As we enter another predictably unpredictable year in medicine, we all have some sort of goals for this year, or at least we should. Goals help us experience mastery, even if our goals include brushing our teeth daily, leaving medicine or traveling.

Hopefully, more boundaries are on every physician’s goal list for 2022.

The word “boundaries” brings up our medical school psychiatry rotation or physician-patient relationship for most physicians. But what if boundaries were actually a tool to help us reclaim ourselves as a person and a physician?

Boundaries can be the space between two objects that defines the objects as separate entities with their own shape and definition, physical and emotional space between us. For example, the boundaries of my dog’s body and my cat’s body as they sleep at my feet: there is no confusion where my dog ends and my cat begins.

Boundaries create predictability and a set of behavior expectations, such as speed limits of roads and different laws across the boundary of each state we cross. Boundaries in interpersonal interactions, including work, help us understand and manage the opposing needs, wants, abilities and limitations of parties involved.

As physicians, our training has eroded any boundaries we may have had before medical school. That training indoctrinates us into a professional culture where our needs are often ignored; we are punished for any limitations (medical, family, etc.). Our abilities are often stretched past what is humanly sustainable such as the sleep-deprived call shifts.

Starting as medical students, we are expected to be available at all hours depending on our rotations 365-24-7, working through hunger, harassment, and sleep deprivation. Such ignorance of our physical and emotional boundaries continues in residency and our lives as attendings.

To have boundaries — one has to be aware of their needs, wants, abilities and limitations and actually understand how to set boundaries and how to tolerate the cost of setting boundaries and saying “no” as a physician.

We are all paying daily the cost of not having boundaries with our time, our physical and mental health, our family, and investment into our personal relationships that may wither due to lack of boundaries with medicine.

Since medical training conditions us to be driven by fear, obligation, and guilt (the FOG), we continue being driven by FOG in our attending life, unaware of how boundaries can help us live our life and practice medicine in a way that is sustainable and possible.

With COVID-19, even more, boundaries have been eroded between our work and life — with us practicing telemedicine from our homes, working longer hours, and more shifts in various roles than before, blending the time boundaries we had between shifts.

With the rapid information surges, most of us had to take on more administrative roles, teaching roles at work (let alone home with my children), placing us in more and more roles with intersecting boundaries. With virtual care, the boundaries of how fast or how late a physician is available to work also have been blurred, leading to expectations of availability that are not sustainable. With the medical and systemic issues and physical exhaustion from the COVID-19 pandemic, the erosion and blurring of boundaries between our needs and abilities and everyone’s expectations of us as physicians have left many doctors burned out and leaving medicine. What if before we left medicine, we considered trying boundaries as goals for 2022?

Imagine yourself, a skilled physician who is also likely a partner or spouse, a parent, a child, a sibling, a friend, a colleague, a teacher — as a masterpiece that everyone wants a piece of.

If everyone keeps getting a “piece” of you — whether time, emotional availability, money, physical energy— there may be very little left of this masterpiece, leaving you feeling drained, burned out, and trapped.

Boundaries are like the ropes at the museum that keep every eager visitor at a safe distance to preserve the masterpiece and allow the visitors to enjoy the art. There is also a security guard at the museum that reminds visitors of the boundaries. Unfortunately, in our lives, there is no one but us who has to set and keep up our boundaries.

What people want from us may be reasonable for them — everyone wants the closest distance to the masterpiece. And yet, every person is likely one of the hundreds that day visiting the masterpiece. As physicians, we often have hundreds of various “asks.” Having boundaries is like installing the ropes around the masterpiece to preserve it. Having boundaries also helps you to preserve who you are as a person versus the given identity expected of you by others.

All boundaries have a cost, but so is not having boundaries. We need to be aware of the cost of boundary setting and if we can “afford it” at this current time. At worst, setting a boundary may result in loss of relationships, employment, threats, retribution, physical harm, loss of income. At its healthiest setting, boundaries may result in temporary disappointment and change that leads to our needs being met and feeling the sense of mastery in our lives. Not having boundaries can lead to feeling trapped, helpless, resentful, taken advantage of, regretful, as well as financial and personal costs.

Setting boundaries can look like setting a time limit for patient appointments, availability for email responses, the number of shifts worked this month. You can set boundaries by saying “no” to low compensation, setting a time limit on conversations with friends, setting a limit on our after-hours availability for work-related texts and emails and taking time off as a “pause” rather than getting to a point where we are so burned out we lose any interest in medicine and leave.

Boundaries help the system keep physicians even though it may be inconvenient in the short term. Boundaries help us design the careers we deserve and the life we want.

What boundaries do you need to preserve the “masterpiece” in 2022?

Maryna Mammoliti is a psychiatrist.

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