My identity crisis attempted its first appearance five years ago. I had decided to 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.
I suspected that some of my colleagues were struggling with a similar misalignment. It permeates the entire field of medicine. Role confusion, loss of autonomy, and loss of purpose have led us to here. We are practicing out of alignment with our core values.
Why does this even matter? Why can’t we just “do our jobs”? See our patients, play nicely with others, finish our charts, 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 ,judgment and integrity. Unfortunately, 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.
I understood the importance of my personal values too. 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.
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 couldn’t control the external forces, but realizing that I had absolute control over understanding my core values, allowing me to explore my options, gave me hope.
I imagined that my experience wasn’t unique. If all physicians were to assess how their core values and lived experiences align, I’m sure that like me, many would find inconsistencies. Many of us entered medicine, expecting that as highly trained experts, our clinical practice would embody our values. We could then more fully realize our more idealized versions of our personal and professional selves.
Clarified core values allow us to better define our expectations and roles as physicians in the medical field. We can engage in more creative ways in shaping 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 fulfills all of our core values. However, most of us have options. Most of us can make choices that ring more true to who we are.
Put it into action
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 me 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.
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.
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