Walking Out
On Facing Down Burnout
"...to fully and uncritically surrender to such agon against individuals is to invite one's own ethical degeneration; to implicitly give a pass to those others in the ruling class more inclined to decorously veil the misery from which they profit; and to lose focus on the system of which such turpitudinous figures are symptoms.
Which is to risk exonerating it."
— China Miéville, A Spectre, Haunting
You near the end of a 12-hour shift. Every day is stressful, but this one? Well, it was next-level. Your colleagues are still all business—feeling the pull of home, a meal, maybe a beer but not allowing themselves to even contemplate anything that’s not the pile of work that’s still in front of them.
You know you have options (even if others don’t see them). You can stay and pitch in, help everyone get out a few precious minutes earlier. Or you can pack up your bag at the end of your shift and go take care of yourself.
What do you do?
In Season 2, Episode 12 of The Pitt, the day shift in the emergency department begins to wind down after yet another harrowing twelve hours. The team is staying late—of course—to catch up on steep piles of (literal) paperwork and ensure that their patients are properly handed off to the night shift. In the midst of the hustle and bustle, one of the med students, Joy, packs up and heads for the door.
Dr. Langdon asks her where she’s going.
Langdon: You leaving?
Joy: Uh, yeah, my shift is over, and I ain't getting paid to be here. Quite literally the opposite, in fact.
Langdon: Well… I don't know if you noticed, but we're sort of in disaster mode here still. We put in the extra time if needed.
Joy: [ long pause ] You know, 62% of ED docs report suffering from burnout.
Langdon: Painfully aware.
Joy: So maybe all you lunatics need to learn how to set some boundaries. Like me. Well, see you tomorrow, doc.
Joy doesn’t seem particularly proud of her choice to leave. She’s uncomfortable. She hesitates several times. I got the sense that she believes this is what she needs to do and has prepared for just such a confrontation.
Dr. Langdon doesn’t stop her. She walks out, and I assume we won’t see her again this season.
Joy has been a puzzling character. Most of her on-screen time presented her as detached, a bit apathetic. She was regularly on her phone, often standing back from “the action.” Her participation in this rotation appeared perfunctory, no real engagement with the discipline of emergency medicine. And yet, she was also clutch at a few key moments in the shift.
When she “punched the clock” and made for the exit, I felt torn. Part of me wanted to scream, “You go, girl! Show the healthcare industry you can’t be pushed around!” And the other part of me wanted to chide her for not being a team player, for not recognizing that working together could get the whole team out of there faster. Joy’s choice echoes the (likely exaggerated) fear that Gen X managers have about their Gen Z employees—that “I’ll do my job and nothing more” philosophy. At the same time, she reminds us (and Dr. Langdon) that she is not a worker; she’s a student paying for the privilege of participating in a shift.
Universal problems with work…
A huge part of what I love about The Pitt is that it illuminates universal problems with work and caregiving in our current system but does so in a high-stakes environment. Upholding boundaries, pushing back on exploitative practices, or asking for what you need rather than getting by with what you have isn’t easy—no matter your work—but when lives are on the line, the calculus is that much more fraught. At the same time, the stakes highlight the ways in which prioritizing people over profit is a life-or-death issue, too.
Physician burnout in the United States is a real problem. A series of studies tracking burnout and job satisfaction over the last 15 years show that physicians experience symptoms of burnout at a substantially higher rate than the population on average.
The 62% statistic that Joy cites comes from this series of studies. Though, for what it’s worth, that’s the percentage of doctors reporting at least one symptom of burnout. And it was the survey result captured at the height of the pandemic—the latest numbers are still alarmingly high but down from that peak.
The most recent study, published in July 2025, highlights four factors that contribute to the physician burnout crisis (and read as if a creative brief to the writers on The Pitt): increased administrative burdens, consolidation within the industry, increased expectations for “productivity,” and an increasing complexity of care:
“Physician burnout and job satisfaction have become critical issues during the past 2 decades, a time of substantial disruption in the health care system. The 2009 HITECH Act led to rapid expansion of electronic health record use, resulting in increased administrative burden for physicians, with a high proportion of electronic health record–related work performed during personal time. Health care consolidation has resulted in most physicians being employed by large organizations, contributing to loss of control, flexibility, and autonomy. Demands to increase productivity have translated into shorter visits and less time with each patient, even as the complexity of care has increased.”
