Why physicians must be able to say no and why health systems must let them

Physician shortages are not going away in 2026. Across health care, clinicians are being asked to do more, carry more responsibility and push the limits of how much they can take on. In this environment, the ability to recognize and respect those limits is no longer optional. It is essential.

Everyone in health care works hard, but physicians are trained, both explicitly and implicitly, to step up, close gaps, absorb pressure and do more with less. That instinct is deeply tied to medicine’s mission, and it has sustained our health care system through extraordinary challenges. But in today’s reality of persistent workforce shortages, rising administrative burden and increasing financial strain, an unexamined culture of yes is no longer viable.

I address this directly with every physician who goes through Adventist HealthCare’s Physician Leadership Academy. I remind them of a simple truth: The system will always ask for more. There will always be another shift to cover, another committee seat to fill, another initiative framed as urgent and important. The ability to say no, clearly, professionally and without guilt, is not a lack of commitment. It is a requirement for physician well-being, retention and quality of care. It is not the responsibility of physicians to keep others warm by lighting themselves on fire.

Why limits matter more during a physician shortage

The physician shortage is projected to reach up to 124,000 physicians by 2034. When there are fewer physicians, it becomes even more critical that each one is practicing at full strength mentally, emotionally and physically. Yet shortages often produce the opposite effect. Longer hours, higher patient volumes and growing nonclinical responsibilities are layered onto already full workloads.

When clinicians feel compelled to say yes regardless of capacity, burnout accelerates. Cognitive overload increases the risk of error. Threats to patient safety escalate. Emotional exhaustion erodes empathy and patient connection. Patient satisfaction, engagement and adherence to care plans deteriorate. Over time, the burnout drives turnover and early retirement and, in some cases, compromises the consistency and quality of care patients receive.  There can be an even higher cost as well. Rates of physician depression and suicide are higher than in the general population in some studies. For female physicians, the rate of completed suicide is more than 50% higher than in women of the general US population.

The more acute the physician shortage becomes, the more important it is for physicians to articulate their limits. Saying no is not about doing less work than baseline expectations. It is about doing the right work well and sustaining the ability to do it over time. It’s about collaborating with the health system and tactically working toward eliminating inefficiency and making the limited physician resources more efficiently utilized. Physicians who understand and respect their capacity are more likely to remain in practice, maintain productivity and deliver high-quality care consistently. These physicians are then poised to be the kind of high-quality physician partners that health systems need.

Culture determines whether no is truly possible

While physicians must learn how to set boundaries, a great responsibility also rests with hospitals and health systems. No amount of individual resilience can compensate for a culture that quietly rewards overextension and penalizes when a physician says “I can’t.”

If physicians believe that declining an additional request will be interpreted as a lack of engagement, leadership potential or team commitment, they will continue to say yes and absorb the consequences silently. We want hard workers fulfilling the deeply important mission of patient care, but if not curated carefully, over time, that silence turns into disengagement, cynicism or departure from the organization.

Culture is shaped by what leaders tolerate and reward. Health systems that genuinely want physicians to speak up must demonstrate through both words and actions that setting limits is acceptable. That means acknowledging capacity constraints, responding to no with respect and doing our best to avoid subtle signals that equate advancement with personal sacrifice.

Psychological safety is not a soft concept. It is foundational to clinical safety, operational reliability and workforce stability.

Supporting physicians when they decline additional asks

Creating a culture where physicians can say no requires more than reassurance. It requires infrastructure.

Health systems must equip leaders with the skills to recognize early signs of overload and intervene before burnout becomes visible. If a physician suddenly acts in a disruptive manner to colleagues, nurses or patients, one must look for signs of burnout and life strain before launching into punitive measures. Adventist HealthCare has a zero tolerance policy for disruptive physician behavior, but we are also a mature enough organization to closely examine the “why” of misbehavior. Proactive workload conversations, clear role definitions and realistic resource planning are essential if boundary setting is to work in practice, not just in theory.

At Adventist HealthCare, with physician leaders, we emphasize that setting limits is a leadership competency. Physicians who understand their capacity are better decision makers, better mentors and better stewards of patient care. Supporting those boundaries benefits not only physicians but the organization as a whole.

Trust, feedback and why surveys matter

One of the clearest indicators of organizational health is not what physicians say publicly but what they say anonymously.

Regular, well-designed physician surveys are critical to understanding whether clinicians trust leadership enough to speak honestly about workload, autonomy and psychological safety. Survey data often reveal gaps between leadership intent and frontline experience. Is the environment of patient care one in which physicians have the resources needed to care for patients? If not, this often only becomes actionably clear in a physician experience or engagement survey.

However, surveys alone are insufficient. Physicians quickly learn whether feedback leads to action or disappears into a report. When results are acknowledged, shared transparently and followed by visible change, trust grows. When survey results are ignored or minimized, silenced or even worse, disruption becomes the default choice.

A shared responsibility for sustainability

Teaching physicians that it is acceptable and necessary to say no is not about lowering standards for work or reducing accountability. It is about aligning expectations with reality and designing systems that support long-term performance.

Physicians have a responsibility to communicate honestly about capacity. Health systems have a responsibility to listen, respond and create environments that do not rely on constant overextension to function.

In a profession built on caring for others, we must extend that same care to those providing it. Empowering physicians to say no must not be perceived as a threat to access or efficiency. It is one of the most effective strategies we have to protect the future of the health care workforce and the patients it serves.

Knowing when to say no is not a weakness. It is a competency of strength. And in this moment, it is one that health care systems cannot afford to ignore.

Patsy McNeil, M.D., MBA, FACEP, is the executive vice president and system chief medical officer at Adventist HealthCare.