Physician Burnout: Caring for Patients in a Crowded Cockpit Leads to Moral Distress

Imagine if a commercial pilot, after years of training and thousands of hours in the cockpit, had to call her airline operations manager with no flight credentials to ask his permission to change course around a storm. Imagine if the operations manager could delay the pilot’s decision, ask for more paperwork, then insist the pilot fly through the storm. Imagine if the pilot’s only recourse was to ask for a review by another pilot employed by the same airline, all while she remained responsible for everyone on board the flight. As a pilot, would you feel satisfied flying for that airline?

The comparison seems ridiculous, of course, but is it? In medicine, clinicians are routinely asked to justify necessary care to people who do not hold the same training, do not know the patient the same way, and do not bear the same responsibility for the outcome. And for most physicians, that kind of interference is no longer occasional. It is built into the work. 

Physicians are dealing not only with constant second-guessing, but also with chronic overwork. Patient visits end, but the day does not. The inbox is still full. Notes still need to be closed. Prior authorizations are holding up care. Denials need to be appealed. A 2023 study of primary care physicians shows clinicians spent a median of 36.2 minutes in the EHR for each visit, including 7.8 minutes on the inbox and 6.2 minutes of after-hours “pajama” time (spent between 5:30 pm and 7:00 am or on weekends). [i] While pajama time may sound cozy, after-hours administrative work is likely not what physicians had in mind when they chose a career in primary medicine.

The problem, unfortunately, runs much deeper than independence and work-life boundaries. A 2026 study found that 39.1% of physicians reported a high level of moral distress in their practice. [ii] The study concluded that moral distress was common among physicians and experienced at higher rates than the general US working population. Among physicians with high moral distress, 75.1% had burnout symptoms, compared with 30.7% of physicians with lower moral distress. They were also far more likely to say they intended to leave practice within 24 months—34.5% versus 18.2%. If moral distress continues to drive physicians away, the consequences will be felt far beyond the individual clinician, in the strength and reliability of the health care system itself.

The same 2026 study notes that moral distress can arise when physicians feel unable to do what they believe is right for patients because of problems with reimbursement. Prior authorization is one of the clearest examples. In the AMA’s 2024 prior authorization survey, practices reported completing 39 prior authorization requests per physician per week, with physicians and staff spending an average of 13 hours each week on that work. [iii] The same survey found that 93% of physicians reported care delays related to prior authorization, 82% said it can at least sometimes lead to treatment abandonment, 89% said it somewhat or significantly increases physician burnout, and 29% said it had led to a serious adverse event for a patient in their care. Is it any wonder physicians feel moral distress? Prior authorization forces physicians to navigate a system in which financial control takes precedence over their clinical judgment and the well-being of their patients.

The encouraging news is that the research points to practical system changes that help. In that same EHR study, greater team contribution to orders and the presence of a pharmacy technician were associated with lower total EHR time, lower after-hours time, and lower inbox time. In other words, burnout can be shaped by workflow and staffing. That is why physician burnout should not be treated as a wellness issue. It certainly impacts wellness, but it is a payer issue, a workflow issue, and a leadership issue. Clinicians need operational relief, not more lectures about resilience. 

That is where Mansfield Primary Care Support can help. Mansfield is built around a simple idea: many of the forces driving physician burnout are real, deeply felt, and more fixable than they seem. That does not mean physician burnout has one cause or one solution. It does not. But many of its strongest drivers are not mysterious. They are administrative. They are operational. They are strategic. And they should not be left on clinicians’ shoulders alone. Mansfield cannot remove every pressure from modern practice, but it can help practices clear some runway, steady the cockpit, and make it easier for physicians to spend more of their time where they always wanted to be: caring for patients.

[I] https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2812258

[ii] https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2846921

[iii] https://www.ama-assn.org/practice-management/prior-authorization/fixing-prior-auth-nearly-40-prior-authorizations-week-way