N.J.’s physician burnout crisis is pushing doctors to leave | Opinion
Somewhere in New Jersey tonight, a primary care doctor is sitting at her kitchen table, still in her work clothes, clicking through an electronic records system to document patient visits she never had time to finish at the office. In medicine, this has a name: “pajama time.” For many New Jersey physicians, it is now simply part of the job.
New Jersey already has one of the worst primary care shortages in the country. According to the New Jersey Health Care Quality Institute, the state has only 17 primary care physicians per 100,000 residents — among the lowest concentrations in the nation and a fraction of what most other states can claim.
In practical terms, that means longer waits for primary care appointments, more rushed visits and fewer doctors available as New Jersey’s population ages. A national physician shortage projected to exceed 187,000 doctors by 2037 will only make New Jersey’s problem harder to solve.
Whether a patient lives in Newark, along the Shore, in suburban Middlesex County or in a rural part of South Jersey, fewer available physicians mean care becomes harder to reach.
Roughly one in four New Jerseyans already lives in an area officially designated as medically underserved. New Jersey ranks 48th out of 50 states in spending on primary care — a number that helps explain why the shortage keeps getting worse.
This is not an abstract workforce problem. It is the difference between catching cancer early and catching it late. It is the senior in Salem County driving an hour for a routine visit. It is the uninsured worker in Passaic whose only option is an emergency room. When physicians burn out and leave practice, their patients do not simply find another doctor. In many parts of New Jersey, there is no other doctor to find.
So what is pushing doctors toward the exit?
The electronic health record — the EHR — was supposed to modernize care, and in many ways it has. But it has also become what physicians describe as a “digital tether,” an inescapable administrative pull that follows them home long after the last patient has left.
In New Jersey’s busy outpatient offices, where physicians are expected to move quickly from one patient to the next, that work often gets pushed into the evening. Documentation that cannot be finished during a packed schedule gets completed at the kitchen table, late into the night.
Doctors are not burning out because they forgot how to work hard. They are burning out because too much of the work no longer feels like medicine. Research consistently identifies the loss of clinical autonomy — the sense that administrative systems, rather than patient needs, are driving the day — as one of the most corrosive forces behind physician burnout.
When a doctor’s worth is measured in clicks and checkboxes instead of patient relationships, something vital breaks down.
Compensation models make the problem worse. Many physicians in outpatient settings across New Jersey — from independent practices in Bergen County to Federally Qualified Health Centers in Camden to urgent care groups along the Shore — are paid through relative value unit (RVU) systems.
In essence, RVUs reward the volume and complexity of care. Too often, however, they fail to account for the unpaid work performed before and after patient visits.
In practice, these models create quota pressures that clash with the values that first drew many physicians to medicine. A grieving widow in Bergen County managing five chronic conditions, or a young man in Camden facing a daunting new diagnosis, is not well served by a productivity-driven model.
Meanwhile, New Jersey Medicaid reimburses primary care physicians at roughly half the rate of Medicare, making it increasingly difficult for practices that serve the state’s most vulnerable residents to remain viable — and even harder to retain the physicians committed to their care.
The U.S. surgeon general has formally classified health care worker burnout as a national crisis, calling for structural reform rather than more wellness seminars or mindfulness apps. New Jersey should treat that call as a local policy challenge, not just a national talking point.
Physicians cannot meditate their way out of three hours of nightly documentation. And New Jersey cannot solve a patient-access crisis by asking exhausted doctors to be more resilient.
This is a problem for health systems, insurers, NJ Medicaid, the Department of Health and lawmakers in Trenton because physician burnout quickly becomes a patient-access crisis.
New Jersey leaders should start by measuring how much after-hours EHR work physicians are doing and use that data to demand documentation reform from technology vendors and federal regulators.
Addressing this crisis will require deliberate action from state leaders, starting with a few clear steps:
- Expand team-based care models that allow medical assistants and care coordinators to shoulder administrative tasks, freeing physicians to practice at the top of their training.
- Examine whether payment models — including NJ Medicaid rates — reward continuity, complexity and quality of care or simply push more visits into already overloaded schedules.
- Invest in FQHCs, independent practices and community health centers that serve the New Jerseyans least able to absorb the consequences of a shrinking physician workforce.
None of these are simple. But the alternative — continuing to treat physician burnout as a personal problem while the shortage deepens — is a choice with real costs, paid by real patients across this state. The New Jersey doctor sitting at her kitchen table at midnight is not failing. She is being failed. And so, quietly, are her patients.
Moishe B. Singer is a health care executive based in New Jersey and a doctoral candidate at the Edward J. Bloustein School of Planning and Public Policy at Rutgers University, where his research focuses on physician burnout in ambulatory care settings.
Soumitra S. Bhuyan is the executive director of the Health Administration Programs at the Edward J. Bloustein School of Planning and Public Policy, Rutgers–New Brunswick.