Every patient who walks into a clinic trusts that, in that moment, the doctor in front of them is fully present — listening, thinking, caring. That belief is not sentimental. It is the foundation of medical trust.
Yet a familiar claim keeps resurfacing: Younger doctors simply do not want to “work hard” the way previous generations did. The premise is comforting. If the problem is attitude, the solution is character.
But the premise is wrong.
I say this as a practicing internal medicine physician in Georgia. Last week, I spent more time documenting a patient visit than speaking with the patient it described. I did not step away because I wanted to. I stepped away because the chart, the inbox and the billing requirements were already pulling me from the room.
Patients experience this as distance. Physicians experience it as erosion, and sometimes, so do outcomes. When a doctor’s eyes are fixed on a screen, we can miss the tremor in a hand, the hesitation before an answer, the quiet sadness that signals a deeper crisis. Those details are not sentimental. They are often the difference between reassurance and diagnosis, between safety and harm.
How the profession is different today
Credit: Handout
Credit: Handout
The accusation that younger doctors “don’t want to work” depends on a hidden assumption that medicine is still fundamentally the same job it once was — that only the people have changed.
That assumption collapses under contact with reality.
Today, vast amounts of invisible labor surround every act of care. Prescriptions trigger insurer negotiations. Referrals require layered authorization. Electronic inboxes refill faster than they empty. Studies show physicians now spend nearly two hours on electronic and administrative work for every hour of face-to-face patient care — work few patients ever see, but every physician must complete.
These hours do not disappear when clinic doors close. They spill into evenings, weekends and the margins of family life — time spent accounting for care already delivered rather than delivering more of it.
This is not less work.
It is different work, and much of it is misdirected.
Older physicians did, and still do, work extraordinarily hard. Many built their lives around call schedules, sleepless nights and an unwavering sense of duty. They deserve admiration, not caricature. But the center of their workday was still the patient.
My father’s documentation was often a handwritten note capturing the essence of a life. Mine is a multipage, auto-generated record built to satisfy billing codes, compliance thresholds and audit trails — one that can easily obscure the patient it is meant to describe.
That world is gone.
Visit times are shorter even as expectations expand. Physicians are responsible not only for clinical judgment, but also for quality metrics, coding precision, documentation standards and system performance we do not control. A single medication refill can require multiple portals and repeated justifications — sometimes for a patient I may not even see that day.
Burnout discourages students from entering the field
Georgia, like much of the country, already faces physician shortages, particularly in primary care and rural communities. Blaming younger doctors for structural strain will not solve that problem. It will worsen it.
Calling this laziness mistakes structural change for moral decline.
Younger physicians are not less committed. They are questioning whether exhaustion should be medicine’s primary badge of honor. They are asking whether devotion must require depletion, and whether the measure of a doctor is how completely the system is allowed to consume them.
Working “part time,” in many cases, simply redistributes labor, balancing clinic time with inbox management, teaching, leadership and quality oversight. Pursuing hybrid or system-level roles is not retreat. Medicine has always depended on those willing to improve the system as well as those working within it.
Beneath the criticism lies an older belief: Suffering proves legitimacy, and the honorable physician is the one who disappears most completely into the job.
That belief is not noble.
It is corrosive.
It burns out the physicians who remain. It discourages thoughtful students from entering the field. And it deepens the shortages already straining our communities.
Rebuild system that strains doctor-patient relationship
In all my years in practice, I have never met a physician who chose this path casually. No one spends a decade in training, assumes heavy debt and accepts daily emotional exposure for convenience. The commitment is real.
The architecture of the work has changed.
What wears physicians down is not effort. It is misallocated effort — hours spent proving care rather than providing it, clicking instead of listening, documenting presence instead of being present.
My father practiced in a system that asked a great deal of him, yet still allowed him to belong to his work.
I do not want less commitment than his generation gave.
I want a system that earns it.
Blaming younger doctors is easy. It keeps responsibility safely away from the institutions that redesigned the profession. But no field can demand infinite output from finite human beings and remain humane.
Medicine will not be the exception.
If we care about patients, the real question is not whether younger physicians are willing to work hard.
It is whether we are willing to admit the job has changed and rebuild it around what matters most: the patient in the room and the doctor who still wants to be fully there with them.
Ryan Nadelson, M.D., is a practicing internal medicine physician and department chair at Northside Hospital Diagnostic Clinic in Gainesville.
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