Years inside medicine, both at the bedside and in the boardroom, made one thing clear to Dr. Bhatia: The system asks physicians to give continuously, with almost nothing built in to restore them. Physicians are trained to recognize burnout in their patients, but rarely in themselves. She wants to shift that conversation.
In this series, Dr. Bhatia will offer practical, evidence-informed ways to bring balance back into clinical life, drawn from both modern medicine and the older traditions she has studied.
In medical school and residency, we were taught to prioritize the patient above everything else.
We learned to manage complexity, make decisions under pressure, and stay focused regardless of fatigue. The expectation—often unspoken—was that physicians would continue to perform at a high level, even when the conditions around them were not designed to support that. At no point did we talk about sustainability.
Most physicians remain clinically competent and highly functional. But over time, the experience of practicing medicine begins to change.
The work takes more effort.
Focus becomes harder to sustain.
The day feels more compressed, with little margin to reset between decisions.
The instinct in those moments is familiar: improve efficiency, move faster, push through. But sustainability in clinical practice is not solved by working harder within the same structure.
Click here to read Dr. Bhatia's column about the clinical costs of physicians running on empty—and how a quiet shift in medicine is helping create conditions where physicians can continue to practice with clarity, presence, and purpose over the long arc of their careers: 'Doctors are Practicing Medicine on Empty'
Sustainability is often misunderstood
When sustainability is discussed in medicine, it is often interpreted as reducing workload or stepping away from clinical responsibilities. That is not what most physicians are asking for.
Most want to continue practicing at a high level. They want to stay engaged in patient care. What they are looking for is a way to do that without operating in a constant state of depletion.
Sustainability, in this context, is not about doing less meaningful work.
It is about reducing the conditions that make that work difficult to sustain over time.
Where the strain actually comes from
It is easy to attribute fatigue in medicine to long hours. But in many cases, the issue is not just the number of hours worked.
It is how those hours are structured. In a typical clinical day, physicians are expected to:
Maintain continuous attention across a high volume of patients
Make rapid, high-stakes decisions, often with incomplete information
Navigate documentation, inbox management, and system requirements in parallel
Manage emotional interactions without time to reset between them
There are few natural pauses built into this workflow.
The result is not just time pressure. It is sustained cognitive and physiological load without recovery. Over time, this becomes difficult to sustain—even for highly experienced physicians.
Related: 'After 28 hours on call, I didn’t care if I made it home alive'Efficiency alone doesn’t solve the problem
Healthcare systems have spent years optimizing for efficiency. In many ways, that has improved access and throughput.
But efficiency and sustainability are not the same.
A system can be highly efficient—maximizing output per hour—while still being difficult for physicians to sustain over time.
Many physicians are now working in environments optimized for volume, but not for how human attention and decision-making function across a full day.
As a result, even when workflows are technically efficient, they can still feel exhausting.
The reality of sustainable practice
Sustainable clinical practice does not require a complete redesign of the healthcare system.
In most settings, that is not immediately feasible.
Instead, it often begins with smaller, practical adjustments that change how the clinical day is experienced.
Examples include:
Creating brief transition points between patients, even if only for a few minutes
Structuring documentation to reduce end-of-day backlog
Limiting unnecessary context switching between tasks
Using tools or support systems that meaningfully reduce administrative friction
Being more deliberate about when information is reviewed, rather than reacting continuously
None of these changes are dramatic on their own.
But together, they reduce the cumulative load that builds over the course of the day.
A shift in how physicians approach their work
There is a growing recognition among physicians that sustaining a career in medicine requires a different approach.
Not less commitment to patients.
But a more realistic understanding of what allows physicians to function at a high level over time.
This includes asking more practical questions:
What supports clear thinking throughout the day?
What allows for consistent attention across multiple patient interactions?
What reduces cognitive load without compromising care?
These are not abstract concerns. They are directly tied to clinical performance.
A more useful definition of sustainability
Sustainability in clinical practice is not about eliminating pressure or complexity. Those are inherent to medicine.
A more useful definition is this: The ability to continue practicing at a high level without ongoing, cumulative depletion.
That means:
The structure of the day allows for sustained attention
Workflows reduce unnecessary friction
The physician is not operating in a continuous state of physiological deficit
This is not a “wellness” concept. It is a performance requirement.
A question worth asking...
If many physicians are currently practicing under conditions that are difficult to sustain, the next question is straightforward:
What changes—at the level of daily practice—would make clinical work more sustainable?
Not in theory, but within the realities of patient care, time constraints, and system demands.
Because the long-term strength of the healthcare system depends not only on clinical innovation, but on whether physicians can continue to do the work effectively over time.
Sonal Bhatia, MD is a physician, former pharmaceutical executive, TEDx speaker, and founder of Ojas Vida. She writes and speaks on the intersection of modern medicine, human physiology, and sustainable clinical practice.