The Risk of Staying Safe: Why Physicians Must Embrace Change

Since I became a doctor a decade ago, the landscape of healthcare has remained frustratingly stagnant.

Few people today have a primary care physician. Those who do often wait months for an appointment that lasts a mere 10 to 15 minutes. Afterward, they're left grappling with unresolved questions: How do I choose the right health insurance plan? How can I overcome depression without resorting to a cocktail of medications, each with its own side effects?

If you want to discuss nutrition, where do you turn? Certainly not your doctor, who likely spent just a day on the subject in medical school—a day considered a "free pass" since it never appeared on exams. What if you're exploring unconventional treatments like fasting, psychedelics, peptides, or early cancer screening? The system offers little guidance.

Pajama Time → Unprecedented Burnout

Today, 50% of physicians are burned out, with women and primary care doctors—the bedrock of our medical system—being the most affected [1].

Among physician communities, the chief complaints stem from administrative burdens that inflate workloads.

What are these tasks consuming our so-called "pajama time?" They're the notes we finish, the patient messages we answer, the lab and imaging reports we review—all tasks that, in any other profession, would be completed during compensated work hours. Yet for doctors, this work goes unpaid because health systems argue it's necessary for our clinical work to even count.

In essence, we're working more hours, spending less time with patients, and often earning less money.

At a recent physician conference, we reached a sobering consensus: the smartest doctors no longer practice full-time clinical medicine. The diminishing returns of relentless work erode not just our emotional well-being but also the value we place on the money we earn.

But What About AI?

Yes, documentation has become easier with the adoption of AI-enabled software. It helps—to a point. That is, until your employer decides to add more patient visits to fill any time you've saved.

Burnout aside, there's another issue: practicing medicine more efficiently with AI doesn't change the kind of medicine we practice. It just makes it marginally more efficient.

Our medical guidelines are woefully outdated. Take the Framingham Risk Score, which still guides the American College of Cardiology and the American Heart Association's guidelines for cardiovascular risk assessment. The original Framingham cohort was predominantly white and middle-aged, limiting the score's applicability to other ethnic groups and older adults. For example, it underestimates coronary heart disease risk in older adults, especially women [2].

Moreover, the Framingham Risk Score omits several crucial risk factors we know are essential, such as family history, high-sensitivity C-reactive protein (hsCRP), physical activity, and body mass index (BMI—which is itself an oversimplified metric). This leads to incomplete risk assessments.

Furthermore, the score focuses on a 10-year risk horizon, which may not adequately capture the lifetime risk of cardiovascular disease, particularly in younger individuals who may have a low 10-year risk but a high lifetime risk [3].

Perhaps AI-driven data synthesis will eventually prompt necessary changes in guidelines. But for now, these guidelines are crafted behind closed doors by a handful of experts whose incentives often discourage them from challenging the status quo.

What Is a Doctor to Do?

We're caught in a catch-22. Doctors today are gridlocked, trying to appease employers, colleagues, and payers by ticking the requisite boxes for care—a survival tactic driven by a deeply ingrained sense of self-preservation.

If a doctor orders additional preventive screenings, they not only have to customize their electronic health record workflows but also train colleagues and staff to handle the influx of unfamiliar data. If they invest time educating themselves and their patients on evidence-based lifestyle changes—how to eat, sleep, and exercise better—they're seen as "wasting" valuable time on tasks deemed below the "top of their license."

Most troubling of all, introducing new interventions is often viewed as "dangerous." Whether it's a new supplement, psychedelic-assisted therapy, or off-label use of a medication, such practices are met with suspicion and can lead to professional ostracization.

A Way Out

I recognized these conflicts early in my medical career, and my conclusion then, as now, is the same: the only way out is to exit the system.

By adhering to the rules of insurance-driven care, doctors relinquish control to non-clinical insurance administrators. By conforming to the demands of sprawling health systems, we become cogs in machines so vast and complex that no clinician, not even those in leadership, can hope to enact meaningful change.

More doctors than ever are reaching out to me, curious about how I've forged a career outside traditional medicine. Our backs are breaking under the weight of the conventional system, and our passion for our work is evaporating.

The answer is both simple and challenging: let go of what you perceive as safe. "The greatest risk, in a life full of change, is to take no risk at all." This quote, attributed to figures like Mark Zuckerberg and Patrick Warburton, offers wisdom rarely heeded by the inherently risk-averse medical community.

So Many Options, None Easy

There are avenues for physicians eager to make an impact without abandoning their craft entirely. Many of my inspiring classmates from Stanford have become consultants, finance analysts, and startup founders. I myself run a longevity practice, am building a new startup venture, and advise several others.

Yet when I speak with colleagues, most remain hesitant, even fearful of taking the leap. Golden handcuffs, isolation from professional support networks, and the daunting task of building a business—skills we were never taught in medical school—intimidate even the most brilliant among us.

I don't have an easy answer. None of these paths are easy. But the challenge is worth embracing because we entered this field to care for people's health. Even with the advent of AI, it's the human element that guides the direction of care.

Transforming healthcare requires more than incremental adjustments within a flawed system—it demands bold action from those willing to envision and create a better future. Physicians have the unique power to reshape the landscape of medicine, but this necessitates stepping beyond the comfort of tradition and embracing innovation.

It's time for doctors to reclaim our autonomy, reignite our passion, and redefine what it means to truly heal. By overcoming the fear of the unknown and daring to take risks, we can forge a new path—one that honors our commitment to patients, fosters genuine wellness, and restores the art of medicine to its rightful place at the heart of healthcare.

References

1. Ortega MV, Hidrue MK, Lehrhoff SR, et al. Patterns in Physician Burnout in a Stable-Linked Cohort. JAMA Netw Open. 2023;6(10):e2336745. doi:10.1001/jamanetworkopen.2023.36745
2. Rodondi N, Locatelli I, Aujesky D, et al. Framingham risk score and alternatives for prediction of coronary heart disease in older adults. PLoS One. 2012;7(3):e34287. doi:10.1371/journal.pone.0034287
3. Berry JD, Lloyd-Jones DM, Garside DB, Greenland P. Framingham risk score and prediction of coronary heart disease death in young men. Am Heart J. 2007 Jul;154(1):80-6. doi: 10.1016/j.ahj.2007.03.042. PMID: 17584558; PMCID: PMC2279177.

‍