Nearly half of physicians report symptoms of burnout, and the numbers are worse for women. We are more likely than our male colleagues to leave medicine altogether, and we die by suicide at higher rates than women in almost any other profession. Pediatrics, meanwhile, is a field increasingly staffed by women. Put those facts next to each other and the conclusion is hard to avoid: the wellness crisis in medicine is not gender-neutral, and pediatrics is not exempt from it. If anything, we should be among the most urgently concerned.
I don’t think this is a coincidence, and I don’t think it’s simply a matter of workload. It’s something deeper, laid down early and reinforced constantly: the belief that a good physician sacrifices everything for the well-being of others, and that our own humanity is the acceptable cost of doing so. Think about what we learned without ever being taught it directly. How many of us trained ourselves not to drink water during a shift so we wouldn’t have to find time to use the bathroom? How many of us learned to inhale a meal in four minutes while standing at a workstation so we could get back to seeing patients faster? How many of us still eat lunch in front of a computer, charting, without noticing that we’ve stopped tasting the food? These aren’t quirks of a demanding job. They’re the residue of a training culture that taught us, early and effectively, that our own bodies and needs come last.
The martyrdom mentality, and why it lands harder on women
This conditioning doesn’t start in medical school, and it doesn’t affect all of us equally. Women are socialized from childhood to attend to the needs of others before their own — to notice who’s uncomfortable in a room, to smooth things over, to give more than they take. Medicine then builds an entire professional identity on top of that same instinct and calls it virtue. For women physicians, the message isn’t a new one we have to learn; it’s an old one that gets validated, professionalized, and handed a white coat. That makes it stickier, and harder to see as a choice rather than simply “who I am.”
As pediatrics becomes a field where women make up the majority, this matters for the specialty as a whole, not just for individual physicians. A profession dominated by people who were taught from two directions — as women and as physicians — to put themselves last is a profession at serious risk of losing its people, or of keeping them only at the cost of their health. Recognizing that pattern is the first step. Deprogramming it is the harder, ongoing work, and it doesn’t happen by accident. It takes intention, and it takes actively training ourselves to do things differently than we were trained to do them the first time.
Why this matters for how we build our practices
This is where Direct Primary Care becomes more than a business model. DPC is not the only way to realign a medical career with your own wellness — plenty of employed physicians have found ways to protect their time and energy, and plenty of DPC physicians have not. But DPC does something valuable: it hands the physician the structural control needed to design a practice around actual human needs, including her own. The opportunity is real. It is also easy to squander.
I say that because I’ve watched colleagues, and been that colleague myself, open an independent practice with every intention of doing things differently, only to recreate the exact same pressures we were trying to escape — just now with our own name on the lease. If we don’t approach practice ownership with real intention, we will simply rebuild the old system, unconsciously, because unconscious is how we learned to operate in the first place. Taking back control of our practices only helps if we also, deliberately, use that control to establish boundaries and design a working life that lets us care for ourselves with the same seriousness we bring to caring for our patients.
In practice, that means asking ourselves some honest questions before we build the structure, not after we’re already trapped inside it. How many hours a week do I actually want to see patients — not how many I think I should want, but how many I want? What hours am I genuinely willing to be available, and what happens after those hours end? How large a panel can I realistically and sustainably manage, given the kind of care I want to provide? What administrative support do I need so that running a business doesn’t quietly consume the time I intended to protect? And just as important: how much do I deserve to earn, given my years of training and expertise? How much is my time and presence actually worth? How much vacation should I build in, and how will I save for my own future rather than only tending to everyone else’s?
These aren’t indulgent questions. They’re the same questions any well-run business asks about its most valuable asset, applied to a system that has spent a career training us not to ask them about ourselves.
My own version of this
When I opened my practice, my dream was to work three days a week — longer days, if that’s what it took, but only three of them. I wanted the other days for the parts of my life that had nothing to do with medicine: gardening, running, hiking, sewing, simply having unstructured time to learn new things. I also knew that I loved learning in a more formal sense too, so I built in room to take up to two months a year, between vacation and conferences, away from the practice entirely. I understood, realistically, that almost no employed position would offer that kind of flexibility. If I wanted it, I would have to build it myself.
For a while, I did. Then the business grew, I took on employees, and the weight of payroll started to change my decisions in ways I didn’t fully notice at the time. I moved to four days a week. I started an integrative medicine fellowship. Not long after, I began an MBA. Each choice made sense on its own, and each one quietly ate into the boundary I had set for exactly this reason. It took actually feeling like I was burning the candle at both ends — not just knowing it intellectually, but feeling it in my body — before I stepped back and returned to three days a week.
That return wasn’t free. I had to raise my rates to make the math work, and raising rates always comes with a moment of fear that people will leave. Some grumbled. Most didn’t. And the change has been entirely worth it. I feel like myself again, in a way I hadn’t for a couple of years, and I’m a better physician for my patients because of it, not despite it.
The intention this requires
I share that story not because three days a week is the right answer for anyone else, but because the process behind it is the part worth borrowing: naming what you actually want, building a structure around it, noticing when life’s pressures start eroding that structure, and having the self-respect to correct course even when correcting course costs something. DPC gives us the tools to do this. It does not do it for us.
If we open our own practices and simply replicate the pace, the martyrdom, and the self-neglect of the system we left, we will have changed our business model without changing anything that actually determines our wellness. The opportunity in front of us — especially for those of us who are women, and especially in a specialty that is increasingly full of us — is to use the control we’ve fought for to build something genuinely different. Not just a practice that serves our patients well, but a life that lets us keep showing up for them, and for ourselves, for the long run.
If you’d like more guidance launching or growing your own direct care practice, DPC Pediatrician offers a startup guide, coaching programs, on-demand courses, and even one-on-one consulting.
