Physician burnout is not going away; experts offer ideas on reducing regulatory burdens

Physician burnout remains problematic as awareness has grown, but burdensome prior authorizations, unneeded and excessive documentation, and other barriers between doctors and patients have not shrunk.

On Feb. 11, the U.S. Senate Special Committee on Aging convened the hearing “The Doctor Is Out: How Washington’s Rules Drove Physicians Out of Medicine.” Four experts offered their perspectives on the layers of paperwork and computer work that sap the energy — and sometimes the lives — of physicians and other clinicians who are trying to care for patients. The U.S. health care system is “broken,” with physicians increasingly unable to focus on patient care because of growing administrative and regulatory demands, said Sen. Rick Scott (R-FL), the committee chair. Doctors who treat patients covered by Medicare and other government-supported programs face heavy paperwork requirements and compliance rules that consume time and create barriers for patients seeking care.

Federal mandates and reporting standards have forced physicians to spend more time navigating bureaucracy than treating patients.

“The result is, patients can't get the care they need from doctors, and doctors can't give patients the care they deserve,” Scott said during the hearing.

The burden is especially severe in rural and underserved communities, where provider shortages already limit access, Scott said. Physicians who treat older adults face particularly intense regulatory pressures. These challenges contribute to physician dissatisfaction and burnout, creating a cycle that makes the situation worse and worse.

“It's no wonder the doctors really report feeling higher levels of burnout than other U.S. workers,” he said. “That burnout leads to more doctors quitting their jobs, which creates more doctor shortages, which leads to increased administrative burden, which creates more disconnection and fewer rewarding interactions with patients, which results in more burnout.”

In the most serious cases, Scott said, burnout can lead to severe mental health consequences for physicians, including depression and suicide.

‘The current system has flaws’

Burnout among health care workers has declined since its peak during the COVID-19 pandemic, but remains widespread and continues to strain care delivery, said Sen. Kirsten Gillibrand (D-NY), the committee’s ranking member. She cited the American Medical Association definition of physician burnout as a stress reaction marked by emotional exhaustion, depersonalization and a reduced sense of personal accomplishment.

Those factors become major drivers of physicians leaving the profession, which worsens workforce shortages and undermines patient access to care, Gillibrand said. Contributing factors include regulatory and administrative requirements, financial pressures within health systems and the broader culture of medical practice. Regulations play an important role in ensuring safety, quality and fraud prevention. “Simultaneously, it's clear that the current system has flaws,” she said during the hearing.

Gillibrand specifically noted the strains on independent practice and measures that could help those doctors. Those include streamlining the prior authorization process, improving the usability and interoperability of electronic health records, and simplifying or standardizing payer forms used in insurance claims.

“This can help delay early exit from the workforce and keep independent practices afloat,” she said. “This is especially important as we continue to see an unprecedented rise in smaller physician-owned practices closing their doors, integrating with larger health care systems or receiving private equity investment.”

Practice under a new boss does not necessarily guarantee fewer obstacles to care. Gillibrand called the practice closures and consolidation “structural changes” that can create system-level financial pressures that diminish physicians’ agency while adding to burnout.

“Under these circumstances, physicians can face business-oriented performance targets that require an increase in patient volume. This means seeing a greater number of patients in shorter, increased frequent visits that create even more administrative work, which can be compounded by the reduction of clinical and administrative support staff.”

The consequences and stakes of health care burnout are too high for lawmakers to ignore, Gillibrand said.

“Healers are suffering,” she said. “Providers are facing sky-high costs to replace each clinician that leaves remaining staff are working at reduced capacity, putting themselves and their patients at greater risk. Patients are losing access to the care they need.”

Regulation in place of passion

Physician burnout is a growing national crisis, with approximately 400 incidents of physician suicide a year, said Alma Littles, M.D., dean and chief academic officer of Florida State University College of Medicine in Tallahassee. The National Academy of Medicine, the Association of American Medical Colleges and the American Medical Association are all developing resources to help physicians who are leaving medicine, “not because they've lost their passion, but because the regulatory environment has made it nearly impossible to practice the way they were trained,” she said.

The consequences of burnout extend beyond clinicians to patient access, the speaker said, noting that one physician leaving practice can leave thousands of patients without care. In response, medical schools in Florida collaborated to identify root causes and expand support programs, including wellness curricula, counseling services and efforts to reduce stigma around mental health care. The Florida State University College of Medicine was noted for integrating wellness initiatives such as stress management resources, fitness programs and suicide prevention efforts into its training model.