And while these particular factors are specific to the medical field, they easily map onto other forms of work in the 21st-century economy. Productivity tools may help us get more done or stay more organized, but they also tend to create new administrative work. Private equity slowly turns what appear to be mom-and-pop businesses into zombie outlets that reduce pay, benefits, and worker autonomy. Trying to keep up with the incentives of the creator economy leaves less time and energy for each video or podcast episode. The list of examples could go on and on.
A plodding, extended treatise…
This season of The Pitt has been a plodding, extended treatise on the ravages of burnout. Dr. Robby is about to go on a 3-month sabbatical to exorcise some personal demons. Dr. Langdon is just back from a 10-month stint in recovery. Dr. Mohan is heading full-on into an existential crisis about her future and family. Javadi is navigating the crushing expectations of her parents. Drs. Santos and King are both dealing with loneliness in their own ways. And Nurse Dana is sick and tired of the abuse that she and the other nurses are constantly subject to.
What The Pitt does so brilliantly, if at times with a heavy hand, is to highlight how personal troubles are exacerbated (and often created) by structural and systemic choices beyond the team's control. Administrative burdens, public policy, and cultural expectations shape how everyone in the emergency department experiences their work-lives. We also see how different positions in the hospital hierarchy are shaped by their connection to those structural and systemic choices; doctors with higher status and more responsibilities are often stuck between management and workers.
I perused some of the American Medical Association's educational resources on physician burnout and found them dripping with the kind of reformist interventions that do little more than entrench the status quo. Some ideas include creating a Well-Being Committee led by a Chief Well-Being Officer, conducting a burnout assessment, and establishing burnout and well-being as "quality indicators" of the organization. They recommend interventions in "patient care workflow" design, optimization of electronic health records, reduction of administrative burdens, and "improved organizational support for individual clinician well-being.
Now, I'm not purporting that my scan through a few webpages is an accurate representation of the AMA's work on this issue. Nor am I saying that there are no helpful interventions or more innovative ideas out there among organizations that haven't had a major hand in bringing the US healthcare system to exactly the state it's in today. What I want to point out is simply that these interventions seem to sit atop assumptions about how things must work.
Doctors must be efficient. They must deliver care in ways that are legible to insurance companies. They must go into hundreds of thousands of dollars of debt and submit to the will of for-profit companies to pay it off. They must deal with the consequences of inadequate staffing because otherwise the organization can't increase its bottom line or prove to donors how cost-effective it is.
Nothing is inevitable…
That long list of musts reflects policy choices. None of them is inevitable.
Healthcare doesn’t have to be a profit-seeking industry. But if you don’t want to go even that far, profit could be managed in balance with real standards of care that include whether or not a doctor has the resources they need to do their work in a sustainable way. Instead of “dealing with” the challenges faced by medical professionals and healthcare institutions alike, we could get to the root of them and solve them before they ever becomes challenges. However, it takes questioning every assumption up and down the chain, making different choices than the ones industry has made to this point.
In the US, policy makers have—time and again—chosen a for-profit medical system. They have chosen to limit the number of residencies available to doctors-in-training, thereby limiting the number of doctors that can be trained each year. They've decided to limit access to Medicare and Medicaid.
Again, these are all choices specific to work in the medical field. But there are corollaries throughout all forms of work. We all deal with our own personal issues, exacerbated and often created by the structural and systemic forces that act on our working conditions.
We must make personal choices about how to navigate the systems that fail us. But the most effective intervention will always be one that upends those systems.
For viewers of The Pitt, Joy’s end-of-shift departure forces us to ask: What would happen if all the doctors and nurses left at the end of their scheduled shift and refused to work off the clock?
And while the obvious (and short-term) answer to this question is chaos and suffering, the more complicated (and long-term) answer is that something would have to change about the way the hospital (and the medical field as a whole) is organized.
The system benefits from the ways we tend to pitch in to help others out.
It profits from our mutual concern for each other. It scales by leveraging our care for patients, clients, and customers.
We have options. If you’re self-employed or own a business, you probably make system-defying choices on a regular basis. There are always more system-defying choices to make. If you work from someone else, you can help question the assumptions made by management or ownership. You don’t even have to out yourself as the office radical; asking good questions that open new avenues of consideration is often a solid way to get ahead.
We can continue with the status quo, helping each other survive the systems we live and work in. We can walk out, like Joy, and dare others to do the same. Or we can find a middle way—not as an appeasement but as a collective refusal. We can help each other survive and walk out together. We can take care of those in our care and take care of ourselves through solidarity.
We can resist burning out by burning our assumptions about the way things must be to the ground.
