For physicians, burnout is the inevitable consequence of the way that medical education is organised and the subsequent maladaptive behaviours that are reinforced in healthcare organisations via the hidden curriculum. Thus, burnout is an important indicator of how the organisation itself is functioning. A central theme in this paper will be the degree to which the organisational systems are responsible for the disconnect between performance and physician health. Healthcare pays considerable ‘lip-service’ to systems approaches, but in practice it valorises the role of the individual physician in terms of both success and failure. Thus, this contradiction needs to be addressed.