I want to tell you about the year I almost left medicine.
I was not burned out in the way the surveys measure it. This was not the kind of exhaustion you sleep off or address with a wellness app or a mandatory resilience seminar. I mean the specific, quiet, devastating kind of “done” that sets in when you realize that the profession you have devoted your entire adult life to has built a system that makes it nearly impossible to practice the way you were trained to practice, the way your patients need you to practice, the way you still believed medicine could be practiced, if only the conditions were different.
I had been in my OB/GYN partnership for more than twenty years. Two decades of delivering babies in the middle of the night, of sitting with women through diagnoses that changed everything, of building the kind of relationships that are the whole point of medicine. The ones where a patient walks in and you already know her history, her fears, her family, the particular way she holds her shoulders when she is not telling you the whole truth. You do not build those relationships in seven-minute appointments. But seven minutes, more or less, was what the system had decided my time with a patient was worth.
The financial pressure was not sudden. It accumulated the way these things always do, slowly, then all at once. Reimbursements that had never adequately valued the time-intensive, relationship-based work of women’s health declined further. Administrative costs consumed more. The volume expectations increased to compensate, which meant less time per patient, which meant more compromises in care or in my own self care, which meant the kind of moral injury that does not show up on a balance sheet but lives in the body of every physician who has ever apologized to a patient for being rushed. I watched colleagues leave. I watched the partnership strain under pressures that were structural and systemic and had nothing to do with how much any of us cared about our work.
When the split finally came, It felt like loss. The bitterness of that separation - from partners I had built a practice with, from a clinical home I had known for more than half my career, form patients and families who I had known over more than one generation, from a version of my professional life that I had believed in even as it was making me miserable - was real, and I will not dress it up. Some of that still stings. These things do not resolve cleanly, and anyone who tells you otherwise has either not been through it or has decided to tell a tidier story than the truth allows.
What kept me in medicine was not a plan. It was an offer that came from a direction I had not been looking. A startup called Monarch MD, building a membership medicine model for women’s health, needed a Chief Clinical Officer who was willing to be both the architect and the beta test to help design the model and to live inside it, to put her clinical reputation and her patient relationships on the line for something that did not yet have a track record. It was not a safe choice. It was the right one. And the fact that I am still practicing medicine, still serving the patients and the mission I have devoted my adult life to, is because that offer existed and because I was willing to say yes to something uncertain rather than say goodbye to something essential.
I tell you this not for sympathy. I tell you this because my story is not exceptional. It is ordinary. It is happening everywhere, to physicians of every specialty and every career stage, in forms that vary in their specifics but are identical in their structure: a system that makes it financially and morally unsustainable to practice the kind of medicine that actually helps people, and a physician who has to choose between their patients and their sanity, between their mission and their survival.
The difference in my case was that I found a door. Most of my colleagues are still looking for one.
This is not a crisis. This is a reckoning.
We have been calling this a healthcare crisis for so long that the word has lost its meaning. A crisis implies something acute: a rupture in an otherwise functional system that, with sufficient will and resources, can be repaired and returned to equilibrium. What is happening right now in American medicine is not that. There is no equilibrium to return to. The system was not functioning before the rupture.
I recently spoke with Dr Elisabeth Potter. You may know her from her years of advocacy in reconstructive breast surgery and women’s health or from a viral video of her being called out of the operating room during surgery by United healthcare functionaries. She helped me refine the language for this spiral we find ourselves in: What we are in is a reckoning. A reckoning implies that the foundations themselves are being examined. That the accumulated weight of deferred failures has finally reached a tipping point. That the polite fictions - the ones that kept physicians in their lanes, kept patients in the dark, kept advocates focused on incremental gains - are no longer holding.
The reckoning did not arrive from one direction. It arrived from all of them at once.
The forces converging
The pandemic did not create the failures in American healthcare. It revealed them. It stripped away every polite fiction about who the system serves and who it discards. Physicians saw it in real time - the PPE shortages, the ventilator rationing, the communities of color dying at rates that were not surprising to anyone who had been paying attention. Patients felt it in real time - in canceled procedures, in delayed diagnoses, in the discovery that their health insurance did not actually protect them from financial ruin. The curtain came down. And it did not go back up.
The menopause visibility movement arrived not by accident at exactly this moment. A generation of women who had built careers, raised children, served institutions, and navigated professional worlds designed for men reached midlife and found themselves experiencing a transition that the medical system had spent decades undertreating, understudying, and dismissing. But this generation was not willing to accept that. What is remarkable about this moment is that the same women demanding better menopause care from their physicians are often the same women who are physicians. We are simultaneously experiencing the failures of the system as patients and perpetuating its constraints as practitioners. That convergence of the personal and the professional arriving at the same crisis point in the same bodies at the same time is not a coincidence. It is the definition of a reckoning.
The physician exodus has grown and gone viral and this changed things. There is something different about what is happening now compared to the burnout statistics we have been citing for years. When a 33-year-old ENT surgeon posts an Instagram reel announcing she is leaving medicine entirely and the comments fill with physicians saying ‘me too’ and patients saying ‘I knew something was wrong,’ the cultural meaning of that departure shifts. It becomes visible. It becomes undeniable. A 2023 JAMA study of nearly 19,000 physicians found that approximately one-third reported moderate or greater intention to leave clinical practice. By 2025, 35% of physicians said they had considered leaving medical practice since the start of the year alone. More than 70,000 physicians - over 6% of the country’s physicians - left medicine just between 2021 and 2022. These are not dramatic people having public breakdowns. They are exhausted professionals making rational decisions in response to irrational conditions. The TikToks and Instagram reels and LinkedIn essays are not the story. They are the evidence that the story has finally become impossible to ignore.
