I didn’t expect to find my own words in a Forbes article. But there they were.
A public health foundation president, writing about burnout in healthcare, landed on this:
“Burnout isn’t a personal weakness; it’s a warning.”
And I’ve written the same:
“Burnout is not the problem. It is the signal.”
Same sentence. Different people. Different paths to get there.
His came from data and policy. Mine came from fifteen years inside hospital systems, watching colleagues disappear, not all at once, but slowly, the way a person stops laughing before they stop showing up. I made this statement from my own experience of being driven from the heart of care to the head games of making money.
What the mainstream conversation is finally getting right
Brian Castrucci, president of the de Beaumont Foundation, wrote a piece for Forbes responding to a scene from The Pitt, a medical drama where a third-year student simply leaves at the end of her shift while the ER is overwhelmed. The debate it sparked online was revealing. Viewers were genuinely stunned that a healthcare worker would go home on time.
Castrucci uses that moment well. He points to the data, roughly 60% of emergency physicians reporting burnout symptoms, 71% of public health workers experiencing at least one burnout marker. He draws a pointed analogy to aviation, where fatigue is regulated because exhaustion in that context is taken seriously as a safety issue.
His central argument: burnout is a system failure, not a personal one. And when workers leave because of it, communities lose expertise, speed, and relationships that can’t be easily rebuilt.
He’s right. And it matters that a piece making that argument ran in Forbes, not just in a public health journal most people will never read.
The mainstream conversation is moving. Slowly, but moving.
Where I want to take it further
What the Forbes piece doesn’t ask — and perhaps can’t, within its frame — is why the system works this way.
Castrucci describes a machine that isn’t functioning well. My question is whether it’s malfunctioning at all.
I’ve written that the U.S. healthcare system is not broken. It is functioning exactly as it was designed to function. And that design was never about care.
Healthcare in this country was built inside capitalist logic, where health is a market product, survival is something you qualify for, and labor is extracted as efficiently as possible from anyone close enough to suffering to do the work. Healthcare staff are required to study social determinants of health of each patient because we know that if you can’t pay for care you’re more at risk for injury and mortality.
We spend $13,432 per person annually on healthcare, nearly twice what other wealthy nations spend, and still have worse outcomes and persistent workforce instability. The money isn’t going to people. It’s going to administrative complexity, price inflation, and revenue-driven care models.
That’s why 1 in 10 healthcare workers live below the poverty line. Nearly 25% experience food insecurity. We ask people to hold the hands of the dying, to clean infected wounds, to sustain composure through grief and urgency shift after shift, and we don’t pay them enough to eat reliably.
That is not a broken system.
That is a system built to take from employees, patients, and communities, then hand it back to them and tell them they should be grateful for the care.
Burnout as an intelligent response
Here’s what I’d add to the Forbes framing:
Burnout is not just a warning to administrators. It is the body and spirit responding logically to unsustainable conditions.
It is intelligent. It is appropriate. It is what happens when a person with a conscience is asked, repeatedly, to give more than the system gives back.
The system does not just exhaust caregivers. It weaponizes them. It takes the very thing that drew people into this work, the heart, the conscience, the commitment to another person’s survival — and uses it as leverage. You will stay because you care. You will absorb the impossible because you care. You will not speak up, walk out, or set a boundary because somewhere a patient needs you and the system knows it. Caring itself becomes the mechanism of harm. Burnout is not an accident of this profession. It is an undeniable secondary injury of it.
To everyone I coached, and everyone I spoke to at conferences while I was still working inside healthcare: I’m sorry. I told you to go home earlier, find a hobby, sleep better, and talk to your boss— as if the system’s failure was yours to solve. It took stepping away for me to understand what I should have known sooner: burnout is not a personal problem to be managed. It is a systemic one to be dismantled.
It is a form of gaslighting to tell someone that deeper breaths and better work-life balance will fix what the system broke. People are made daily to feel that their exhaustion is a personal failure rather than an accurate reading of reality.
When we only frame burnout as a workforce supply problem we risk solving for throughput instead of dignity.
The question isn’t just how we keep people in these roles. Why would anyone stay in a system that doesn’t value them? More importantly, what would the system look like if it did?
Two conversations that both need to happen
I want to be careful here, because I’m not dismissing the reform argument. Policy change is real and necessary. Better staffing ratios, living wages for direct care workers, protected rest, reduced administrative burden. These matter enormously.
But there are two conversations happening in this space, and they are not the same.
One is the reform conversation calling to fix the conditions inside the system we have.
The other is the transformation conversation, calling for a complete reimagining.
That second conversation requires us to look at capitalism not as a backdrop but as a design choice, one that treats care of its staff as ancillary to revenue, that rations survival through insurance choice and availability, and that has always compensated proximity to power more generously than proximity to suffering. Even goes as far to tell the ones suffering, that they need to suck it up.
A policy frame can get us to better working conditions.
But bringing the heart back to healthcare, truly back and not as a branding exercise, requires us to ask harder questions about what we built, why we built it, and whose lives have always been treated as negotiable inside it.
I’m a nurse. A healthcare leadership coach. Someone who spent fifteen years inside systems that were quietly consuming the people I worked alongside, including, at times, me.
When I read that Forbes piece and found my own sentence inside it, I felt two things at once: relief that the mainstream conversation is finally moving toward structural honesty, and a quiet urgency to name what’s still being left unsaid.
Joy left the ER at the end of her shift. The system called that a betrayal.
Maybe she was just the first one telling the truth.
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This is a bridge piece connecting to my ongoing Substack series, “Capitalism Was Never Designed to Care for Us.” Part III will center the voices of patients, clinicians, and leaders living inside this system. If you have a story to share, reply here or reach out privately. Anonymity is always respected.
Read the full series:
Part I: Capitalism Was Never Designed to Care for Us [link]
Part II: Capitalism Was Never Designed to Care for Us [link]
So much truth here.. thank you for sharing! I've noticed similarities as a healthcare worker in a third world country where not having access to the tools and equipment you know can make a difference is also a frustrating factor. Education is even worse.