Health professionals — who have the most knowledge about prevention, healthy habits, diagnosis and treatment — show worse health than the general population. Endless shifts, overnight on-call duty and constant pressure at work, among other factors, have transformed medical practice into an environment that deteriorates the health of those who practice it. This paradox shows that knowledge does not always translate into action, and that those who should heal others can end up ill because of the system they support. And if the system makes doctors sick, who will heal the patient?

Physicians’ Chronic Burden

Chronic conditions are relatively common among physicians and affect various aspects of their quality of life. According to the study “Prevalence of chronic diseases and associated factors among physicians working in Gaziantep, Turkey,” nearly 23% of physicians have some chronic disease, with a small difference by sex: 25% in men vs 20% in women. By specialty, prevalence varies notably: 17% in residents, 22% in general practitioners, and up to 46% in hospital specialties.

The most common conditions were hypertension and thyroid disorders (both at 6%). Other frequent problems include hypercholesterolemia, diabetes, and obesity, more common in men, whereas thyroid disorders predominate in women. In addition, physicians with chronic diseases tend to be older, specialists or married, suggesting that the combination of age, experience, and responsibilities increases vulnerability.

The study also highlights that physicians often have unhealthy lifestyles, with low physical activity, unbalanced diets, and relatively frequent tobacco and alcohol use. Perceived stress levels were moderate to high, suggesting that workload contributes to poorer overall health.

Overweight and Obesity

More than 15% of the adult population in Spain has obesity, whereas nearly 40% have overweight, according to the latest Spanish National Health Survey (SNHS). Although large-scale studies comparing obesity in physicians with the general population are lacking, the study “Variables associated with overweight and obesity in Spanish healthcare workers,” which analyzed nearly 45,000 health workers in Spain, found that more than half of the physicians have overweight, and about 1 in 7 have obesity (15%). The same study found that more than 38% of midwives had overweight and more than 15% had obesity. Among nurses, more than 24% had overweight, and nearly 10% had obesity.

Shift work and lack of sleep are indirect contributors to overweight and obesity among health professionals, acting through poor sleep quality, fatigue, and irregular eating habits, according to the study “Poor sleep quality and overweight/obesity in healthcare professionals: a cross-sectional study.” Irregular schedules and night shifts disrupt circadian rhythms, causing hormonal dysregulation, increased cortisol and insulin resistance, which favor fat accumulation.

The study “Circadian disruption, clock genes, and metabolic health” notes that circadian rhythm disruption is an important risk factor for metabolic health. Evidence from animal and human research suggests that core circadian genes such as CLOCK, BMAL1, PER, and CRY, along with hundreds of downstream circadian output genes, regulate cellular metabolism. Dysregulation of these circadian mechanisms can contribute to obesity, metabolic syndrome, and type 2 diabetes, providing plausible pathophysiologic pathways linking disrupted sleep rhythms to poor metabolic health.

Finally, “Shift work and the risk for metabolic syndrome among healthcare workers: A systematic review and meta-analysis” supports an association between shift work and higher risk for metabolic syndrome in health professionals. The review found that shift workers have more than twice the likelihood of metabolic syndrome compared with day workers. The authors link this increased risk to biological and environmental changes driven by shift schedules that affect cardiovascular risk factors such as insulin resistance, obesity, dyslipidemia, and hypertension.

Physicians’ physical health is not only an individual matter but also can influence the quality of care they provide to patients with weight problems and shape their attitudes toward promoting healthy behaviors. The study “Impact of physician BMI on obesity care and beliefs” examines how physicians’ BMI affects clinical practice and beliefs about managing patients with excess weight. Physicians with normal BMI were more likely to initiate conversations about weight loss, diet, and exercise with patients. Conversely, physicians with overweight or obesity were less likely to intervene in weight management, suggesting that a clinician’s BMI can influence preventive and educational practice.

An Obesogenic Environment in Hospitals

In December 2025, Spain’s minister of Social Rights, Pablo Bustinduy, Consumer Affairs and Agenda 2030 announced the details of a royal decree to guarantee healthy food in hospitals and care homes. The decree aims to promote healthier and more environmentally sustainable hospital food by setting minimum nutritional and sustainability standards, limiting ultraprocessed foods and fried items on menus, and requiring that at least 80% of vending-machine products be healthy and not placed in the most visible slots. This follows the April 2025 Royal Decree on Healthy and Sustainable School canteens.

Patricio Pérez-Armijo , PhD, a dietitian-nutritionist who teaches and conducts research at Isabel I University, Burgos, Spain, welcomes the progress being made in state regulations that guarantee healthy, safe food adapted to the needs of patients and older people in hospitals and nursing homes.

High Levels of Stress and Exhaustion

Medical unions have been vocal in protests and strikes during 2025 and into 2026, calling attention to working conditions that affect clinicians’ health — long shifts, on-call duty of up to 24 hours and excessive workloads — which contribute to high levels of stress and professional exhaustion (burnout). These conditions are linked to negative outcomes such as chronic fatigue, deteriorating mental health and reduced quality of life.

The Confederation of Spanish Medical Unions (CESM) says the current draft of the national statutory framework (Estatuto Marco) does not improve or protect the specific conditions of physicians and even retains elements that harm their health.

Víctor Pedrera , CESM’s general secretary, summarized the group’s main demands: “That physicians have the same right as any health worker to a 35-hour workweek; that on-call duty or overtime required to guarantee 24-hour coverage be considered voluntary extra work, paid above the regular hourly rate and counted as actual worked time.” Pedrera stressed that current physician schedules harm health, causing “weariness, burnout and increased pathologies, especially in mental health.” Data from the Comprehensive Care Program for Sick Physicians (PAIME) show alarming increases in mental health disorders and suicide risk, he said.

