Story by Ellie Kollme
Dr. Amir Barzin, a family medicine physician and the chief operating officer at UNC Health, starts each morning with a solitary run to clear his mind before the day begins. The routine, he said, helps him manage the daily pressures of working in health care, pressures that many physicians across the country continue to face.
His approach reflects a growing awareness among medical professionals of the mental and emotional toll their work can take. Physicians like Barzin often operate in high-stress environments, responsible for patients during their most critical moments. These demands can contribute to widespread issues such as burnout and depression.
A 2025 Wellbeing Survey by the Physicians Foundation found that out of more than 1,000 U.S. physicians, 55% reported debilitating stress and 46% said they withdrew from family and friends. The foundation said that burnout is associated with poor mental and physical health, and that 54% of physicians reported experiencing it.
The effects of burnout reach beyond physicians themselves. These harms are tied to patient safety and satisfaction, with direct consequences for patient care and health care outcomes.
“You can make errors in finance and what happens is people lose their money,” said Dr. Theodore Stamatakos, a urologist based in Charlotte who has been practicing for 31 years. “But when you make errors, and I’m talking about major errors in medicine, people lose their lives or people suffer.”
Burnout and moral injury
According to the National Library of Medicine, burnout is a work-related stress syndrome resulting from chronic exposure to job stress. The National Institute for Health Care Management (NIHCM) identifies three components of burnout: emotional exhaustion, which can lead to irritability; cynicism, which replaces empathy with negativity and emotional numbness; and a low level of professional effectiveness.
Dr. James Romanowski, an orthopaedic surgeon specializing in sports medicine in Charlotte, said he has seen these symptoms appear through gradual changes in physicians’ attitudes.
“They get grumpier, they get snappy, they’re less connected, they’re less engaged,” Romanowski said. “The signs aren’t obvious, but they’re there.”
Similarly, Dr. Robert Seymour, an anesthesiologist in Raleigh, said physicians can become callous, have less empathy for patients and avoid participating in community events at the hospital.
“They just kind of tune out and say, ‘I’m going to show out and do my job and that’s going to be it,’” Seymour said. “It is unfortunate because a lot of times, these people are the ones that have a whole lot to give and are very talented and skilled physicians.”
Many physicians experience moral injury, the top cause of physician burnout, according to NIHCM. It occurs when physicians know the right course of action for a patient but are unable to carry it out, or when they witness events that contradict their moral beliefs or expectations.
The experience can lead to guilt, shame, a sense of betrayal, sadness and a loss of confidence, and is associated with symptoms of depression and post-traumatic stress disorder. Other contributing factors include too many bureaucratic tasks, long hours and lack of respect from other staff.
The emotional cost of care
For many physicians, moral injury stems from the emotional burden of their work. Stamatakos said it can occur when doctors expect to help a patient but cannot achieve the desired outcome.
Sindhuja Damodaran, a UNC-Chapel Hill senior from Charlotte, shadowed various doctors around the Triangle this summer to gain insight into the different roles’ doctors play in health care and how different conditions receive different types of treatment. An environmental health science major at the Gillings School of Global Public Health, Damodaran hopes to go to medical school after graduation.
One of her biggest takeaways from shadowing health care providers, Damodaran said, was that despite doctors’ best efforts, they cannot always achieve their goals.
“All these people work really hard and try very hard,” she said. “This is basically their entire life, and sometimes it just doesn’t work, and I think that can be very disheartening.”
Romanowski said that as an orthopaedic surgeon, it can be difficult when there’s nothing more he can do for a patient, as his role as a subspecialist often means he’s the final stop in their care journey.
“They’re coming to me hoping that something can be done,” Romanowski said. “And I’m not a miracle worker, but I feel like I can help a lot of people. But the ones that I can’t help, they weigh on you. Despite all my training and all my years, that sometimes I have to tell people, ‘This is what it is.’”
He added that it’s the people he couldn’t help who have had a lasting impact.
“You don’t remember all the people you helped; you remember the ones that you couldn’t help,” Romanowski said. “And that’s just human nature. We just remember the bad stuff and don’t focus on the good. That can be stressful too.”
The administrative burden
In addition to emotional strain, many physicians point to administrative challenges as a major driver of burnout. A 2024 study by Google Cloud and The Harris Poll showed that administrative work decreases job satisfaction and impacts patient care, as clinicians reported spending about 28 hours per week on administrative tasks like documentation and communication. The study found that administrative work contributes to feelings of burnout for 82% of clinicians and 81% of medical staff.
Romanowski said medical school did not teach him much about the administrative or financial aspects of medicine, which he encountered only after entering the workforce. Barzin agreed, adding that few doctors pursue the profession for those parts of the job.
“If you’re thinking about what allures you to medicine, no one ever says, ‘I’m really excited about going to work and arguing with insurance companies about a prior authorization,’” Barzin said. “What excites them and gets them really happy about going to work is providing care for the patients.”
He said many physicians experience burnout due in part to administrative responsibilities, such as obtaining insurance approvals or coordinating with hospital systems to ensure patients receive necessary procedures or medications.
Romanowski said the financial side of heath care can be difficult to overlook, as administrators are focused on bringing in revenue.
“The more efficient you are, the more revenue you bring in,” Romanowski said. “But the price to pay is your ability to deliver high-quality care.”
The influence on patients and coworkers
As burnout intensifies, its effects extend beyond individual doctors. In roles that require frequent patient evaluations and multiple diagnoses, burnout can affect both staff well-being and patient safety.
