the lead here and address this relationship at every turn. Medical committees need to be run by physicians. Drug guidelines need to be created by practicing medical doctors. The delivery of health care needs to be directed by the clinician, not the government, big business, or non-physician administrators.

This starts with terminology. Physicians are not providers; they are physicians. Patients are not consumers; they are patients. It is a small change, perhaps, but it sets the tone for everything else.

Addressing Physician Burnout

Many attempts to improve burnout — access to mental health care, buddy systems, anonymous help lines — are beginning to be put in place. Little improvement in the incidence of burnout has occurred, however.

I was a burned-out physician and am a survivor of multiple suicide attempts. During the latter years of my practice, I sought help, receiving mental health therapy. I tried to change my lifestyle. I tried to be more well-rounded. For me, and for many other burned-out physicians, these efforts came too late.

I believe that only when we educate medical students to understand that practicing excellent medicine depends on taking excellent care of their own mental health will we begin to see real change. This education must begin during the clinical years of medical school, and it should be led by practicing physicians — those who know what it is like to live this life.

I propose a two-year course running through the clinical years, defining what burnout is, what its root causes are, and the risks each student will face. The Culture of Overwork would be named as a root cause. Much of the course would center on lifestyle: the importance of a well-rounded life, setting limits on what a student is willing to sacrifice, and concrete techniques for building — and protecting — that balance. It would also cover the practical risk factors that compound burnout: financial planning for first-time earners, destigmatized access to mental health therapy, and a clear-eyed look at malpractice, tort reform, and the realities of litigation.

Reasons for Optimism

I am optimistic that burnout is addressable through education. The doctor-patient relationship is a harder problem — so entrenched that a full return to the exam-room model may never happen. The institutions now making medical decisions believe they do it better than physicians do, and they will not give up that ground easily.

But entrenched is not the same as impossible. Every physician who insists on being called a physician, who pushes back on a committee decision, who trains the next generation to protect their own well-being before it's too late, is a piece of that reversal. I intend to keep being one of them, and I hope other physicians reading this will too.

William Lynes, MD

^[1]OECD, Health at a Glance 2025: United States. The U.S. spends $14,885 per capita on health care (17.2% of GDP), compared with an OECD average of $5,967 (9.3% of GDP), while performing better than the OECD average on only 3 of 10 key health outcome indicators.

^[2]American Medical Association, National Physician Burnout Survey, 2025. 41.9% of physicians reported at least one symptom of burnout, down from a pandemic peak of 62.8% in 2021.

^[3]American Foundation for Suicide Prevention. An estimated 300 physicians die by suicide each year in the United States — nearly one per day — a higher rate than the general population.

^[4]Association of American Medical Colleges, 2024 physician workforce projections. The U.S. faces a projected shortage of up to 86,000 physicians by 2036.