Doctors Weren’t Designed to Be Healthcare Factory Workers - The Factory Model, Physician Burnout, and the Case for Direct Care

Doctors Weren’t Designed to Be Healthcare Factory Workers

The Factory Model, Physician Burnout, and the Case for Direct Care

Yoon Hang Kim, MD, MPH

Board-Certified in Preventive Medicine | Integrative & Functional Medicine Physician

A family physician who once worked on a factory floor before medical school has given a name to something many clinicians feel but rarely articulate: the sense that modern medicine has quietly reclassified doctors from professionals into production workers. His essay has resonated across physician circles because the analogy is uncomfortably apt — and because a growing body of evidence, along with a shifting legal and policy landscape, suggests the discontent it names is structural rather than personal.

Where the Argument Began

The essay “Doctors Weren’t Designed to Be Healthcare Factory Workers,” by Tod Stillson, MD, was published on SimpliMD in August 2023 and cross-posted on his companion platform, Dr. Incorporated. Stillson is a family physician and entrepreneur whose work encourages doctors to reclaim professional autonomy through business literacy and independent practice structures.

Stillson draws on his own experience as a factory laborer before medical school to argue that physicians today face the same dynamics he once knew on the shop floor: dependence on a large employer, loss of autonomy, and monotonous, quota-driven work. His central claim is that professional training historically earned physicians “the power of autonomy and self-determination,” but that the rise of large health systems has reduced many doctors to “physician labor” — a commodified input on a corporate assembly line. His prescription is direct: physicians should reconsider employee status and operate instead as independent practitioners or “micro-corporations,” reclaiming the sovereignty that clinical training was meant to confer.

The essay struck a nerve because it named, in personal terms, a structural shift many physicians live daily but seldom articulate: the transformation of medicine from a profession governed by clinical judgment into a labor category governed by throughput metrics.

Solution Shops and Production Lines

Stillson’s framing aligns closely with a widely cited distinction advanced by the American Medical Association. In a 2022 perspective piece in the New England Journal of Medicine, Christine A. Sinsky, MD, and Jeffrey Panzer, MD, MPH, separate two fundamentally different kinds of clinical work.

“Solution shop” work involves diagnosing unstructured problems and building trust with patients — the work that draws on the highest levels of physician expertise and judgment. “Production line” work, by contrast, covers standardized, predictable tasks such as preventive screening prompts, prescription renewals, and order entry — work that trained team members can often handle without a physician’s involvement.

The authors argue that requiring physicians to perform both kinds of work simultaneously, without redesigning the practice to separate them, places an unsustainable burden on doctors and directly fuels burnout. Their proposed “frameshift” would direct production-line tasks away from physicians and preserve their time for the problem-solving, decision-making, and relationship-building that form the irreducible core of clinical practice. The point is not that individual physicians are failing; it is that the architecture around them misallocates their most valuable capacity.

The Evidence That the Factory Model Drives Burnout

Structural and Economic Pressures

A growing literature supports the view that burnout is a systemic design flaw rather than a failure of individual resilience. A 2026 analysis in the journal Health (Scientific Research Publishing) describes physician burnout as “a structural consequence of economic models that reconfigure medical practice around metric-based performance,” noting that tying compensation to relative value unit (RVU) production incentivizes short visits, high patient turnover, and template-driven documentation divorced from clinical meaning. Physicians in volume-driven settings, the analysis reports, describe feeling like “factory workers on an assembly line” — and productivity-based pay is associated with higher burnout than salaried or value-based models.

The financial stakes are substantial. A landmark 2019 study in the Annals of Internal Medicine — the first to estimate the overall economic burden of physician burnout — calculated that burnout costs the U.S. healthcare system roughly $4.6 billion each year (with a range of $2.6 to $6.3 billion), or about $7,600 per employed physician, through turnover and reduced clinical hours. The authors, led by researcher Joel Goh with collaborators from the AMA, Mayo Clinic, Stanford, and the University of North Carolina, emphasized that the figure is conservative, since it omits harder-to-quantify costs such as medical errors, malpractice exposure, and patient attrition.