The estradiol patch shortage cracked open a conversation the system had been avoiding for decades. I know, because I wrote about it, and the response told me everything about how hungry people were for someone to finally say it out loud. When Jennifer Weiss-Wolf and I published our op-ed in the LA Times, we weren’t reporting a supply chain anomaly. We were naming a structural truth: the shortage was not driven by a sudden surge in demand. It was driven by the same forces that have shaped women’s healthcare for generations: a reimbursement system that undervalues the medications and procedures that serve female bodies, a pharmacy benefit management industry that controls formulary access with near-zero accountability, and a regulatory and market environment that has never treated menopause as a medical priority worth protecting. The women who still cannot fill their prescriptions aren’t victims of bad luck. They are experiencing the logical endpoint of fifty years of policy choices that said their hormones were not worth the same investment as a man’s. The shortage made visible what had always been true. And the thousands of responses from patients, from clinicians, from women who had been managing their symptoms for years and suddenly couldn’t told me that people were not surprised. They were exhausted. There is a difference. Surprise implies the system had been working. Exhaustion implies they always knew it wasn’t.
And then there is Dr. Elisabeth Potter. Her story belongs in this conversation because it is mine, and mine is hers, and both of ours belong to every physician who has tried to build something better inside or outside a system determined to make that impossible. She left hospital-based care to build a high-quality, lower-cost outpatient surgery center. This is exactly the kind of site-neutral, patient-friendly model that insurers claim to support. UnitedHealthcare approved her surgeries. Then denied payment for a medically necessary overnight stay while her patient was still on the operating table. She fought CMS when they planned to eliminate procedure codes for DIEP flap breast reconstruction and won. This surgery rebuilds a breast cancer patient’s body using her own tissue. She did not go quietly. She went publicly, loudly, with documentation. And in doing so she gave language to something thousands of physicians had been experiencing without a frame: that the system was not malfunctioning. It was functioning exactly as designed. And the design was the problem.
On roadmaps and authenticity
I admit that I am frustrated when traditional leadership claims that what we need is a strategic plan. A roadmap. A working group. A multi-stakeholder process with clear deliverables and a 36-month implementation timeline.
I understand the impulse. The problems are structural and the solutions must eventually be structural. But I want to say something that I think matters in this specific moment: the roadmap is not what is needed first. What is needed first is the willingness to see clearly. We must call the system what it is, to stop protecting institutions that have failed us out of misplaced loyalty or fear of being seen as unreasonable.
Dr. Potter has spoken about this as a call for authenticity. Not performance. Not strategic positioning. Authenticity is the willingness to say what you actually see, to name what is actually happening, even when the room is full of people who would prefer a more diplomatic framing. That willingness is not a strategy. It is a moral stance. And in my experience, it is the only thing that has ever actually moved anything.
The path forward will not be designed in a committee. It will be built by practitioners who refuse to participate in a system that has stopped serving its stated purpose, and by patients who demand more than the system has ever offered them. The direct care movement, the membership medicine movement, the menopause advocacy movement are not fringe experiments. They are early proof of concept. The proof is accumulating. And at Monarch MD, I am living inside that proof every day not as a thought experiment but as a clinical reality, seeing what medicine looks like when the structure finally matches the mission.
What this moment asks of each of us
It asks something different depending on who you are.
If you are a patient - especially a midlife woman who has been rushed, dismissed, undertreated, or handed a seven-minute appointment for a decade of symptoms this moment asks you to stop accepting that as the standard. To find physicians who have time for you. To advocate for yourself in ways that feel uncomfortable, because the system has counted on your discomfort to keep you quiet. You are not asking for too much. The system has been offering too little for too long.
If you are a physician still inside the system - exhausted, behind on notes, fighting a prior auth on your lunch break - this moment asks you to stop carrying the dysfunction privately. To say out loud what you are experiencing. To stop protecting institutions that are not protecting you or your patients. Your silence is being used against both of you.
If you are a policy maker, an administrator, a health system leader this moment asks you to hear what the physicians who have left are actually saying, rather than pathologizing their departure. When the most experienced, most committed clinicians in your field are walking out the door, that is not a human resources problem. That is a signal. Treat it like one.
If you are an advocate for women’s health, for menopause care, for research equity this moment asks you to expand the frame. The knowledge gap is real. The training gap is real. The research gap is real. And none of them will be closed by education alone as long as the economic architecture of medicine makes it impossible to translate knowledge into care. The advocacy must go where the money goes.
A closing thought
I have been practicing medicine for a long time. I have been an integrative physician, an OB/GYN, a menopause specialist, an entrepreneur, an author, and a public voice in a field that is finally, painfully, belatedly having the conversations it should have been having for decades. I have made choices that were costly financially, professionally, personally because I believed the mission mattered more than the institution.
I am more certain of that now than I have ever been.
What I see in this moment - in the physicians leaving, in the patients demanding, in the advocates connecting dots across policy and economics and clinical reality - is not collapse. It is clarification. The system is showing us exactly what it is. And we are, slowly and then all at once, building the capacity to say: this is not enough, and we are not waiting any longer.
If you have felt this shift in your practice, in your body, in your waiting room, in the resignation letter you have been drafting for years - you are not alone. You are not wrong. You are not too much.
You are early. And early is exactly what this moment needs.
Up next → Part Four: The Most Expensive Failure in the World — what $14,885 per person buys you, and what it doesn’t.
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.