Family physician and author-filmmaker Dr. Todd R. Otten joins host Dr. Jack Rocco to unpack what’s really broken in American healthcare—and how to fix it. From 120-hour training weeks to 18 million EMR clicks, Todd explains the difference between burnout (personal depletion) and moral injury (systemic barriers that prevent ethical care). He shares the origin of his book Ripple of Change and his forthcoming documentary Suck It Up, Buttercup, which weaves clinician, nurse, and patient stories to show how greed and bureaucracy are undermining outcomes, safety, and clinician well-being—and why policy-level change is essential.

• Burnout: anger, compassion fatigue, and personal depletion from relentless workload, pajama time, and click burdens.

• Moral Injury: the ethical harm clinicians sustain when systems, payers, and policies block them from doing the right thing (eg, prior auth hurdles, time and financial constraints, EMR inefficiencies).

• How moral injury drives burnout, not the other way around.

• One controlled-substance refill can take 27 clicks; Dr. Otten estimates ~18 million clicks before his own burnout.

• 17-page postop notes with one useful sentence—how documentation for billing buries clinical signal.

• Residency tales: 100+ hour weeks, 80+ hour continuous shifts, cafeteria “rules” that defy common sense—death by a thousand cuts.

• Burnout moments: the visceral shift from loving medicine to hating the job you once cherished.

• Traditional Triple Aim: population health, patient experience/outcomes, cost.

• The necessary fourth pillar: clinician well-being. Without it, quality, safety, access, and affordability all decline.

• Since the late 1970s, administrative roles have grown ~20x relative to physician growth.

• We spend 2x other developed nations with worse outcomes and a declining life expectancy.

• Why “sick care” rewards downstream revenue instead of upstream prevention and primary care.

• Three intertwined arcs: physicians, nurses (including a triage nurse who survived a stabbing), and patients.

• Goal: Unlearn learned helplessness, build solidarity, and mobilize policy change through an impact network.

• Half of clinicians are burned out; it affects access, empathy, and outcomes.

• Your voice matters—combining patient and clinician advocacy is key to shifting policy and payment.

• “Moral injury is what happens when systems block you from doing the right thing for patients.”

• “A 17-page note to find one sentence is not quality—it’s billing.”

• “We are not in a healthcare system. We’re in a sick-care system—and it’s killing people.”

• “Add clinician well-being to the aim, or the other aims collapse.”

• Ripple of Change (Book): rippleofchange.us

• Suck It Up, Buttercup (Documentary): suckitupbuttercupfilm.com

• Connect with Dr. Todd R. Otten: LinkedIn (search “Todd R Otten”)

• Website: TheUltimateMensClinic.com

• Location: New Bedford, Massachusetts (virtual options available)

Key Topics Covered1) Burnout vs. Moral Injury2) EMR and Click Fatigue3) Training Reality and Human Cost4) The Quadruple Aim (Reframed)5) Follow the Money6) The Documentary: Suck It Up, Buttercup7) What Patients Need to KnowMemorable QuotesResources and LinksConnect with Dr. Jack Rocco / Ultimate Men’s Clinic