Early in her residency at the Veterans Hospital in Virginia, Eleonora Fedonenko, MD, thought the goal was to outrun the clock. Now, after 28 years in internal medicine and cosmetic dermatology, she sees the mistake.

“The clock doesn’t care,” she said. “That’s the wrong fight entirely.”

Most clinicians know this. But knowing never made the clock slow down. Patients are still waiting, notes are still due, so you fight it anyway. You squeeze in one more appointment, and you chart at midnight. You skip lunch on Tuesday and Wednesday and, okay, on Thursday too. You keep running the race you know you’ll lose because stopping feels worse than losing.

This behavior is how you get to nearly half of all US physicians reporting at least one symptom of burnout. The most recent national survey, published in Mayo Clinic Proceedings and led by Tait D. Shanafelt at Stanford University, Stanford, California, put the figure at 45.2%. That’s down from a pandemic peak of 62.8% in 2021, but still higher than the general working population.

After adjusting for age, gender, and hours worked, physicians are 82% more likely to experience burnout than other American workers. The problem isn’t that doctors work more hours — although they do, about 10 more per week than the average worker. It’s that the hours themselves are harder.

The next decade looks worse. The US faces a projected shortage of up to 86,000 physicians by 2036, according to the Association of American Medical Colleges — driven by population growth, an aging patient base, and a physician workforce in which more than 40% of active doctors are 55 or older and approaching retirement.

Technology provides some relief. A 2024 study in JAMA Network Open found that ambient AI scribes cut the documentation burden significantly, with burnout dropping from 51.9% to 38.8% among participating physicians after just 30 days. But you probably know the catch: The time those tools free up tends to get filled with more patients, not more breathing room.

The system isn’t going to fix itself. But maybe you can prevent the system from deciding how you feel.

The ‘Redeeming Lost Time’ Myth

When clinicians fall behind, the instinct is to accelerate: Push harder, move faster, compress the next appointment to reclaim the previous one. The research says otherwise. Physicians working under time pressure make, on average, 37% more diagnostic errors than those given adequate time, according to a study published in Academic Medicine.

Kristine Lee, MD, physician and associate executive director with the Permanente Medical Group in Northern California, has spent the past 2 years studying how technology can reduce physician workload. “The burden of clinical documentation contributes to burnout and job dissatisfaction and impairs physician-patient interactions that are linked to lower quality of care,” she said.

There’s more: Time pressure increases perceived stress and reduces the number of diagnostic hypotheses a clinician considers. The result is a mind that moves faster and sees less.

Jennifer Adams, RN, has watched this play out from the administrative side. As vice president and lead trainer at the Texas Academy of Medical Aesthetics, Texas, she has a name for the reflex: “redeeming lost time.” It rarely redeems anything.

“It tends to take the form of rushed consultations, putting procedures one after another with no interruptions,” she said. “It’s a contradiction because it increases cognitive load and danger. When healthcare professionals get that feeling of being behind, they make faster decisions, but not necessarily better ones.”

The trap, in other words, is self-defeating by design. Accelerating compounds the cognitive burden, leaving the clinician to function with degraded processing capacity just when clarity matters most. The sensation of catching up can be deeply misleading. In reality, it often signals a deeper move into overload.

The source of the fatigue is usually not what clinicians think it is. Jason Schroder, an anesthesiologist who spent years in the operating room with cardiac and lung patients before co-founding Craft Body Scan in Tulsa, Oklahoma, said, “The majority of the fatigue I saw, in myself and others, didn’t come from the hard calls. It came from the low-stakes decisions.”

Such as a workflow-disrupted medication update. An un-triaged page. A rigid documentation template that doesn’t fit a complex patient. These micro-decisions accumulate invisibly throughout the day, never resolved cleanly enough to release.

“The accumulation is never named,” Schroder said, “until it surfaces as exhaustion or detachment.” By that point, the clinician isn’t just tired. Their brain has been quietly degraded by a thousand small demands that clinical training never prepared them to manage, because clinical training is built around the hard calls, not the administrative noise surrounding them.

Why Agency Matters More Than Hours

The clinicians who hold up best over time aren’t working less. They’ve found a way to reclaim a different kind of control. Not over how many hours they have, but over where their attention goes inside those hours.

Schroder describes it this way: “The feeling of control over your time has almost nothing to do with the number of hours you have and everything to do with the number of decisions the system takes away from you.”

Schroder began blocking nonclinical work into fixed windows instead of letting it bleed into patient time. His total hours didn’t change, but he improved “attention integrity,” the ability to be fully present in a clinical moment instead of being present while also managing a queue with no assigned end.

“Before the separation, some part of my attention was always on unfinished administrative work that had no place to land,” he said. “The drain was bigger than I registered until it stopped.”

The research is specific about why control matters more than hours. A 2024 study published in Annals of Internal Medicine, co-authored by Christine Sinsky at the American Medical Association, Chicago, and colleagues at multiple institutions, found that poor control over workload was associated with nearly four times higher odds of burnout than adequate control. Physicians who reported adequate control over their schedules had burnout rates close to half those of physicians who reported inadequate control, even after adjusting for hours worked and specialty. The variable was agency — specifically, how much control they had over how they did their work.

That finding helps explain what Lee observed at Kaiser Permanente when her organization rolled out ambient AI scribes to reduce documentation burden. The goal was never to squeeze more patients into the time saved but to focus more on patient care, she said. 

The result: Physicians didn’t just save time. They felt less scattered. “These tools reduce total documentation and inbox time and therefore help physicians feel less cognitively fragmented and better supported,” Lee said. What Schroder describes as “attention integrity” turns out to be something technology can help restore, not just something individuals have to will into existence.