“If the provider is burnt out, not thinking clearly because they’re so out of it, I would not want that,” Damodaran said. “It’s scary, especially if you’re in a vulnerable position where you have a super-serious condition. It takes away from the provider being able to give proper health care advice.”
Barzin said doctors must be on their game all the time because they are making decisions about human lives.
“It boils down to the fact that there is a lot of personal ownership of doing the right thing, making the right decisions, making sure that everyone is tended to,” he said. “We have to be very, very good about making sure that the decisions we’re making are sound.”
He said that when physicians are not performing at their best, patients notice and can lose trust in the physicians and in the overarching health care system.
“The impact of you not being on your game is really important for society as a whole,” he said. “The second we lose trust in medicine and the way that we provide care for patients, that’s the second our society sees worse outcomes from health care.”
Connection and camaraderie
Aside from burnout influencing decision-making, it also interferes with physicians’ efforts to connect with others. Romanowski said the physician-patient relationship is special and is essential to care quality and outcomes.
“They’ll feel like you care, they’ll feel like you’ve connected and more importantly, they’ll believe in your treatment plan,” Romanowski said.
Seymour said that a physician’s attitude can heavily influence the limited interactions they have with patients.
“They’re coming to see you for two or three hours of their life, and you’re probably never going to see them again,” Seymour said. “You want that to be as good for them as it can be, but if you’re preoccupied, if you’re stressed, if you’re tired, if you’re worried about something, that will carry over into those interactions with your patients in a very negative way.”
Barzin said teamwork in hospitals is equally important, as collaboration fosters trust and a shared purpose.
“You have to show humility and let everyone speak and have their voice heard so you can do what you’re there to do, which is provide the best care possible for patients,” he said. “That’s very important, so because of that, there’s this tight, connected weave in how we interact at work.”
Stamatakos said mistakes in medicine are inevitable, but that weakness is looked down upon. He said the culture needs to change and that health care workers need to be more supportive of each other.
“When somebody makes a mistake, they don’t go out of their way to help him and tap on the shoulder and say, ‘Hey, tomorrow’s gonna be a better day,’” Stamatakos said. “There’s not as much camaraderie as there should be.”
Emerging resources
To address these issues, hospitals are beginning to address burnout more systematically across institutions. At the UNC School of Medicine, Barzin said physicians have access to a peer mentoring program and the Taking Care of Our Own program, which promotes well-being.
At Novant Health, where Romanowski practices, the American Medical Association recognized the organization in 2023 as a Joy in Medicine health system for its commitment to physician wellness. Novant also launched the Leadership Development Program in 2013 to help remove barriers to professional fulfilment.
Nationally, the American College of Physicians offers online resources focused on wellness and burnout prevention.
As burnout continues to affect physicians and the systems that rely on them, the issue remains a pressing concern within the medical community. While new programs and increased awareness represent progress, many physicians acknowledge that there is still a long way to go. Future improvements in medicine, they say, depend not only on the quality of care patients receive, but the extent to which the system supports the well-being of those who provide it.
Coping and resilience
Even though systematic resources are being implemented to avoid harmful interactions with patients, coworkers and prevent burnout itself, physicians have developed further personal coping strategies, specifically by focusing on what is important to them.
“If you can focus on those key things, then the rest is just noise,” Romanowski said. “Not everything’s gonna go your way. I think you have to have some resilience on the inside for this.”
Seymour said compartmentalization is essential to maintaining balance between work and home.
“If you let it consume you, you will always find something to take your time, take your attention, away from the things that are really important in life, like your spouse or your family,” Seymour said.
While balance is important, Stamatakos said when you’re called to take care of a sick patient, “you gotta go.” He said he missed some of his daughter’s dance competitions because of his responsibilities as a physician.
“That’s your priority,” Stamatakos said. “You kind of accept it.”
Seymour said he practices “detached concern,” but that there are still events at work that stop him “in his tracks.” He said the most mentally taxing cases have been from child organ donors, because the children have no visible damage and look “completely normal.”
“It is so difficult looking down at these kids, perfectly sleeping, angelic,” he said. “The only way to cope is to keep remembering that there are other kids waiting for these organs who would die without a transplant, but it is very hard to do.”
The coping mechanism of compartmentalization is not only important for difficult situations but also for difficult conversations. Damodaran said that when she shadowed an oncologist, breaking difficult news seemed like a major burden.
“I didn’t want to go to the last case that I was there for because they were going to tell the person that he was dying,” she said. “He was super young and his girlfriend was there, his mom was there, his entire family was there and they were obviously hoping for a semblance of good news. He was getting told he wasn’t probably going to have much longer.”
She said that the doctor seemed angry when delivering the news.
“I think it’s something that’s going to dwell,” she said. “He just kept shaking his head, upset.”
The rewarding aspects of medicine
Despite the challenges, each physician said they do not regret going into medicine.
“I don’t think that a single doctor or a nurse walks into the job saying that they’re doing it because they want to receive praise,” Barzin said. “We genuinely love the aspects of providing care.”
He said he still receives birthday cards for himself and his children from a patient he has taken care of for over 13 years, a reminder of the meaningful work he has done.
Stamatakos said the profession is rewarding because it allows him to play a role in people’s lives and gain insight that few other jobs offer.
“Who’s there when you’re born?” Stamatakos said. “A doctor’s there when you’re born. Who’s there when you die? Usually a doctor. And who’s there when you most critically need them, at least from a psychological or physical point of view? A physician.”
Stories from the UNC Media Hub are written by senior students from various concentrations in the Hussman School of Journalism and Media working together to find, produce and market unique stories — all designed to capture multiple angles and perspectives from across North Carolina.