The Decline of Ownership

Underlying much of this is a shift in who owns the practice. According to the AMA’s Physician Practice Benchmark Survey, 2016 marked a historic tipping point: for the first time since the survey began, fewer than half of patient-care physicians (47.1 percent) held an ownership stake in their practice, down from 53.2 percent in 2012. The trend was most pronounced among younger physicians, nearly two-thirds of whom were employees by 2016. More recent AMA data show private practice now accounting for less than half of physicians in most specialties. Ownership is not merely a financial arrangement; it confers authority over scheduling, panel size, visit length, and clinical protocols — the very levers of autonomy that burnout research consistently links to physician well-being.

The Weight of Documentation

Documentation compounds the problem. Tebra’s 2025 Physician Burnout Survey identified documentation and charting as the single largest driver of primary care burnout, outpacing patient demands and long hours. Many primary care physicians report spending roughly two hours on paperwork for every hour of direct patient care — 15 to 20 hours of administrative work over a full clinical week, much of it done at home during what physicians wryly call “pajama time.”

Roughly half of primary care physicians report active burnout. The AMA/Mayo Clinic longitudinal study found 45.2 percent of physicians reporting at least one burnout symptom in 2023 — down from a pandemic peak of 62.8 percent in 2021, but still well above other U.S. workers — while the Physicians Foundation’s 2025 survey put the figure at 54 percent. The Commonwealth Fund’s 2025 international comparison found U.S. primary care physicians reporting the highest burnout rate among ten countries studied.

Direct Care as a Proposed Way Out

Stillson’s prescription mirrors a broad and fast-growing movement toward Direct Primary Care (DPC), a model in which physicians charge a flat membership fee — commonly $25 to $200 or more per month — and bypass insurance billing entirely. In exchange, patients gain unrestricted access to their physician by text, phone, email, and same- or next-day appointments, with longer visits and more personalized care. It is the same membership-based, insurance-free approach practiced at the integrative telemedicine practice of Yoon Hang Kim MD, www.directintegrativecare.com.

The model has grown quickly. AAFP data indicate the number of physicians practicing in DPC settings grew by 555 percent between 2017 and 2025. As of 2023, nearly 10 percent of surveyed AAFP members were operating a DPC practice, up from 3 percent two years earlier, and DPC Alliance tracking counts more than 3,600 distinct practices nationwide.

What the Satisfaction Data Show

Multiple surveys point to a striking gap between DPC and non-DPC physicians. The AAFP’s 2024 DPC data brief — drawn from 374 respondents, 177 of them already in DPC — found that 94 percent of DPC physicians were satisfied with their practice, compared with 57 percent of non-DPC physicians, and that 49 percent of DPC physicians reported no burnout at all, versus 14 percent of their peers. A separate survey reported in Medical Economics found DPC clinicians more likely to recommend medicine to their children and far less likely to spend heavy hours on non-clinical paperwork, though that comparison draws on DPC data collected in 2017 against a general physician survey from 2016 and should be read with that timing in mind.

Measure	DPC Physicians	Non-DPC Physicians
Satisfied with practice	94%	57%
Report no burnout at all	49%	14%
Would recommend medicine to their children	~67%	54%
Spend >10 hrs/week on non-clinical paperwork	26.4%	48%

Sources: AAFP 2024 DPC data brief (satisfaction, burnout); Medical Economics / “Moral and Practice Patterns of DPC Providers” compared with the 2016 Physicians Foundation survey (recommendation, paperwork).

The Pediatric Experience

A 2025 national survey of 73 pediatricians across 26 states practicing DPC — published in Cureus and the first large-scale look at pediatric DPC — found that 94 percent were happier than in their prior job and 89 percent reported reduced moral injury. Most practices were lean by design: 85 percent were single-physician offices and 79 percent cared for fewer than 200 patients. Notably, while 73 percent earned less initially, 65 percent of those in practice three or more years reported income equal to or greater than before. As one throughline in the responses put it, without an insurance intermediary the physician again decides what to test, when to follow up, what to prescribe, and how long to spend with each patient — the clinical control Stillson identifies as the antidote to factory-style medicine.

A Shifting Policy Landscape

The movement is no longer confined to the margins. The One Big Beautiful Bill Act, signed into law in July 2025, expanded Health Savings Account (HSA) eligibility to cover DPC membership fees beginning January 1, 2026 — removing one of the most significant financial barriers to patient adoption. The law caps qualifying DPC fees at $150 per month for an individual and $300 for a family and reclassifies those memberships as qualified medical expenses, allowing patients to pay with pre-tax HSA dollars. For many working families, that lowers the effective cost of membership meaningfully, particularly for those already carrying high-deductible plans. The change signals a growing, bipartisan recognition that insurance-intermediated care is not the only legitimate model for the physician–patient relationship.

