The Scottish Government and health boards across the country have struggled with many challenges over the last year, according to Dr Brian Keighley, chairman of the British Medical Association (BMA) in Scotland.
These include the ageing population, rising expectations from patients and their families about care and the expectation that levels of care should be the same at weekends as well as during the working week.
Dr Keighley used his New Year message to argue that changes to the health service should be made by evolution, not revolution.
Any reforms should be made through a system-wide approach to the NHS and should only be brought in "once there is a clear indication that these changes will produce sustainable benefit and not merely shuffle the deckchairs", he said.
The Government and NHS managers need to "propose less low-value process changes that disrupt health services" and "focus on more consolidation and evolution of existing human and other resources and services".
Politicians should "be transparent with the public that, despite political ambitions, there is a limit to the financial resources available" for the NHS.
Dr Keighley spoke of the "resultant pressure" from "operating within financial constraints" and that "reports of stress and burnout amongst all grades of clinical staff are now emerging across the service".
He said: "An ageing population, increasingly sophisticated technology and pharmacology, legitimate rising expectations from patients and their families, the expectation of consistent levels of patient care over all seven days of the week and faster access to treatment are all pressures with which the Scottish Government and its 14 health boards have struggled over the past year."
It is "only by working with doctors and other healthcare professionals that a solution will be found".
Dr Keighley, who ends his term as BMA's Scottish chairman in the summer, noted the "steady reduction of hospital beds, contrary to medical advice, and without a wider whole-system approach".
This "has led to the inevitable but predictable assertion that it is an intrinsic lack of capacity which has resulted in rising waiting lists and pressure on accident and emergency over recent years".
He said: "Doctors and their clinical colleagues are ready and willing to work in different ways to secure the future of the NHS in Scotland but there is already a danger that the existing workforce is limited in its ability to generate and deliver solutions because of exhaustion with current arrangements."