Low pay, high workloads, and a labor shortage are all contributing to a burnout epidemic among American physicians, and it could spell disaster for health care, according to a new survey. 

Around 81% of doctors say they’re overworked in the 2024 Physician Compensation Report released today from Doximity, an online networking platform for medical professionals, and shared exclusively with Fortune. Researchers polled 33,000 full-time U.S. physicians in 2023, and drew on data from thousands of other recent surveys. Another 88% say the existing physician shortage is causing their practice to suffer, and 86% say they’re concerned about the American health care system’s ability to care for an aging population.  

Morale is so low that around 30% of doctors are considering early retirement—a potential disaster for a country in which 70% of people already feel like the health care system has failed them. 

“We find ourselves in a position where we are often stretched quite thin,” Dr. Amit Phull, Doximity’s chief physician experience officer and an emergency medicine physician, tells Fortune. “I think as the [pandemic] dust settles, there’s a lot of reconsideration for folks who at the outset might have felt, ‘This is the place that I need to be, this is why I trained.’ They’re now reconsidering careers in medicine, in terms of the cost and the balance.”

More work for less pay 

Physicians have always had tough jobs, whether that means long hours, emotionally taxing conversations, or a dizzying amount of responsibility. 

But patients today are sicker than they were just a few decades ago, and often suffer from multiple comorbidities such as arthritis, diabetes, and asthma. “The specter of taking care of this aging, sicker population is just that much more daunting,” says Phull.  

Doctors are also buckling under a heavy administrative burden, one of the most significant drains on their time and energy, according to the report. For every hour of direct patient care, doctors spend around two hours on paperwork during the day, and another one to two hours at night. Around 75% of doctors surveyed said that reducing their administrative burden could meaningfully improve feelings of overwork and burnout.

“That imbalance between what we went to school for and what we trained for and what we are practically, really doing? I think improvements there can be quite substantive,” says Phull.

And while pay for doctors is actually increasing overall, top-line numbers don’t tell the whole story. Average physician pay went up 6% in 2023, according to the report, and physicians in major metro areas like San Jose, Calif., and St. Louis, Mo., are earning salaries of around $450,000. But Medicare physician payment has plummeted 26% since 2001, according to the report, and many regions are not adequately adjusting physician salaries after several years of sky-high inflation. Many doctors are also carrying the burden of medical school debt, with the average loan for physicians clocking in at around $200,000, according to the Education Data Initiative. 

That means that although there are some doctors taking home big paydays, adjusted compensation for many has actually gone down—a bitter pill to swallow, especially considering that many Americans still believe that all doctors are rich. 

To be sure, relative to the median income of the U.S. workforce, doctors are still well compensated. The average salary for full-time U.S. workers is just over $59,000, according to the most recent Bureau of Labor Statistics earnings report, while the average compensation for doctors in metro areas is about $400,000. But the gap between how people still think about doctor salaries, and how demanding and precarious the job has actually become, is one of the factors leading to a sense of burnout and disillusionment, according to Phull. 

“Being a physician in today’s health care system, there’s dissonance between reality and other people’s perceptions,” he says.

The gender pay gap, which plagues the U.S. workforce as a whole, is also particularly pronounced among this group of professionals. It decreased slightly to 23% in 2023 from the 26% of 2022, according to the report, but it remains significant. Women physicians earn, on average, nearly $102,000 less than their male counterparts. Doximity further estimated that over the course of a career, male physicians make over $2 million more than women in the same field. 

“I could not believe it was that high,” Dr Tina Chu tells Fortune. As a San Diego–based pediatrician, Chu is in one of the lowest-paying fields of medicine, in one of the most undercompensated regions in the country. 

“Reading the report was definitely a little bit disheartening,” she adds. “But it also brought awareness and transparency, because without it I wouldn’t have known where I stood as far as knowing my potential worth and being able to advocate for myself in the future.” 

The future of practicing medicine

As the U.S. population ages, so do its physicians. 

Even before questions around burnout leading to early retirements, an older population of doctors were a threat to the existing health care system. Doximity’s report supports previous findings published by the Association of American Medical Colleges (AAMC) that 20% of today’s doctors are 65 or older, and 22% are between 55 and 64. The organization projects the U.S. will face a physician shortage of up to 86,000 doctors by 2036.

The question of finding their replacements is complicated, according to Phull. To start with, new doctors aren’t hitting the labor pool fast enough. And the creation of new positions that could help alleviate the doctor shortage, including nurse practitioners and physician assistants, is also failing to keep pace with the cascading labor shortage. 

So are we all doomed? Not necessarily, says Phull, who, despite all of these challenges, remains optimistic about the future of U.S. health care. Many physicians are hopeful, for example, that the recent Federal Trade Commission’s ban on noncompete clauses may wind up being a benefit. 

“That could enact tremendous change in the space where there’ll be a ton more mobility for physicians like myself [who] hold licenses in a few states,” he says. “My ability to potentially practice in a whole host of other geographies could expand exponentially, which would ideally mitigate some of this issue with the shortage of the physician workforce.”

Survey respondents had other ideas about what would help ease the burden, as well: increasing education funding to train more doctors, implementing loan forgiveness programs to incentivize work in underserved areas, expanding virtual visit options to boost patient access to care, and using AI tools to assist with administrative tasks. 

“Doctors surveyed said that they could save anywhere from 12 to 13 hours a week if they had well-developed AI tools [for] documentation, helping with their notes, helping with appeal letters,” says Phull. “So I think that could be a tremendous improvement.”