Legal Pushback on “Factory” Treatment

The tension has also surfaced in the courts. In a 2026 ruling, the Madras High Court in India declined to let MIOT Hospitals treat a cardiothoracic surgeon like a “factory workman,” holding that doctors are independent professionals whose services hospitals utilize rather than employees bound by restrictive covenants. Justice N. Anand Venkatesh voided the non-compete clause as contrary to public policy, observing that hospitals depend on doctors for their existence rather than the reverse. The court rejected the hospital’s attempt to force arbitration and ordered it to pay the physician’s costs.

The case illustrates that the framing Stillson critiques has drawn scrutiny well beyond the United States. Similar questions are unsettled in American courts, where a 2025 review in Neurosurgery found that most non-compete agreements against surgeons are at least partially upheld — even as recognition grows that such restrictions distort the market and fall hardest on physicians early in their careers.

The Trade-Offs of Autonomy

The evidence consistently favors autonomy-driven models on burnout and satisfaction, but an honest account must weigh the costs. DPC is not a costless solution.

Income uncertainty. Building a membership panel takes time, and many physicians earn less at the outset — a real challenge for those carrying educational debt or supporting a family.

The work of ownership. DPC physicians must market their practices, recruit members, and educate patients about an unfamiliar model, all layered atop full clinical duties — and they must self-fund the health insurance, retirement, disability, and malpractice coverage that employers typically provide.

Isolation. Solo practice can mean the loss of the informal consultation networks and peer support that larger organizations supply, though professional communities increasingly help fill that gap.

Equity. Critics warn that, at scale, the model could widen disparities in access for patients who cannot afford membership fees. Advocates counter that fees are often lower than insurance copays and that many practices offer sliding-scale options — but the question remains genuinely unresolved.

Most important, individual exits to DPC, however beneficial for the physicians who make them, do not by themselves repair the financial and administrative structures that produce burnout across the profession. Resilience training does not fix a broken system — but neither does one physician leaving it. Addressing burnout at scale ultimately requires rethinking RVU-based compensation, documentation demands, prior-authorization burdens, and the consolidation of practice ownership.

What the Evidence Supports

Three conclusions follow. First, the factory model is not merely a metaphor; it is a reasonably accurate description of how many health systems organize and pay for physician labor, and the burnout it produces is a predictable result of that design. Second, direct care offers a demonstrated alternative that yields markedly better outcomes on satisfaction and burnout — driven by restored autonomy, smaller panels, and freedom from insurance-intermediated administration. Third, direct care carries real trade-offs and should not be sold as a universal cure.

The most durable path forward likely runs through both: systemic reform inside institutional medicine — redesigning practice along solution-shop and production-line lines, revising volume-based pay, and easing documentation through delegation and better tools — alongside the continued growth of models like direct care that prove what physician-centered practice can look like once the factory constraints are removed.

Stillson’s essay endures because it captures something true: physicians were trained to think — to diagnose, interpret, sit with uncertainty, and build healing relationships over time. The factory model asks them instead to produce. The growing refusal of that bargain, whether through direct care, independent practice, or institutional redesign, is not a fringe reaction. It is a rational response to a system that has misallocated the most valuable resource in medicine — the physician’s judgment.

Disclaimer: This article is for educational and informational purposes only and does not constitute medical, legal, or financial advice. It does not create a physician–client relationship. Readers should consult a qualified professional regarding their individual circumstances. References to research are provided for context; readers are encouraged to consult the original sources.

About Dr. Kim

Dr. Yoon Hang “John” Kim is a board-certified physician with more than 20 years of experience in integrative and functional medicine. He completed his fellowship in integrative medicine at the University of Arizona under Dr. Andrew Weil and holds board certification in preventive medicine along with certifications in medical acupuncture and integrative and holistic medicine. His clinical focus includes low-dose naltrexone (LDN) therapy, autoimmune conditions, chronic pain, integrative oncology, fibromyalgia, chronic fatigue syndrome, mast cell activation syndrome (MCAS), and mold toxicity. He is the author of three books and more than 20 peer-reviewed articles.

Professional: www.yoonhangkim.com    |    Clinical: www.directintegrativecare.com