Feeling the Squeeze

At this year’s Combined Otolaryngology Sections Meeting, I had the opportunity to reconnect with friends and colleagues from around the country. The conversations were familiar, but this year there was a different tone, one that felt heavier and more widespread. Across academic medical centers and private practices alike, physicians described feeling increasingly squeezed by productivity pressures over which they had little voice or control and which did not align with the stated mission of their institutions.

The message many were hearing was clear: Work harder simply to maintain the same compensation. See more patients. Fill more operating room time. Generate more RVUs. At the same time, continue teaching, publishing, and mentoring.

Many colleagues flew in for only a few hours before rushing back home to avoid losing clinic volume or operating room productivity. Others skipped the meeting altogether because of concerns about utilization metrics or falling behind on RVU targets. Conferences were once viewed as essential opportunities for education, collaboration, mentorship, and innovation, but are increasingly seen as luxuries that compete with productivity demands rather than investments in individual and collective professional growth.

The irony is difficult to ignore. Academic medicine frequently celebrates its tripartite mission of clinical care, education, and research. Yet many physicians feel the metrics used to evaluate them increasingly value only one of those missions. Teaching residents and medical students, mentoring junior faculty, conducting research, participating in committees, or attending CME conferences are often uncompensated activities squeezed into evenings and weekends after clinical work is done. This system works for a while with a highly motivated group committed to the stated tripartite mission, but everyone has a breaking point, and this discussion does not even touch on the demands outside of work and work—life integration.

Additionally, physicians are being told to become more “efficient.” AI-powered documentation tools introduced to reduce administrative burden and improve well-being are, in some institutions, being used to justify expectations to see even more patients per day. Physician revenue is being held back, or the RVU benchmark has increased to cover institutional capital expenses. Electronic health records promised streamlined workflows and reduced billing costs, yet many clinicians feel administrative complexity has only grown. Prior authorization demands continue to consume enormous amounts of time and energy for physicians, staff, and patients alike. When delays lead to cancellations, the consequences affect not only patient care but also operating room utilization and physician compensation.

This growing disconnect reflects a broader misalignment between institutional mission statements and the lived experience of frontline clinicians. Wellness initiatives often focus on resilience training, mindfulness seminars, or pizza lunches while the operational realities driving distress remain unchanged. Physicians do not need another lecture on resilience when workloads are unsustainable, and schedules leave little room for thoughtful patient care, teaching, scholarship, or recovery. The Centers for Medicare and Medicaid Services has provided additional production pressure, finalizing a -2.5 % “efficiency adjustment” for non-time-based services in the 2026 Medicare Physician Fee Schedule, highlighting the continued lack of inflationary adjustments to physician payments.

Burnout is often framed as an individual problem. In reality, it is frequently a systems problem. Recognizing that distinction matters. Clinicians are not failing because they lack grit or dedication. Most entered medicine highly motivated, mission-driven, and deeply committed to their patients and trainees. But even the most committed workforce has limits.

Meaningful solutions require operational reform, not just wellness programming. Institutions gain credibility when they reduce administrative burden, improve staffing, protect academic time, involve frontline clinicians in redesign efforts, align incentives with mission, and evaluate leadership not only on financial performance but also on workforce experience and sustainability.

The concern is not one of physician dissatisfaction alone. It is that, under relentless pressure to produce more, we risk losing the humanity that drew many of us to healthcare in the first place. 

—Robin