⚡️ NIMITZ HEALTH NEWS FLASH ⚡️ 

“The Doctor Is Out: How Washington’s Rules Drove Physicians Out of Medicine”

Senate Aging Committee

February 11th, 2026 (recording linked here)

WITNESS

• Alma Littles M.D.: Dean & Chief Academic Officer, Florida State University College of Medicine

• Lee Gross M.D.: Founder, Epiphany Health Direct Primary Care

• Jeffrey Smith CPA, MBA, FACMPE, CGMA: Incoming Board Chair of Medical Group Management Association (MGMA) and Chief Executive Officer, Piedmont HealthCare, PA

• Corey Feist JD, MBA: Co-Founder and Chief Executive Officer, Lorna Breen Heroes’ Foundation

QUICK SUMMARY

• Burnout was framed as a bureaucracy problem (prior auth, EHR clicks, compliance) that was shrinking access for seniors and rural patients.

• Prior authorization was repeatedly cited as a top driver of delays, staff burden, and clinician exits.

• Direct Primary Care was pitched as a lower-bureaucracy model, with concerns about affordability and scale.

• Speakers said the U.S. needed retention + pipeline fixes—training more clinicians would not work if burnout kept pushing them out.

• Mental health harms were tied to workplace design and stigma/licensure fears, not just “lack of resilience.”

PARTY MESSAGING

🐘 Republicans

• Burnout and access problems were framed as the result of top-down regulation and administrative overload that had weakened the doctor–patient relationship.

• The solution focus was cutting red tape, restoring clinician autonomy, and increasing flexibility (including enabling alternative models like direct primary care), with an emphasis on cost control through simplification.

🫏 Democrats

• Burnout was framed as a system-wide workforce and patient-access crisis driven by admin burden plus structural forces like payment design, consolidation/private equity pressures, and workplace conditions.

• The solution focus was streamlining prior authorization and EHR burdens, strengthening workforce pipeline and retention, improving workplace safety and mental health supports, and protecting access for vulnerable communities (rural, seniors, Medicaid-reliant).

MEMBER OPENING STATEMENTS

• Chair Scott (R-FL) said that older Americans had struggled to get timely access to doctors and care, and that many seniors had felt rushed and disconnected even when they found a physician. He argued that doctors had not been villains but had been trapped in a broken, top-down system in which federal mandates and paperwork had forced clinicians to spend more time on compliance than on patient care. He said the resulting burnout had worsened shortages and outcomes, especially in rural and underserved areas, and he stated that the hearing had aimed to examine how Washington’s regulations had contributed to the crisis and what reforms could restore the doctor–patient relationship.

• Ranking Member Gillibrand (D-NY) said that burnout had declined from its pandemic peak but had remained widespread and harmful to access and quality of care, particularly for older adults and rural communities. She said that regulatory requirements had served important purposes such as protecting safety and privacy, but she argued that the current system had been flawed because administrative burdens, prior authorization fights, and billing-oriented technology had drained clinicians’ time and energy. She urged reforms to streamline prior authorization, improve electronic health record usability and interoperability, and simplify payer processes, while also warning that consolidation and private equity pressures had reduced physician autonomy and increased volume-driven demands. She added that stigma and licensing fears had deterred clinicians from seeking mental health care, and she said that Congress and health system leaders had needed to work together to support and retain the workforce.

WITNESS OPENING STATEMENTS

• Dr. Littles said that physician burnout had become an urgent national crisis driven largely by unsustainable administrative burdens that had undermined doctors’ ability to practice as trained. She cited elevated rates of suicide among physicians and higher depression rates among medical students and residents, and she said that many physicians had left medicine not because they had lost passion but because mandates and complex compliance demands had made practice increasingly untenable. She described how Florida medical schools had collaborated on solutions, including wellness programming, expanded counseling supports, and efforts to reduce stigma and reform licensure questions about mental illness. She concluded that wellness efforts had helped but said that meaningful progress had required reducing administrative burdens and reforming federal policies so the system had protected both patients and the clinicians who cared for them.

• Dr. Gross said primary care doesn’t to be routed through an insurance product filled with billing codes and claims for every transaction. He described how unstable Medicare policies, compliance mandates, and federally certified electronic health record requirements had made practice inefficient and impersonal, and he said the medical record had shifted toward billing rather than clinical clarity. He explained that he had moved to a direct primary care model with a monthly subscription, no insurance billing, and transparent cash-based pricing for services outside his office, which he said had kept the cost of purchasing care nearly flat over many years.. He argued that the country had been capable of far more personalized care but that overregulation had pushed medicine toward mass production instead of mass personalization.
  

• Mr. Smith said that administrative and regulatory red tape had fueled physician burnout and had undermined patient access to care through longer waits, shorter visits, and reduced capacity to take new patients. He said member surveys had shown that practices had lost physicians to burnout and that regulatory burden had played a substantial role in many departures. He highlighted Medicare Advantage-related burdens such as audits, denials, prior authorization, downcoding, and lack of standardization, and he said practices had needed dedicated teams simply to interpret quality requirements. He supported legislation to streamline Medicare Advantage prior authorization and urged reforms to MIPS, Medicare enrollment and credentialing, and Medicare Part B reimbursement policies, arguing that payment pressures and regulation together had threatened the survival of independent practices.

