Some physicians enter medicine clearly grounded in their purpose only to be reinforced by their work experiences. Early in my career, I was inspired by my personal internist’s clear, unwavering passion for his work. He was on faculty at a medical school and volunteered with Doctors Without Borders. His joy and dedication to his works created challenges when his family insisted that he take time away for travel. He embodied his values. He understood his “why”.
This was not my experience.
My identity crisis attempted its first appearance 5 years ago. I had decided to I leave my job as a psychiatrist in an outpatient, community-based practice. My professional role had become incongruent with the doctor I had envisioned becoming. In my misalignment, I had lost clarity in my identity as a physician. I was frustrated and felt ineffective and disconnected from my work.
Somewhere between starting residency and settling in as an independently practicing physician, my core values had become obscured. Actually, I had never clearly articulated my values. I worked under the simple dictum of “doing the best for my patients”. I had plowed through my training, my head tucked into my textbooks and charts, without articulating my core values more clearly.
I suspected that some of my struggling colleagues were experiencing a similar misalignment. I saw it mirrored in the field of medicine as a whole.
As physicians, we are in the middle of an identity crisis. It’s marked by marked by role confusion, loss of autonomy and loss of purpose.
Why does this even matter? Why can’t we just “do our jobs”? See our patients, play nicely with others, chart to meet legal and billing standards, serve on a committee or two and stop complaining. In part, because when we live out of alignment with our values, we become frustrated, anxious and discontent. I entered medical school envisioning a career in which I would be free to practice with compassion, evidence-based clinical judgement and integrity. However, the cultural values within my prior organization supported perpetually increasing workloads, loss of personal agency, and expected compromises in clinical care in the spirit of increasing revenue.
"In part, because when we live out of alignment with our values, we become frustrated, anxious and discontent."
I had personal values too. They were buried under exhaustion, unrelenting professional expectations and frustration. It took me a while to find them again, but they were there. My faith, spending time with loved ones, and caring for my physical and mental health.
Core values matter.
Performing in a professional capacity that is incongruent with our core values can contribute to negative feelings toward work. This internal discontent triggered me to step back and reassess where I was.
A 2009 Canadian study looked at the impact of values congruence on burnout. Values congruence refers to the agreement between personal values and an organization’s cultural values. This study found that workload and values congruence predicted burnout among physicians.
Managing work life imbalance, job dissatisfaction and burnout demands attention to both an internal awareness of core values as well as external work demands and expectations. I realized that while I couldn’t control the external forces I was under, I had absolute control over understanding my core values which allowed me to explore my options. This gave me hope.
Taking a step back, my values were pretty clear. I like my family, I want to be around them. My faith is my compass. My body revolts when I ignore it. So I shouldn’t do that. I hate being grumpy, so my emotional well-being needs care too.
I imagined that my experience wasn’t unique. What if all physicians were to assess how his or her core values and lived experience align? I’m sure that like me, many would find some inconsistencies. Some may even find those inconsistencies intolerable. It’s not surprising since many of us entered this field with an expectation that as highly trained experts in our respective fields, we would be able to practice in a way that would allow us to embody our values. We could then more fully realize our more idealized versions of our personal and professional selves.
Clarity of our core values might allow us to better define our expectations and roles as physicians in the medical field. We could engage in more creative ways to regain ownership over the shape of our field and how we show up in the spaces that we work in. We are often called leaders in our professional settings, but too often find ourselves hampered in our scope of power and responsibility.
In all reality, most of us have real adult responsibilities and expectations. In many cases, in our current lives, we might not be able to find a professional role that checks every box on our list of core values. However, most of us have options. We might be able to make choices that ring more true to who we are.
Imagine if you were asked to divide your life up into individual bits, and then had to let some fall away. Which pieces would you have to keep to maintain a sense of who you are? How can you work in a way that allows you to hold onto those precious parts of yourself?
Ultimately, I realized that rather than converging with my personal values, the chasm between my and my organization’s cultural values was deepening. I had the option to leave, so I did. My leaving was steeped in personal and professional loss. I was losing relationships with patients that I cared about and colleagues who I respected. I lost a steady income and teetered in the uncertain instability of unemployment. But, I gained clarity in what was important to me and was able to make choices that were more in sync with my core values.
Identity crisis was averted, although not entirely. I experienced some distress and a sense of grief in my changing professional roles. However, I felt more at peace with who I was as a physician. I’ve been able to intentionally move towards a better version of myself rather than running away from the discomfort of my old self. Today, that’s seeing patients in my private practice, becoming a physician coaching and writing.
What does that look like for you?
What steps can you take to start clarifying your core values? Start by writing them down. It’s possible that you have never stopped long enough to consider what your values are. They’re yours. You have a right to name them and own them. With this new powerful knowledge, you can see which parts of your life fit and which parts are the square pegs trying to fit into round holes. What choices do you have? Whether large or small, you do have some choices.
What does that look like collectively as physicians?
We need a blueprint to recalibrate our identities and understanding our values is the starting point. What do we value? What do we want to hold onto and align with as a field? How can we use this clarity to collectively position ourselves to be our own advocates? We could become better versions of the experts and leaders in our field. In doing so, we could more effectively engage with our colleagues, form stronger relationships with other workers in health care and most importantly, be fully present for our patients.
For a long time, I had hoped that physician wellness could be nicely packaged in retreats, workshops and flexible work schedules. But this externally derived solution just temporarily holds us together in the same place. We need to heal from within with a greater understanding of who we are and what our true purpose and value in this work really is.
Image: Arek Socha/Pixabay