Tonie Reincke MD had not been asked whether the practice should be sold. When private equity took over, the vote simply did not include the physicians delivering the care. What followed, Reincke says, was a series of directives that made the injury concrete: treatments selected not by clinical judgment but by metrics and profit margins. That is the moment that tends to get labeled burnout in the public conversation, but Reincke and a growing number of colleagues argue the word is doing something harmful by being so imprecise.
The distinction matters because the two problems have entirely different causes and therefore entirely different solutions. Exhaustion can be addressed with shorter hours, more support staff, better scheduling. What Reincke is describing is something closer to a forced compromise of professional integrity, being required to act against what you know a patient needs because the organization's financial interests point somewhere else. That is not a wellness problem. It is an ethical one.
"Being bought out by private equity (not my vote) and told to implement treatments that were clearly motivated purely by metrics and profit."
Reincke had seen enough of the direction things were heading to act on it quietly, saving toward an independent practice before the situation reached a breaking point. By 2021, that plan became a reality. The decision to leave and build something outside the private equity model was deliberate, and Reincke is unequivocal about it.
The broader conversation in medicine tends to focus on physician wellness programs, mindfulness initiatives, and reducing administrative burden, all reasonable on their own terms but largely beside the point if the underlying structure keeps asking clinicians to subordinate patient care to financial targets. Reincke puts the pressure directly on the people who profit from that structure, asking how anyone sleeps at night making millions while patients are denied basic care.
That question does not have a comfortable answer, and it is probably the right one to be asking. The term burnout, whatever its usefulness in other contexts, tends to locate the problem inside the physician, as a personal failure of resilience. The physicians pushing back on that framing are pointing somewhere else entirely.