• Mr. Feist recounted stories of clinicians and trainees who had died by suicide, emphasizing that they had not lacked resilience but had been overwhelmed by the demands and culture of the system, including fears that seeking mental health care would jeopardize careers. He warned that the country had faced a looming demographic shift as the older population had grown and projected shortages had intensified, and he said administrative tasks like prior authorization had been a leading driver of physician burnout across professions. He argued that programs under the Dr. Lorna Breen Act had demonstrated measurable improvements in retention and mental health outcomes, but he said reauthorization without full funding had been hollow and he urged full FY27 funding and passage of prior-authorization reforms to protect and retain the workforce.

QUESTION AND ANSWER SUMMARY

• Sen. Moody (R-FL) said Florida’s senior-heavy population made physician burnout and access urgent, and she argued that administrative and compliance work had overtaken patient care in an overly regulated system. She said physicians had been leaving traditional practice—often into concierge or direct primary care—and she worried those options might not be affordable for average Americans while shortages worsened.

  Sen. Moody asked what Congress should do to improve quality and cost efficiency without losing more physicians. Dr. Gross said direct primary care had differed from concierge care and that overburdened physicians had otherwise left practice entirely. Dr. Gross said federal law had forced him to opt out of Medicare across his NPI if he directly contracted with Medicare beneficiaries. He urged changing that rule to expand flexibility, especially for rural communities, while noting subscription payment had enabled rapid pivots during COVID-19 and disasters.

• Ranking Member Gillibrand (D-NY) asked for concrete examples of reducing administrative burden via the Impact Well-Being Guide. Mr. Feist said implementations had reduced after-hours EHR work by minutes per patient and streamlined tasks like refills through standing orders.

  Ranking Member Gillibrand asked how CMS’s WISER model would affect traditional Medicare. Mr. Smith said it would increase prior authorizations and denials, discourage physicians from pursuing contested care, and push patients into higher-cost emergency and hospital settings.

  Ranking Member Gillibrand asked how training-practice mismatches drove burnout and consolidation. Dr. Gross said many graduates had lacked practical preparation to run small or rural practices, which deterred entry and accelerated consolidation.

  Ranking Member Gillibrand asked what programs had done to prepare trainees. Dr. Littles said schools had expanded counseling and wellness supports and exposed students to real administrative barriers, while noting practice-management training often got attention only near graduation and that employed practice trends could worsen autonomy pressures.

• Sen. Warnock (D-GA) asked how worsening shortages would affect clinicians already facing burnout. Mr. Feist said staffing reductions had forced remaining workers to absorb more administrative work, worsening access, quality, and cost.

  Sen. Warnock then asked how adding Medicare-funded GME slots would improve seniors’ access. Mr. Smith said more doctors would help but warned debt and pay disparities pushed trainees away from primary care, requiring incentives and reduced administrative burden.

  Sen. Warnock asked about education cost barriers. Dr. Littles said debt and low primary-care pay had discouraged entry and that improving practice conditions could keep more trainees in primary care. Dr. Littles also warned that recent caps on federal loans for health-professions students had risked worsening shortages.

• Sen. Alsobrooks (D-MD) said burnout had stemmed from paperwork-heavy systems that reduced time, support, and autonomy, worsening access and safety risks, especially amid Medicaid cuts.

  Sen. Alsobrooks asked what root-cause reforms mattered most. Mr. Feist said reducing administrative burden and addressing workplace violence and safety—especially for nurses—had been key to retention.

  Sen. Alsobrooks asked about OSHA safety standards. Mr. Feist said physical and emotional safety had been foundational and that routine abuse had been unsustainable.

  Sen. Alsobrooks asked about prior authorization’s effects. Mr. Smith said it had delayed care, driven high staff turnover, and pushed patients toward urgent and emergency care, reinforcing the need for near-term prior-auth reforms.

• Chair Scott (R-FL) asked how documentation and reporting requirements affected rural practice interest. Dr. Littles said EHR cost, complexity, poor interoperability, and after-hours “pajama time” had increased stress and discouraged rural work.

  Chair Scott asked how a day differed in direct primary care versus fee-for-service. Dr. Gross said the old model had forced overbooking, short visits, and box-checking, while the new model enabled same-day access, fewer downstream referrals and ER use, and more care handled within primary care.

  Chair Scott asked about the scale of prior-auth/compliance costs and the difficulty of keeping up with payer and Medicare/Medicaid changes. Mr. Smith said it had been substantial (often at least one staffer per office) and hard for smaller practices to manage.

  Chair Scott asked how much burnout-related mental health harm had been driven by bureaucracy. Mr. Feist said burnout had largely reflected modifiable workplace design and operational choices.