The good news: The crisis is solvable, Littles said. But now doctors need the help of federal legislators and regulators because broader, systemic reforms are necessary. Priorities include reducing administrative burdens, simplifying regulations and ensuring federal policies strengthen rather than strain the physician workforce. Addressing burnout, she concluded, is essential to sustaining the nation’s health care system.

“Addressing this issue is no longer an option. It is critical to ensuring access to care,” Littles said.

A health care epiphany

Administrative complexity and insurance-driven payment systems have made it increasingly difficult for independent primary care practices to survive, said Lee Gross, M.D., founder of Epiphany Health, during the hearing.

“Epiphany Health is a very strange name for a medical practice, but in fact, we had an epiphany. And the epiphany was, why are we insuring primary care? Why are we taking relational and longitudinal care and funneling that through an insurance product, using tens of thousands of diagnostic codes, hundreds of thousands of diagnostic and billing codes, filing an insurance claim for every single transaction, and then we're disappointed and surprised that it's impersonal, it's inflexible and it's expensive?”

By 2002, Gross had a medical practice that worked with insurance companies and Medicare. Amid federal policy debates, Medicare payments fluctuated, creating uncertainty that at times forced him to take out personal loans to meet payroll and cover expenses. But the federal government became an unreliable business partner, Gross said, one that needed to be fired.

He described the increased need for computer systems to track patient health and Medicare compliance. Referrals ballooned from one-page summaries to “16 pages of computer-generated rubbish,” he said. Electronic health records became cash registers, patients were like ATM machines and medicine became about volume, not care, Gross said.

“We kind of joked in my practice that we're just going to go ahead and stop billing Medicare, we're just going to charge $100 for parking,” Gross said. “But effectively, that's what we did.”

Patients pay a monthly subscription for care, including tests, with no insurance billing. Laboratory tests are relatively inexpensive because the labs don’t have to code and interact with insurance companies, he said.

Gross was an early practitioner of direct primary care, but now there are thousands of physicians stepping away from the system to pursue better primary care, he said.

“What we don't need is mass production in medicine. We need mass personalization, and that's the kind of care that we deliver,” Gross said. “And I'm hoping that we can get to that through removing some of the over-regulation in health care.”

‘A confluence of administrative and financial pressures’

MGMA represents more than 70,000 members working in approximately 15,000 medical practices. Survey data consistently show a strong link between regulatory burden, payment system challenges and workforce stress, said Jeffrey Smith, MBA, CPA, CGMA, FACME, incoming board chair of the Medical Group Management Association (MGMA). He is also the CEO of Piedmont Healthcare in Statesville, North Carolina.

Physician burnout has worsened access to care. In a 2026 MGMA survey of more than 230 physician practices, over half reported losing at least one physician to burnout in the past three years, and more than 75% of those said regulatory burden was a significant factor. These losses lead to longer wait times, shorter visits and practices closing to new patients, he said.

Smith cited the experience of his daughter, who works as a primary care physician in the same practice and who spends time outside the practice completing regulatory tasks. Because of the significant lack of standardization across Medicare, their practice has hired consultants to interpret quality measures.

One potential solution would be passing the Improving Seniors Timely Access to Care Act, which would streamline prior authorization for Medicare Advantage.

“A confluence of administrative and financial pressures is driving physicians out of practice, increasing consolidation and undermining patient access in communities across the nation,” Smith said. “Thankfully, Congress has numerous opportunities to address these issues and help bolster medical groups’ ability to provide high-quality, cost-effective care, and create a more satisfying experience for physicians and patients alike.”

‘Nothing more to give’

When Congress passed and President Joe Biden signed the Dr. Lorna Breen Health Care Provider Protection Act, advocates praised the action. Now it needs full funding, said J. Corey Feist, J.D., MBA, CEO and co-founder of the Dr. Lorna Breen Heroes’ Foundation.

It was his third time testifying in Congress about physicians, other clinicians and their work conditions, Feist said. He noted that each time he carries the stories of workers who were lost not because of a lack of resilience, but because a system failed them.

This time he talked about Breen, an emergency medicine specialist, who felt terrified her career would be over if she sought counseling due to her work in the early days of the COVID-19 pandemic. She died by suicide. He also recognized Tristin Kate Smith, an Ohio nurse who died by suicide in 2023, leaving a note about her feelings of abuse by the health care system, and William West Jr., a Utah native, an ophthalmology surgery resident who died by suicide in 2024.

“In a devastating final note, he wrote, ‘I am simply exhausted and have nothing more to give,’” Feist said. “He used his final moments to plead with administrators to support the residents rather than merely push them. William’s story is a warning that our health care system is claiming our brightest minds before they even finish their training.”