Medicine today is fundamentally different from that of the 1980s and 1990s. The practice of medicine has evolved, but the expectations placed on physicians have not always kept pace.

At the same time, the physician workforce has changed dramatically. Women now constitute a large and growing proportion of physicians, and in obstetrics and gynecology, women comprise well over half of practicing clinicians. That shift matters, not because women are less capable (we are not), but because women, in nearly every society, still carry the majority of the mental and emotional load of family life.

Most women know this reality intuitively. We coordinate households, children, aging parents, schedules, and emotional labor – often invisibly. Many of us now do this while also caring for patients in a healthcare system that is more complex, less forgiving, and financially more strained than it was decades ago.

Insurance reimbursement today is lower in real dollars than it was in the 80s and 90s, while overhead costs, documentation requirements, regulatory burdens, and patient complexity have increased exponentially. As a result, physicians must work harder to keep practices viable – seeing more patients, managing more administrative tasks, and absorbing more unpaid labor just to stay afloat.

Layered on top of this is a newer and growing challenge: the rapid spread of medical misinformation. Social media has become a primary source of health information for many patients, often promoting fear, distrust, or oversimplified narratives that conflict with evidence-based medicine. Physicians are increasingly expected to counter this misinformation – immediately, compassionately, and perfectly – while also navigating a broader cultural erosion of trust in clinicians and science.

All of this happens while physicians continue to show up, day after day, for patients.

What most people don’t see is that seeing patients is only part of the job.

A typical day includes full clinic schedules with little to no break, followed by phone calls, portal messages, lab reviews, prescription refills, insurance authorizations, and documentation – much of which occurs after clinic hours. It is virtually impossible to complete all of this work within a traditional workday.

For many years, I worked late into the evening, at night, and in the early hours of the morning to keep up with work that didn’t involve direct patient contact. Like many physicians of my generation, I believed that this was simply what being a “good doctor” meant. Boundaries were blurred. Availability was constant. Sacrifice was expected.

And for a time, I embraced that model.

But there is a cost to that way of practicing medicine. I lost years with my children – years I cannot get back. And I am far from alone. Burnout among physicians, particularly women and especially obstetricians and gynecologists, is not a personal failing. It is the predictable outcome of an unsustainable system.

If medicine continued exactly as it once did, there would simply be no OB-GYNs left.

We are already seeing physicians leave practice early, reduce hours, or step away entirely – not because they don’t care, but because caring has become incompatible with survival under current expectations.

This is where boundaries enter the conversation and are often misunderstood.

The newer generation of clinicians has taught many of us something essential: boundaries are not a lack of dedication. They are not abandonment. They are not a decline in professionalism.

They are a necessary evolution.

Boundaries allow physicians to remain mentally present, emotionally available, and clinically sharp. They make medicine sustainable. They make care safer.

This may look different to patients. You may not always receive an immediate call directly from your physician. A trusted member of the care team may respond to you. We may ask that certain concerns be addressed through a scheduled visit rather than an additional phone call layered onto an already full clinic day. These changes are not about limiting care – they are about preserving it.

Medicine today requires teamwork, thoughtful pacing, and systems that protect both patients and clinicians.

Boundaries are how we ensure that physicians can continue to do this work – not just today, but for years to come.

They are how we stay present for our patients.
And how we remain whole for our families.
And how medicine survives.