Is Your Employer Taking Advantage Of Your Passion For Medicine?

Closing The Gap Blog – December 2019

In previous generations, work was valued for its extrinsic benefits. We would labor in exchange for compensation, security, and status. But with financial security and stability at an all-time high in human history, the conversation has turned towards the idea that work should also be more than transactional, that it should also be intrinsically rewarding.

Society tells us after all that life is long. If we are going to spend one-third of it working, that work should make us want to get out of bed on Monday morning. We should have a sense of passion or calling with regard to what we do. Even if we could earn the same with less effort, perhaps we wouldn’t choose to do so because of the intrinsic value of the work to us.

And this passion or sense of calling can be powerful in terms of resilience. Research shows that cultivating this sense of meaning in your work can dramatically improve work satisfaction and buffer against burnout. In the Intentional Life Design for Physicians Course at Duke University, my colleague Farr Curlin, MD and I spend a great deal of time focusing on helping physicians re-connect with and re-define their passion. For many of our participants, it is transformative.

Yet there is also a dark side to having a passion for one’s work. When we experience a sense of calling or see our work as intrinsically rewarding, our employers are far more likely to take advantage of us. Research by Professor Aaron Kay at the Duke Fuqua School of Business shows that when we are seen as passionate, others will feel it is more legitimate to ask us to do extra, unpaid, and more demeaning work that is below our level of licensure or skill. They will not hesitate to put more on our plate or ask for more output.

Looking at almost 2500 participants over 8 studies, the results consistently show that when we feel someone is passionate, we will rationalize exploiting them more than their less passionate peers. Furthermore, when we see someone being taken advantage of at work and they don’t quit, we will rate them as more passionate, dedicated, etc.

Given the toxicity of today’s healthcare environment for physicians, we have to ask what role passion and calling might be playing, and how that intersects with conscientiousness. Research has consistently shown that passion and calling are highly correlated with the personality trait of contentiousness. When we have high levels of contentiousness, we aim to do tasks well. We take obligations seriously. If asked, we step up. We aim for high achievement. Unfortunately, this often leads to difficulty saying no and leads to self-oriented perfectionism. It leads to work compulsion and a drive to prove that we can handle anything.

Contentiousness makes us great doctors, but it also makes us the perfect employees to exploit. Imagine you have two employees. One is diligent, reliable, goes the extra mile, and never says no. The other has well-defined boundaries, is more intentional about work-life balance, and does a good job – no more, no less. Who do you rely on? Who do you assign the extra project to, or count on to pick up the slack?

Now imagine you have an entire workforce of passionate, contentious employees who think of their work as calling. A workforce that you can just ask more and more of for less pay and expect no push back. Its called medicine. 

If we are going to be serious about fixing the burnout crisis and toxicity of the physician work environment, we are going to have to face some tough truths – primarily that passion, calling, and the underlying contentiousness that comes with those may make us willing victims of exploitation. Yes, the increasing running of medicine as a business by non-physicians has led to us being ill-treated, but we have equally allowed it to happen.

But fortunately, there is an antidote – boundaries. When we are inspired to do what we do, we are not necessarily good at setting boundaries. This is all too true in medicine where we are implicitly and explicitly taught that setting boundaries is synonyms with a lack of dedication.

But boundaries are what keep our harmonious passion from becoming an obsessive passion. When we lack boundaries, we paradoxically ensure that our hard work will burn us out as we agree to do more and more for less and less. In the long run, a lack of boundaries towards our passion ensures that our passion will be extinguished.

So where could you use more boundaries? Where should you be saying no? Is it the committee that you really have no interest in but someone thought you would be good at it? Is it the research project that bores you to death, but you ought to do for the line on your CV? Is it your employer, who refuses to define what “full time” means in your contract? Is it the colleague who always has a compelling reason to ask for a shift switch and you keep saying yes although it makes your personal life rough? Is it time to speak with your paycheck and leave your toxic work environment because there are better employers out there?

If we are going to avoid exploitation, as individual physicians and as a profession, we have to set more boundaries. We have to realize that we can still be passionate and dedicated while also saying no. While this is hard to do, we need to realize that it is the boundaries themselves that will allow us to do good work for longer. We mistakingly believe that having no boundaries proves our worth as physicians, but in reality, boundaries ultimately allow us to bring our best selves to our patients and the healthcare system as a whole for years to come.

If you want to explore what boundaries you need to set, or what meaningful changes you need to make in your career to thrive again, schedule an initial coaching session today!