We don’t talk about burnout.

I recently reunited with a former medical school classmate for lunch and realized that I talked more to him in two hours about my experiences over the past few years than with my hospitalist colleagues at work or my closest friends. I’ve only ever dared to mention anything to my wife and brother (both physicians).

Lots of sources define burnout as the accumulation of stress over time that leads to exhaustion and feelings of helplessness. Sometimes superficial prescriptions are given, such as the importance of practicing self-care and finding ways to manage stress to mitigate burnout. I do realize that not everyone is burned out. Some people love what they do, and their work lives align perfectly with their personal vision. One of my closest friends is a vascular surgeon with a physician spouse and young kids like me. He works 80-hour weeks and performs complex surgeries without apparent struggle. Sometimes I envy his enthusiasm and wonder what I’m doing wrong. I don’t think I chose the wrong specialty (I switched from Ophthalmology to Internal Medicine a long time ago), and I’ve worked at more than ten hospitals so I know challenges aren’t isolated to any system.

Few physicians, nurses, or other health care professionals I know talk about burnout with anyone. I guess we fear being labeled as weak or having a character flaw. As highly trained health care professionals, we think we are in control and can power through and fix any issue. We dread asking for help, and we worry that even hinting at challenges may be a sign of surrender that many of us can’t bring ourselves to do. So, what do we do? Absolutely nothing different; we keep showing up day after day to help patients.

Burnout can have serious effects on both our mental and physical health, our personal lives, and our career longevity. At some point, many people realize they’ve had enough suffering in silence. They move on to another employer or simply drop out of the health care ecosystem completely in self-preservation.

Institutions keep creating committees, hotlines that we can call, and online resources so that health care professionals can reach out for professional help if necessary. But are the health care professionals who need help actually getting it? What actionable steps are truly effective? Instinctively, many health care professionals realize that having safe staffing ratios and decreasing workload must be helpful (how can it not?). The institutional answer of periodic pizza parties, mandatory wellness modules, once-a-year retreats, or the like certainly don’t seem to work.

A whole private industry focuses on coaching, courses, and other interventions. Many residents and early career physicians likely cannot afford to fork over $500 to 1000 per month for ongoing coaching or $25 to 50K per year for some “elite” mastermind. I don’t doubt the effectiveness of the offerings, but given the premium price point, it’s simply not going to help the masses.

Sadly, I fear that the main issue is a fundamental disconnect between the “no money, no mission” culture of the medical-industrial complex and the needs of the human beings that work in these systems. I predict that the prevalence of burnout among all health care workers will likely get worse and, along with it, the widespread staffing challenges.

Varun Verma is an internal medicine physician who blogs at his self-titled site, Varun Verma, M.D. He can be reached on Twitter @VarunVermaMD.