Competition, Burnout, and the Cost of Always Saying 'Yes' as a Clinician

Adam Friedman, MD, professor and chair of dermatology at the George Washington University School of Medicine & Health Sciences in Washington, DC, traces dermatology's yes-first culture back to residency competition, before trainees ever start their careers.¹

Speaking in an on-site interview with HCPLive at LEADderm 2026, held August 29-30 in Newport Beach, California, Friedman said the pressure to say yes takes root long before a dermatologist has any leadership responsibilities to manage.

Friedman said dermatology's match rate has tightened since he entered the field, citing a rate of about 46% last year compared with roughly 60% when he applied. He said the competitive pressure conditions applicants, and later residents, to say yes to nearly everything just to be seen as part of the field's inner circle.

The mindset does not stop once residency begins. Friedman said residents who already hold an MD and a training license, and who are already seeing patients, still operate as though they need to prove they belong.

"Even where I am in my career, sometimes I think of myself still in that position of trying to get to that cool club, so to speak. It gives you a little bit of anxiety that pushes you to say yes, even when you probably shouldn't," Friedman said.

Friedman said no one ever hands trainees a green flag for when it becomes acceptable to slow down, since the message throughout training is simply to keep saying yes. He said the alternative is not always an outright no, but sometimes telling someone he would love to help, just not right now.

Friedman previewed a LEADderm 2026 product theater session built around the same skill: he will present alongside a faculty member he has never met, delegating slides to each other in real time with no advance rehearsal. He said the format mirrors real-world negotiation dermatologists face with medical assistants, practice managers, residents, and even C-suite executives, all without the luxury of preparation time. Friedman said the outcome is not scripted, calling the unpredictability part of what makes the exercise a genuine test of adaptability rather than a rehearsed showcase.

Editor's Note: This transcript has been edited for grammar and clarity using artificial intelligence tools. Friedman had no relevant disclosures of note.

References

1. LEADderm. About LEADderm: the missing curriculum. leadderm.org.

2. Friedman A. Tips on Saying 'No' as a Dermatology Leader, With Adam Friedman, MD. HCPLive. August 29, 2026. https://www.hcplive.com/view/tips-saying-no-as-dermatology-leader-adam-friedman-md.