When Complexity Outpaces Care: A Conversation with Dr Clif Knight
Listening to Physician Well-being in Modern Cardiovascular Practice
Medicine rarely changes all at once.
It accumulates.
Episode 129 of Parallax, a conversation between Dr Clif Knight and Dr Ankur Kalra, where clinical complexity, professional fulfilment, and modern cardiovascular practice intersect.
New diagnostic tools emerge. New devices reshape practice. New regulatory requirements are layered quietly on top of old ones. Over time, what once felt demanding begins to feel dense, not because the work has lost meaning, but because the environment has grown heavier.
This conversation with Dr Clif Knight explores that accumulation. It reflects on how physician well-being has become inseparable from the systems in which clinicians practise, whether in outpatient clinics, procedural suites, or the cathlab. It also asks what happens when complexity ceases to be episodic and becomes the background condition of medical work.
Complexity Is Not the Problem. Unexamined Complexity Is.
Dr Knight does not describe the present moment as decline. He is careful with nostalgia.
There are undeniable gains. Diagnostics are more precise. Therapeutic options have expanded. Diseases that once progressed unchecked are now managed through longitudinal care pathways, often with measurable improvements in outcomes.
And yet something fundamental has shifted.
“The environment that physicians work in today is significantly more complex,” he observes, “in some good ways. But at the same time there are a lot of other things that make patient care more complex than it has been in the past.”
The issue is not progress itself.
It is how progress is mediated through systems.
Early in his career, strain was visible and contained. A difficult outcome. A traumatic case. A resident who needed support after a bad night on call. In training environments, these moments were recognised and addressed.
Later, overseeing thousands of physicians across multiple hospitals, Dr Knight noticed what was missing. The safety net had not scaled with responsibility.
The expectation of endurance remained.
The infrastructure for support did not.
From Individual Failure to Systemic Strain
Before burnout entered the medical lexicon, physician distress was often labelled differently. Disruptive behaviour. Poor professionalism. Lack of resilience.
The assumption was individual failure.
Dr Knight’s perspective was shaped by proximity. He saw skilled, committed clinicians struggle not because they lacked motivation, but because the systems surrounding them consistently obstructed the work they were trained to do.
“Everybody gets up in the morning wanting to do a great job,” he reflects. “Wanting to serve patients, to improve outcomes. But there are a lot of things in the physician work environment that impede our ability to have meaningful work.”
Burnout, in this framing, is not collapse.
It is sustained friction within clinical workflow.
Generations Compared Unequally
The discussion turns to a familiar tension. Why does burnout appear more visible among younger physicians and subspecialists today.
Dr Knight does not dismiss earlier generations’ resilience. He contextualises it.
When he entered practice, documentation demands were modest. Coding complexity had not yet reshaped daily work. Communication was bounded. Clinical days ended.
One turning point stands out. The introduction of evaluation and management coding.
“That added a level of complexity to my day that was very dissatisfying,” he says. “It did not feel like it added any value to the care I provided.”
The electronic health record intensified this burden. While access and legibility improved, clinical efficiency often did not. Time once spent with patients was redirected towards screens, metrics, and regulatory compliance.
A tool, he reminds us, should make work easier.
For many physicians, including cardiologists managing high procedural volume and risk stratification decisions, it did the opposite.
The Physician Ecosystem
Rather than offering quick solutions, Dr Knight offers structure.
Physician well-being, he argues, exists within an ecosystem.
There is the healthcare system shaped by regulation, reimbursement, and national policy.
There is the organisation whose financial priorities may or may not align with clinical values.
There is the practice environment where teams function, whether in clinics, wards, or catheterisation laboratories.
There is the individual physician with habits, boundaries, and personal resilience.
And finally, there is the culture of medicine itself, including expectations of sacrifice and silence.
Each layer matters. Ignoring one simply transfers strain to another.
“This is multifactorial,” he says. “We are never going to get to perfect. But what can you do to make things ten per cent better or twenty per cent better over the next year.”
Burnout, viewed this way, is not a personal diagnosis.
It is feedback from the system.
Respect as a Determinant of Professional Fulfilment
One of the quiet insights in the conversation is the central role of respect.
Physicians tolerate complexity when they feel valued. When they feel dismissed or reduced to productivity metrics, motivation shifts.
“When physicians do not feel respected by the organisations they are part of,” Dr Knight notes, “the fallback is if you are not going to respect me, then you are going to have to pay me more.”
That transition from vocation to transaction is costly.
Meaning erodes. Fulfilment thins. Work becomes something to endure rather than inhabit.
Leadership in this context is not symbolic. It is operational.
Moral Injury Beyond Fatigue
As the episode closes, Dr Knight names what concerns him most.
The increasing influence of private equity and profit driven models in healthcare introduces a deeper form of strain. One not addressed by resilience training or individual coping strategies.
When fiduciary responsibility conflicts with patient centred care, physicians experience moral injury.
“Our first concern should always be for patients, families, and communities,” he says. “I worry that fiduciary responsibility to shareholders does not always align with doing the right thing for patients.”
This tension does not simply exhaust clinicians.
It disorients them.
Public trust erodes. Physicians feel it. Professional fulfilment becomes harder to sustain.
What Stays With You
This episode does not claim that medicine is broken.
It suggests something more uncomfortable.
That many physicians, including cardiologists navigating increasing subspecialisation and regulatory burden, are practising in systems that no longer reflect why they entered medicine.
That burnout is often the language systems use when alignment fails.
That improvement begins not with fixing individuals, but with examining environments.
It leaves a question worth returning to.
What in your ecosystem supports the work you value, and what quietly undermines it?
Why You Will Want to Listen
If you are trying to understand why clinical practice feels heavier despite better diagnostics and therapies, this conversation offers clarity.
If you lead a service line, a department, or a programme, it offers responsibility without accusation.
If you are early in your career, it offers language for tensions you may already feel.
Some conversations point forward.
This one asks what must be repaired before progress can be sustained.
🎧 🎧 Episode 129 of Parallax is produced by Radcliffe Cardiology in association with MakeADent.org.