From Calling to Career: Why Setting Boundaries Is Essential for Physician Sustainability

The very qualities that make us good doctors — our dedication, our willingness to sacrifice, our sense of calling — are slowly killing us. It's time for medicine to confront an uncomfortable truth.

When I was eleven years old, I was diagnosed with leukemia and spent much of that year in the hospital. During that time, I had three roommates: Dustin, Luis, and Travis. Each of them became a part of my story, and each left a mark I still carry today. Dustin was brave beyond his years, giving himself his own chemo shots. Luis had quiet strength that came from faith and family. Travis fought through relapse after relapse with unwavering perseverance.

I survived. They didn't.

That experience shaped everything about my path into medicine. Like so many of us, I entered this profession with deeply altruistic motivations — to heal, to serve, to answer what felt like a calling. And for years, that sense of purpose sustained me through medical school, two residencies, a fellowship, and into my career as a pediatric anesthesiologist.

But somewhere along the way, I realized that the very qualities that drew me and so many others into medicine — our dedication, our willingness to sacrifice for our patients, our sense of calling — had become weapons used against us.

The System's Exploitation of Our Purpose

The healthcare system has mastered the art of exploiting physician altruism. We're often unfairly labeled as "greedy" when we advocate for fair compensation. We're asked to do more with fewer resources while being told it's "for the patients." We're put in impossible positions where we must choose between our own wellbeing and patient care, knowing we'll rarely let our patients down — and the system banks on that.

I’ve heard these stories frequently, and it has played out dramatically in many anesthesia groups around the country. The perfect storm: a generational workforce shortage, post-COVID scope creep, and leadership struggling to address mounting challenges. As staffing dwindles and workloads increase, we shoulder the burden because that’s what doctors do. We don’t abandon our patients.

The breaking point comes when patient care becomes compromised — operating rooms close, procedures get delayed, access gets limited. By then, many departments have already lost 30-50% of their physicians. The universal response? Healthcare systems pay premium rates for temporary coverage — often 1.5 to 2 times what permanent physicians earn, plus benefits and travel allowances — while offering little to retain the doctors who've stayed. The same institutions that claim budget constraints for retention bonuses or workload adjustments somehow find millions for locums coverage. When token gestures finally arrive, they feel like too-little, too-late attempts to address a crisis that's already in full swing.

The Personal Cost of Professional Martyrdom

This exploitation doesn't just hurt our bank accounts — it destroys us personally. About two years ago, I found myself struggling with burnout in ways I hadn't anticipated. I was doing a good job as an anesthesiologist and a decent job as a father to my two young children, but it took so much bandwidth that I became a poor husband. Post-call exhaustion left me trying to maintain a "normal" life while running on empty.

My story has quietly become an epidemic among physicians nationwide. Recent data from the American Medical Association shows that 63% of physicians report at least one symptom of burnout — up from 38% in 2020. Nearly one in five physicians say they're considering leaving practice within two years.¹

Like many colleagues, I turned to alcohol to cope with the stress, affecting my sleep, workouts, and family life. The stress manifested physically — severe bilateral conjunctivitis followed by facial shingles that left me in agony. These physical manifestations of burnout drove home just how unsustainable my path had become.

The Transformation: From Calling to Career

One year ago, at our group's lowest point, I made a decision that changed everything: instead of looking elsewhere for work, I committed to staying — but on different terms. I also committed to doing better at my job by restarting my journey of self-improvement, but this time with boundaries.

I significantly reduced my alcohol intake. I set limits on the number of calls I would take and increased my vacation time. Most importantly, I began viewing my work through a different lens: this wasn't just a calling anymore — this was also a career, a profession that deserved respect and fair compensation.

The results were transformative. I became more productive than I'd ever been while actually spending more time at home. My relationship with my family improved dramatically.

Paradoxically, by treating medicine more like a job and less like a martyrdom, I found renewed purpose in my work. Setting boundaries didn't diminish my care for patients — it enhanced it by ensuring I could show up as my best self.

The False Choice Between Altruism and Advocacy

In medicine, we've been sold a false dichotomy: that advocating for ourselves somehow betrays our patients or diminishes our noble calling. However, what I’ve come to learn over time is that the truth is just the opposite: When we're well-rested, fairly compensated, and treated with respect, we provide better patient care. By contrast, when we're burned out, financially stressed, and overworked, everyone suffers — including our patients.

Research consistently shows that physician burnout correlates with increased medical errors, decreased patient satisfaction, and higher healthcare costs. By caring for ourselves, we're not being selfish — we're being responsible stewards of our ability to heal.

I still approach every patient with the highest level of professionalism and ethics. I still feel the weight of responsibility that comes with holding someone's life in my hands. But I no longer feel guilty about negotiating my salary, setting work-hour limits, or declining additional uncompensated responsibilities. These boundaries don't make me less dedicated — they make me sustainable.

A Path Forward

I recognize that healthcare administrators face their own pressures — budget constraints, regulatory requirements, and competing demands from all sides. But we must find a way forward that doesn't sacrifice physician wellbeing on the altar of productivity metrics. The current model isn't just unsustainable; it's dangerous.

This pattern plays out across specialties. In outpatient settings, physicians and advanced practice providers are asked to see more patients of higher acuity in shorter timeframes. In hospitals, we're expected to do more with fewer resources while administrators worry about margins. Everywhere, we're told that asking for fair treatment is somehow incompatible with our calling to heal.

What We Must Do

For physicians reading this: Start setting boundaries. Negotiate fairly. Take your vacation time. Say no to uncompensated work. Join or form groups that advocate for physician wellbeing. Your patients need you healthy and sustainable, not burned out and bitter.

For healthcare systems: Recognize that investing in physician wellbeing isn't a luxury — it's a necessity. The cost of turnover, recruitment, and temporary staffing far exceeds the cost of treating your permanent physicians fairly. More importantly, burned-out physicians cannot provide the quality of care our patients deserve.

I think about Dustin, Luis, and Travis often — not just their courage in facing what they faced, but what they would want for the doctors caring for children like them today. They deserved caregivers who were at their best, and so do the patients I see now.

The path from my hospital bed to the operating room taught me that medicine is indeed a calling. But it also taught me that honoring that calling means more than endless self-sacrifice. It means showing up whole, supported, and sustainable. When I negotiate fairly for my time and expertise, when I set boundaries that preserve my wellbeing, I'm not abandoning my purpose — I'm protecting it.

The boy who survived that year in the hospital grew up to become a doctor who could serve for decades, not just burn brightly and burn out. Sometimes the most radical act of service is taking care of yourself well enough to keep serving.

Our patients deserve nothing less than physicians who are empowered to practice sustainably. It's time we demand the same for ourselves.

Reference

American Medical Association. Taking Action Against Burnout: A Systems Approach to Professional Well-Being. National Academy of Medicine; 2023.