On June 4, 2022, CNN.com published an Opinion piece written by Carolyn Chen: “Why ‘do what you love’ is the worst graduation advice.” As a mother of a recent college graduate, with two others close behind, I read it to garner insights into which encouraging words to use with my own babies entering the adult workforce. The target audience is college graduates, narrowing the relevance to those privileged to go to college or able to even consider finding one’s passion and making it one’s job. I expected a commentary about how loving work is impractical or that work is for earning wages, not love.

Instead, the author ended the article with this: “I certainly don’t want you to hate your job. Work is an important source of dignity and meaning for all of us. But to love smart in our work-obsessed world, we need to ask ourselves instead: who do we become when we love work too much?”

In this era of burnout and The Great Resignation, I don’t know many physicians who “love work too much.” Most are trying to work less or find meaning in work again. As doctors, I’ve often wondered why we put up with all the strife, injustices, and countless hardships life in medicine requires. Is it love? I know love is a powerful motivator, so I’m curious: What role is love playing in our career choice? Is it a love of intellectual content? The patients? Being needed? Feeling useful? The paycheck? The social capital?

Full disclosure, I’ve never “loved” my job as a radiologist. Colleagues claim to love their jobs and “couldn’t imagine doing anything else.” I worked in a highly lucrative private practice that prioritized revving up productivity over hiring when the economy tanked in 2008 and reimbursements plummeted. Many had joined the group envisioning a certain lifestyle, including luxury cars, multiple houses, and private schools, which wouldn’t be possible with lower salaries. Rather than hiring more radiologists, the majority voted for a hiring freeze, agreeing to work faster, longer hours with less vacation. Physician assistants were later recruited to perform lower-value procedures, so rads were freed up to read more higher-value MRI cases.

A radiologist friend elsewhere said their group followed suit, encouraging RVU- productivity similar to incentives for kindergarteners. A colorful bulletin board assigned each radiologist a construction paper fish swimming from left to right in an ocean toward a finish line, placed according to productivity with the highest RVU fish furthest to the right. The same fish kept winning month after month, only by a narrow margin. Sadly, that partner also died of a glioblastoma multiforme a few years later, despite their RVU record.

Carolyn Chen also writes, “Your love and energy are limited, so you have to carefully choose your objects of devotion.” I’m deeply envious of the love some have for work, as that hasn’t been my experience. I’ve always wondered why I didn’t love work enough to sacrifice more than I have. What was it my partners loved that kept them reading more cases when I couldn’t bear it?

When I left private practice five years ago, it was challenging for groups to hire partners, confronting differences in values. Millennials seeking employment had different priorities and lots of options. Post-pandemic, the landscape has radically changed. Like nursing, the global shortage of radiologists has practices struggling to find new hires willing to work the hours regardless of the pay. Those who’ve survived the trenches are tired. Love is lost. Did paper fish become less inspiring? Why aren’t previous methods of operating yielding the same devotion?

If you grew up believing your work defines you, it could be hard to find self-worth in anything but work. When pandemic demands on health care workers exceeded the capabilities of most humans, the reward was no longer commensurate with the sacrifices. Self-worth plunged as lots of us didn’t have the skills for sustainability.

Self-worth is an inside job. Obtaining it outside of self is possible but not sustainable. Many accomplished, high-achieving adults have no idea who they are outside of work. That used to be me, unable to sustain my well-being in medical culture but lacking any identity outside of it. Sustainable well-being relies on having the emotional tools to support oneself, regardless of circumstances, and requires time, energy, and attention to develop.

If you’re looking for sustainable well-being, you can only do you, a task requiring a diet high in self-love. Nothing else works long-term. We’ve all sacrificed our well-being for what we believe is more important than our well-being. Achievements, fulfilling obligations, and winning approval are measures of success in our world, but are they sustainable on a personal level? The mass exodus from medicine suggests many are answering “no,” yet they’re confused about the role work is now supposed to play in their lives.

I recently spoke with a 14 year old struggling with perfectionism. They love learning. They love the feeling they get when they work really hard and accomplish their goals. They also confided having anxiety about how to enjoy summer break when they won’t be “earning” their downtime, excited for school to start again so they’ll feel more productive, and not yet able to comprehend that this struggle will haunt them forever if they don’t attribute their self-worth to something inherent in themselves.

The Dalai Lama, when asked what surprised him most about humanity, said: “Man. Because he sacrifices his health in order to make money. Then he sacrifices money to recuperate his health. And then he is so anxious about the future that he does not enjoy the present; the result being that he does not live in the present or the future; he lives as if he is never going to die, and then dies having never really lived.”

Who did you become when you loved your medical career more than you loved yourself? Did you choose medicine because you loved it or because you couldn’t love yourself if you didn’t?

Tracey O’Connell is an educator and coach who fosters positive self-worth, psychological safety, emotional intelligence, and shame resilience among physicians, teens, and LGBTQ+ individuals. She is a certified facilitator of expressive writing programs and Brené Brown’s research. Her change of direction came after many years of feeling “not enough” as a person, physician, parent, or partner. Tracey has found that expressive writing allows us to access our true selves, helps us gain self-trust and self-compassion, and ultimately leads to a more authentic and wholehearted way of belonging in the world. She is also an advocate for universal, affordable, fair, safe, and equitable medical access, education, and practice. Since 1992, she has lived in Durham/Chapel Hill, NC, where she began her medical career in radiology and musculoskeletal imaging, training at UNC-Chapel Hill and Duke University.

She can be reached on her website, LinkedIn, Facebook, Instagram @fertile__soul, and YouTube.

Image credit: Shutterstock.com