The Day the System Broke Me: A Story of Medical System Burnout

7-11-2025

By Dr. Howard Friedman MD | Veteran | U.S. Army Medical Corps | Internal Medicine | HHOM LLC

A hand writes in quiet reflection beneath the gaze of a soldier—medicine, memory, and stillness converge.

I came to heal, not to sell a lie—

But systems bend where profits lie.

I walked away to find what's true,

And built a place that honors you.

—Dr. Howard Friedman, MD

I. My Desire to Heal – One Person at a Time

By age eight, when I gave up on a future in professional baseball, I decided I would become a physician—and heal the world, one person at a time. I even had the name ready: Howard’s House of Medicine.

What drew me to medicine wasn’t status or salary. It was connection—listening, analyzing, and advocating for others. Healing wasn’t just about treatment. It was presence. Service. Compassion. I believed medicine should be without competition, rooted in the light of care—not clouded by profit. This story isn’t just personal—it’s a reflection of what medical system burnout looks like from the inside out.

That belief guided me to Case Western Reserve University School of Medicine, known then for its collegial environment. My career began with the U.S. Army, followed by a brief time in private practice with five partners. That was my first real exposure to how care could be twisted into commerce. Still, we were on the lower rung of the for-profit ladder—until the year 2000.

II. 2000 – The First Fracture

In 2000, we sold our practice to the for-profit side of University Hospitals. We were made to watch a video on how they operated: money first, care second. The training wasn’t about healing. It was about how to ask questions that generated procedures and billing codes—not wellness.

Our compensation would be tied to how much revenue we brought in. I had responsibilities at home, but I knew I couldn’t stay. I didn’t sign up to extract value from patients. I came to serve.

That was the first break—and the beginning of my search for a different kind of medicine.

III. A Better Chapter – The VA

The VA felt like a return to purpose. When I joined, it was about one thing: taking care of veterans. That aligned with everything I believed. Over the next 17 years, that belief held strong. We expanded care—home visits, pain evaluations. It restored my faith in the practice of medicine. For a time, it was a place where service still meant something.

IV. COVID – And the Collapse

Then came new leadership. And then came COVID. We pivoted quickly offering care via video and telephone. Veterans preferred phone calls. Many struggled with video platforms, and for some, the phone was their only safe connection. But the administration decided: no reimbursement for phone visits meant no phone visits. They ordered us to switch to video—or make veterans come in.

The message was clear: once again, money over care. As a supervisor, I also saw inequity creeping in—new hires offered higher salaries than those who had served VA patients for over 20 years. Meanwhile, my own providers were being paid less than colleagues at other VA sites. I had seen enough. This was the final fracture. I would not return to that kind of medicine.

V. Leaving That Kind of Medicine Behind

I wasn’t ready to retire. But I knew I couldn’t go back. I explored legal medicine, but it lacked heart. I wasn’t interested in being flown across the country to testify. Telehealth sounded promising—until I realized many companies just wanted me to prescribe GLP-1s or testosterone.

Other offers included utilization review, where my job would be to deny patient requests. That was an even bigger no. I was done with quotas, dehumanization, and the expectation to "do more with less." But I wasn’t done with medicine. I was done with what medicine had become.

VI. Finding My Place: Nexus Letters, Healing, and HHOM LLC

Then I found Nexus Letters—not a business, but a return to meaning. It was everything I loved: listening, analyzing, advocating. Writing with integrity. Serving veterans—some I may have once served beside.

It was a chance to use my knowledge to defend, not exploit.

That’s how HHOM LLC was born. Every word on this site, I write. One person at a time. No sales pitch. Just service. The heartbreak of my journey became the foundation for hope.

Medicine is broken. It’s a profit system that thrives on disease. Prevention is undervalued. Healing is rushed.

That’s not the medicine I practice. That’s not the medicine I believe in.

VII. Why I Built This Practice

I built this practice for veterans, attorneys, patients, and anyone who wants to heal—not just survive.

This work is small by design. It’s personal, not corporate. Here, care comes first again.

The system may be broken. But I’m still here. And I see you.

Thank you for reading.

I didn’t quit medicine. I just stopped pretending the system was medicine. I built HHOM LLC for the ones who still need care—not just codes.—Dr. Howard Friedman, MD

—Dr. Howard Friedman MD

Board-Certified | Internal Medicine | Veteran | U.S. Army Medical Corps

Founder of Howard’s House of Medicine (HHOM LLC)

https://www.hhomllc.com

Frequently Asked Questions:

Q: What does “The Day the System Broke Me” refer to?

A: It refers to a breaking point—a moment when the burden of bureaucracy, compassion fatigue, and institutional indifference overwhelmed me. This wasn’t about one bad day. It was the accumulation of years within a system that often forgets the human cost paid by both veterans and the physicians who serve them.

Q: Why do so many veterans and physicians feel unseen in the system?

A: Because the system wasn’t built for healing—it was built for managing. Metrics replace meaning. Delays replace care. Veterans feel dismissed. Physicians feel shackled. And when both are dehumanized, healing becomes transactional instead of transformational.

Q: Is there a way to rebuild after being broken by the system?

A: Yes, but not by returning to the same system unchanged. Healing begins with truth-telling. With naming what broke you and refusing to let it define your future. That’s what HHOM LLC is about—restoring voice, dignity, and purpose for those who've been worn down by a system that was never meant to carry the weight of their stories.