“Temporal autonomy doesn’t mean owning your time,” said Fedonenko. “It means making the conscious decision of where your full attention goes and where full attention is not necessary.”

At her practice, patient appointments are grouped in a specific order each day, a small structural choice that removes much of the mental friction from constant reprioritizing. “Autonomy isn’t having more hours,” she adds. “It’s not allowing another person’s sense of urgency to routinely override your own clinical judgment.”

For Subaila Zia, MD, pulmonary and sleep medicine physician who now runs a telemedicine startup in Silicon Valley, the hardest version of this shift has been learning to leave the to-do list unfinished. “I realized there will be days when I simply do not get to everything,” she said. “Learning to live with that instead of being consumed by it was unnerving at first. I am getting used to it now.” The expectation that physicians should be infinitely available and infinitely productive while being paid less and supported less, Zia said, “is not a time-management problem. It is a cultural and structural one.”

Beth Colson, LCSW, social worker and psychotherapist in Santa Fe, New Mexico, frames it most simply. “My increased focus on ‘the time’ — or lack thereof — has only worked to reduce my level of functioning, not enhance it,” she said. “The way I best work is with genuine focus on the moment I am in and on the person in front of me.”

There’s a neurologic reason that framing works. When attention is divided by competing demands the brain has yet to resolve, the default mode network stays active, cycling through what’s incomplete. Present-moment focus quiets that network. A 2023 meta-analysis of 111 randomized controlled trials found that mindfulness-based interventions, which center on redirecting attention to the present moment, produced measurable improvements in working memory and executive attention.

What Colson arrived at through experience, neuroscience has since confirmed: Attention given fully to one thing is less draining than attention split across many.

She spent years in community mental health trying to fit in one more client, one more task. Turning 60 changed something, Colson said, not because she suddenly had more time but because she finally stopped pretending she could outrun the scarcity. “Somehow this realization helped me find more freedom with time itself.”

Tactical Recovery

The simplest intervention might be physiologic. Nina Bausek, PhD, researcher who collaborated with the Mayo Clinic, Rochester, Minnesota, during COVID on a pilot study of healthcare provider stress, found that five intentional breaths between patients, just five, produced measurable results. Combined with 4 weeks of daily respiratory muscle training using a handheld resistance device, the intervention led to an 18% reduction in stress among participating providers.

“While we can’t control any aspect of the autonomic nervous system directly, breathing is the only entry point to regulate it,” Bausek said. “We are retraining our body and mind every time we apply these techniques.” (Bausek serves as an independent chief scientist for PN Medical, the manufacturer of the breathing device used in the study.)

For Aleksey Aronov, AGPCNP-BC, nurse practitioner with almost two decades of experience at Mount Sinai Hospital, New York City, the counterintuitive discovery was that spending more time with certain patients, not less, was what kept him going. He made a habit of lingering with patients in remission, asking about their lives beyond their diagnosis. 

“I did this because it is always uplifting to see patients do well, especially in the field of oncology, where we do not always have favorable outcomes,” he said. “Getting to know my patients who are in remission on a deeper level allows me to really feel the joy of bringing cancer care to my patients, and this gives me the fuel for the future.”

That instinct has now been formalized at NYU Langone Health, New York City, where a prompt called “About Me” is built directly into the electronic health record. Before or during a hospital stay, patients are invited to share something personal about themselves — like a hobby, a life milestone, or something they’re looking forward to — and that information becomes visible to every clinician on their care team.

“About Me was conceived originally to improve the patient experience,” said Katherine Hochman, MD, MBA, director of the Division of Hospital Medicine at NYU Grossman School of Medicine, New York City. “What we’ve discovered is that not only do patients love it, but clinicians and staff do too. We make connections and come to recognize our own humanity. So it’s become a quick, effective, and sustainable way to improve the joy of practice.”

Hochman’s mantra, “slow down to speed up,” sounds paradoxical in a system defined by time scarcity. But the logic is straightforward. When a clinician knows that a patient with cancer is trying to make it to his daughter’s wedding, or that they’re treating a chef who can’t wait to get back into the kitchen, something shifts.

“I am drawn into someone’s life and feel the gravity of the moment,” she said. “The transition into the medical workup, the plan, the prognosis — it’s butter. We’ve already established that we are on the same page.” In many units, over 90% of patients now have their About Me information completed.

Treating the System Like Weather

Fedonenko has spent nearly three decades watching colleagues burn out and figuring out why. “The clinicians I’ve witnessed becoming burned out weren’t the busiest ones,” she said. “They were the ones still expecting the system to correct itself.”

That’s not a counsel of despair. It’s a diagnosis. 

It points toward something that’s actually within reach: a new relationship with the gap between what the work demands and what is humanly possible. The gap is real. It always was. What changes, for the clinicians who find their footing, is that they stop experiencing the gap as a personal failure and start experiencing it as the weather. You prepare for it. You work within it. You stop waiting for it to clear.

None of this solves the structural problem. Zia is right: the expectation that physicians should be infinitely available, infinitely resilient, and infinitely productive inside a system that supports them less every year is not a time-management problem. It’s a cultural and structural one. That conversation needs to keep happening, loudly, at every level.

But while it does, there are still patients in the waiting room and notes to be signed. And for the clinician sitting with those facts, maybe the most useful thing isn’t a new system. Maybe it’s permission — real, evidence-grounded, colleague-tested permission — to stop outrunning the clock.

It was never a race you were going to win. That’s not a failure. That’s the job.