Mental Health and Burnout

The PAIME, an initiative of the General Council of Official Medical Colleges (CGCOM),provides care and treatment for physicians and medical students with physical illness, mental health problems or addictions. Its goal is to prevent health deterioration among physicians, facilitate recovery and protect patient safety by promoting a safe return to work.

Physicians with mental health problems in Spain are increasingly younger and are predominantly women, according to the latest PAIME 2023 report. Mental disorder is the main reason for admission in 84.9% of cases, while addictions account for nearly 8.6%. Alcohol abuse represents 5.6% and drugs use 3%, including benzodiazepines, zolpidem, cannabis, cocaine, and polysubstance use.

In addition, the suicide rate among physicians is higher than in the general population, averaging 1.3% vs 0.8%, according to the Mortality Study of the Medical Profession from CGCOM. The same report notes that female physicians have a suicide rate 7.5% higher than that of women in the general population.

Burnout affects one in four physicians in Spain, according to the SNHS systematic review and meta‑analysis “Prevalence of burnout syndrome in physicians working in Spain.” Among young physicians, the 2025 IKERBURN study found that 93.9% of respondents had symptoms of burnout in at least one dimension (emotional exhaustion, depersonalization, or low personal accomplishment). Some 81.4% met criteria in two dimensions and 50.9% in all three, constituting full burnout. These figures put the problem at critical levels and show it is not isolated but widespread across the profession.

“If there is one sector where burnout is not the exception but the rule — to the point of becoming a silent epidemic — it is healthcare: burned‑out physicians,nurses pushed to the limit, and all other health personnel follow. Everyone is unwell: endless on-call duty, rotating shifts, unrelenting emergency work and a constant emotional burden,” said Carlos Cenalmor , a psychiatrist and psychotherapist who specializes in stress management and burnout recovery.

And the most worrying thing “is that we have become accustomed to living on high alert. To surviving with minimal rest. To putting ourselves on autopilot so as not to feel so much. But healthcare burnout is not just a matter of tiredness, it is a real risk to physical, mental health, and to the quality of care provided,” he added.

Cenalmor moved to a village in Pyrenees of Huesca (located in northeast Spain) after years practicing medicine in Madrid. He said he experienced firsthand the stress and burnout he now helps others resolve.

The ‘Superhero’ Syndrome and Stigma

Another syndrome worth noting is the “superhero” mentality in medicine: the belief that clinicians must be able to do it all, must not get sick, must not fail, and must place work above their own health. This attitude is rooted in traditional medical culture, marked by values such as endurance, sacrifice, and stoicism, reinforced during training through extreme hours and normalization of physical and emotional suffering as part of learning and practice.

Coupled with a strong moral responsibility toward patients, this leads many physicians to prioritize others over themselves and to conform to social expectations of being strong, stable, and available — attitudes incompatible with showing vulnerability or asking for help.

The study “Superheroes? No, thanks. Accepting vulnerability in healthcare professionals” finds that this hero culture creates strong stigma against vulnerability: showing fatigue, emotional distress, or requesting help can be seen as weakness. As a result, many health professionals hide their suffering and face it alone, increasing the risk for burnout, moral distress, and mental health problems.

The Paradox of Adherence

Chronic stress and burnout affect self-care practices. Paradoxically, health professionals tend to self-medicate, have poor therapeutic adherence and sometimes choose treatments different from those they recommend to patients.

A study of 438 health professionals in Spain found self-medication is common, with a prevalence of 59.4% among respondents. Among health workers, physicians self-medicate most frequently (81.3%), exceeding other professions such as nursing (65%). Self-medication is typically occasional, and most people take one to three medications per week, most commonly analgesics and anti-inflammatories. Self-medication is more common in older professionals, suggesting that experience or professional confidence influences this practice. Professional knowledge was also associated: those who knew more about dosages and effects tended to self-medicate more.

A Swedish study shows physicians and their families adhere to clinical guidelines less often than the general population despite their expertise. For example, they may choose broader‑spectrum antibiotics for themselves or take drugs that guidelines advise against during pregnancy, prioritizing what they consider best for themselves over recommendations designed for the public. This behavior reflects a conflict between what is optimal for society and what clinicians view as optimal for themselves.

The Doctor-Patient Relationship Suffers

The “patient first” ethic — a core medical principle — has often been interpreted rigidly and in an unbalanced way, sometimes obscuring the clinician’s own needs. Under this logic, physician well‑being is relegated to a lower priority, as if self‑care were incompatible with good patient care. Yet evidence shows that exhausted physicians working long hours with high stress not only suffer physical and mental health deterioration but are also at higher risk of clinical errors, provide lower‑quality care and experience worse doctor‑patient relationships.

Prioritizing the patient should not mean sacrificing the professional but rather recognizing that the safety and quality of care depend largely on caregivers having working conditions and support that allow them to fully exercise their profession.

We must keep in mind that if the system makes the doctor sick, the doctor cannot heal the patient. Restoring trust in medicine starts with healing health professionals, dispelling the myth of the infallible hero and replacing it with a culture that recognizes vulnerability as part of the human condition and of professional practice. Caring for physicians’ physical and mental health is not a concession or a privilege but an ethical responsibility and an investment in patient safety, quality of care, and the sustainability of the health system. Only when care becomes bidirectional — from physician to patient and from system to physician — will truly humane, safe, and committed medicine be possible.

This story was translated from El Médico Interactivo on Univadis, part of the Medscape Professional Network.