A physician builds something outside the system: a concierge practice, a direct-pay model, a course, a brand. Patients love it. Colleagues quietly envy it. Then she says something in public about her fees, her capacity, her exhaustion, and the internet decides she’s the villain of the week. Screenshots. Moral outrage about access. A defense that reads as tone-deaf no matter how she words it, and a chorus of quote-tweets from other clinicians who, of all people, should know exactly what it costs to build something from nothing. Or maybe they don’t because they have never even tried to think or work outside the box. But that doesn’t stop them from lobbing criticism from the sidelines.
Treating this as a messaging failure or branding misstep is not really accurate.
It’s the predictable output of a pipeline that selects for a very specific kind of person, trains her in a very specific way, runs her body on a schedule that’s physiologically hostile to human beings, and then lets her loose with zero instruction on how any of that interacts with an outrage economy.
Understand the whole pipeline and the reaction makes sense. Look only at the post and it doesn’t.
The Making of a Perfectionist
Medical school admissions doesn’t just filter for intelligence. It filters for personality. The traits that most consistently predict who gets in and who thrives are conscientiousness and what researchers call self-directedness: responsibility, industriousness, a low tolerance for imperfection. Here’s the catch the researchers themselves flag: there’s no validated “ideal doctor” personality, and selecting for the highest scores on these traits risks over-selecting for exactly the profile most vulnerable to perfectionism and burnout. One Australian study followed students through all four years of med school and found perfectionism, already elevated at baseline, kept climbing, while ambiguity tolerance, resilience, and sense of calling all declined and none of it was explained by the personality traits students walked in with. The authors’ conclusion was blunt: it’s the training culture doing this, not the student.
What Training Does to That Person
Then training gets hold of that person. Medical student mistreatment was compared to child abuse in the literature back in 1982, and the comparison still holds. More than 35 percent of U.S. medical students report mistreatment during school. A global meta-analysis puts trainee harassment at 59 percent. One landmark residency study found 89 percent of residents reporting at least one mistreatment episode, most often from senior residents and attendings. In other words, the hierarchy of abuse and tolerance reproduces itself, generation after generation. The consequences are demonstrable. Training-era bullying is linked to depression, anxiety, suicidal ideation, and a higher rate of medical error. Students show real resilience to the hard parts of medicine: suffering, death. They don’t show the same resilience to mistreatment by their own superiors.
The trauma is not the diseases we face and manage. It’s the people who were supposed to be teaching us.
A Body Running Against Its Own Clock
There’s also the schedule. Night and rotating shift work disrupt the circadian system in ways the body never fully adapts to, even after years of it. The research ties it to elevated cardiovascular disease, immune dysregulation, hormonal disruption, and a higher breast cancer risk. Cognitively: a night shift within three days of a mock resuscitation exam measurably degrades performance across the board. So the same people selected for conscientiousness, then shaped by a punitive hierarchy, spend years running on a nervous system medicine itself would flag as malfunctioning in anyone else.
The Wound Underneath the Burnout
There’s a wound underneath the burnout that researchers now give its own name. In 2018, surgeon Simon Talbot and psychiatrist Wendy Dean argued that a lot of what gets called physician burnout is actually moral injury, a term borrowed from research on combat veterans betrayed by their own leadership. Burnout is a depletion model: it implies the individual ran out of resilience. Moral injury is a betrayal model, the damage of repeatedly knowing what a patient needs and being prevented from providing it by forces outside your control, inflicted by the very institution that taught you to care in the first place. For a lot of physician founders, leaving the conventional system is an explicit attempt to stop the moral injury, not just escape burnout. So when she’s publicly accused of “profiting off patients” for building something outside insurance-based medicine, it doesn’t just sting. It reopens the exact wound this new venture was built to close.
Even in a good year, the baseline is rough. The AMA’s newest data puts physician burnout at 41.9 percent in 2025, down from the pandemic peak, but that’s still two in five doctors carrying a burnout symptom into every interaction they have. Medscape’s 2024 numbers show a persistent gender gap: 56 percent of women physicians report burnout versus 44 percent of men.
It’s Not Just the Public
Here’s the part that gets left out of sympathetic accounts of physician burnout: a lot of the hostility successful physicians face comes from other physicians. Researchers call it horizontal hostility, or “tall poppy syndrome”. This is the pattern where visible achievers get cut down by their own peers. One international study found 87.3 percent of professional women reporting being undermined by colleagues specifically because of their achievements. In medicine, a pilot study found 66 percent of U.S. trainees across specialties reporting at least one bullying behavior. Those reporting the highest rates of bullying? Women and non-white residents. The same profession that manufactures relentless perfectionists also manufactures a culture that punishes those perfectionists for standing out.
Then Add Social Media
Social media adds a final layer. A JAMA Internal Medicine study found 23.3 percent of physicians reporting personal attacks on social media, most often tied to public health advocacy. The gender split is stark: 16.4 percent of women physicians report online sexual harassment, versus 1.5 percent of men. Documented tactics include doxing, and contacting a physician’s employer or licensing board directly.
Putting It All Together
Put it all together and you get someone selected for perfectionism, trained by a hierarchy that punishes visible need, physically worn down by a circadian-hostile schedule, carrying moral injury rather than simple burnout, burned out at a higher rate than the general population, undermined by her own peers for succeeding, and then handed a public platform with no instruction manual. She sets a price. She states a boundary. She says what her work actually costs her. The response arrives dressed up as concern about access, but it functions exactly like the tall-poppy dynamics above.
What follows isn’t ego. It’s armor. She dons it for protection.
None of this puts physician founders beyond criticism. Legitimate questions about access and equity deserve their own conversation. But the reflexive over-explaining, the inability to just say “this is my business and I don’t owe anyone an itemized account of my worth” is not a personality flaw to coach away. It’s the predictable output of everything that happened to her before she ever posted the thing that went viral.
What Would Actually Help
If you work with one of these physicians, a few things actually help. Don’t mistake her perfectionism for a control problem that needs more oversight: more scrutiny reinforces the exact pattern that produces burnout, not the confidence that prevents it. Build the buffer against public hostility before it happens, not after. Given the reported harassment rates, assuming it’s coming isn’t paranoia, it’s proportionate. And ask whether what she’s carrying is exhaustion or betrayal before you prescribe a fix. Burnout responds, partially, to rest. Moral injury responds only to restored alignment between what she believes medicine should be and what she’s actually able to do. No amount of individual resilience training undoes a decade of selection and shaping. What actually helps is a structure around her that absorbs some of the hostility, so it doesn’t all land on one very tired, very conscientious person who was never taught it was allowed to land anywhere else.
Dr. Suzanne Gilberg is a board-certified OB/GYN, integrative medicine physician, Chief Clinical Officer at Monarch MD, and founder of the Menopause Boot Camp. She is the author of Menopause Bootcamp and the forthcoming Plant Medicine. Find her at @askdrsuzanne and @themenopausebootcamp.
Sources on request — this piece draws on research covering med school admissions and personality (BMC Medical Education, PLOS ONE), training mistreatment (NPR/Boatright 2020, Medical Education Online, PubMed 2005), circadian disruption (PMC 2022, ScienceDirect resuscitation studies), moral injury (Talbot & Dean, STAT News 2018; RadioGraphics 2022), burnout data (AMA 2025, Medscape 2024), tall poppy syndrome (Billan, 2018/2023), and online harassment (Pendergrast et al., JAMA Internal Medicine 2021).