An excerpt from Boundaries For Women Physicians: Love Your Life And Career In Medicine.

My story is similar to that of countless other women who have chosen careers in medicine. I am a pediatric hematologist/oncologist. A few years ago, I was driving home one afternoon after having spent several hours with a family while they made the difficult decision to withdraw care from their terminally ill daughter. After two years of caring for them and their daughter, the tumor had come back and continued to grow, despite every type of available therapy. Their daughter had spent the last several months in the hospital. And finally, when she was no longer conscious, we knew the end had come.

At these crisis moments, I usually feel deeply connected to my patients and their families and completely in tune with my calling to serve others. While intense and emotionally draining, these times are typically when I am at my best as a physician, when I am most in possession of my inner power and wisdom, and when I feel most vital. However, that day as I was leaving the hospital, I felt exhausted in every way: emotionally, physically, mentally, and spiritually.

For months, our team had been understaffed and reeling with the responsibility of caring for record numbers of new pediatric oncology diagnoses, relapses, and deaths. Added to that had been the deaths of family members, including the young daughter of one of my colleagues. I felt responsible for the well-being of everyone in my group and went above and beyond to help them deal with all of their difficulties. I hadn’t slept well in weeks and had worked every other week and weekend on call for months. I’d gained twenty pounds and couldn’t remember when I’d last had time to exercise, eat a healthy meal, or connect with my husband.

As I drove home that afternoon, the idea of having to return to work at the hospital the next day was unbearable. I kept thinking, “I can’t do this anymore.” I imagined ways to hurt myself so that I would become incapacitated and unable to work. Rounding a curve, I experienced the strong urge to drive off the cliff. Stunned, I pulled over and sat in my car, frozen for what felt like an eternity. I was numb—too numb to cry or to feel any emotion. When I finally made it home, I immediately called my closest friend, the one who knows me like family. He said, “Tammie, it’s time for you to put on your big girl pants. You know how to have hard conversations; you do it all the time with patients and families. And now you have to do it for yourself.”

So, I called my boss and said, “I can’t do this anymore. I need help.” I felt guilty, knowing that my sudden absence would be a tremendous burden on my colleagues. But I simply couldn’t work. I needed to take a break to take care of myself. This low point became the most important learning experience of my life. During my leave of absence, I not only got help—a lot of it—but gained valuable perspective on the difficult working conditions for many physicians—especially women physicians, who are disproportionately affected by emotional exhaustion, burnout, and suicide; are poorly represented in leadership; and often feel compelled to switch to part-time work or leave the workforce altogether due to societal pressures. While away from work, I also discovered the value of coaching, and became a coach myself, going through multiple highly respected coaching certifications. I came back from my leave of absence on fire to change our culture of medicine to make things better for doctors. To do this, I not only returned to my work as a pediatric hematologist/oncologist but also took on several new roles. I became the Medical Director of Provider Wellness for my large health care system, tasked with creating a culture of well-being for our 4,000 providers. And with one of my Brown Medical School classmates, I co-founded Pink Coat, MD, a large digital community and platform designed to bring easily accessible, high-quality, evidence-based resources and professional coaching to women physicians to help them thrive in their lives and careers. I also founded a flourishing coaching business that serves early-career women physicians who want to rise into leadership. And I co-founded ELEVATE, the American Medical Women’s Associations’ first leadership development program for women physicians. My low point forced me to examine my life as a doctor and to formulate my personal mission: to improve the culture for women in medicine now, and for future generations to come.

I learned the hard way what can happen when physicians—especially women physicians—lack personal boundaries. Before hitting my low point, I had no boundaries. I had been raised to give, give, give, and, when times became tough, to give more by working harder. In medical school and training, we were taught to not have boundaries, but rather to do everything in the service of our patients who should always come first. Now I realize that we physicians must put ourselves first. We are hurting ourselves—and doing a disservice to our patients, colleagues, and families—when we put everyone and everything else before our own needs. After all, we are our most precious resource and must use that resource in the best way possible.

As physicians and as women, we experience the double whammy of intense professional and societal expectations. As physicians, we are to care for our patients, staff, and colleagues. And then as women, it is assumed we will also tend to our children, parents, partners, friends, and neighbors. Some of us might even experience a triple whammy of expectations with additional responsibilities dictated to us by our heritage. I am one of them. As a first-generation, first-born, Asian female, I was born into many expectations in addition to those of being a woman physician.

In short, women are often expected to do the impossible: to be everything to everyone. But until we realize this is impossible, we try courageously to fulfill all these roles and we exhaust ourselves in the process. Eventually, we find that we have nothing left to give to anyone. Nothing. When I speak with other women physicians about maintaining boundaries, the one commonality I hear is their visceral rejection of the concept. They understand the need to establish a boundary in the first place, protecting themselves by telling others, “Don’t cross this line.” However, these statements are immediately followed by,

“Maintaining this boundary makes me feel guilty and selfish. I am not supposed to be selfish, so I should give in.” Why is holding to our boundaries so difficult for us? Why do we feel guilty and selfish when we are simply protecting ourselves and our lives?

Let’s turn the concept of “boundaries” on its side and look at it differently. The simple truth of boundaries is that they enable us to protect our most precious resource—our life energy—so we are free to be the healers, partners, parents, friends, and daughters we want to be. Boundaries help us to create freedom because boundaries free our souls. You must determine where you want to use your energy to live your life to its most fulfilled potential. And you must establish boundaries to protect your life energy for this purpose. The boundaries you need are completely personal, and, deep inside, you know what they are. I’m here to walk with you as you figure out your boundaries.

Together, we can do this. My wish is for you to establish boundaries to create personal and emotional sacred space for yourself. Because from this place of strength, you will be able to create anything, including a life and a career you love as a woman in medicine. And my deepest wish is that you will then share your wisdom with every woman you know at any stage of life. When we collectively break down what holds us back as women and physicians, we create a profession full of brilliant, compassionate, and caring people. Our world improves tremendously when women like you are leading and caring for our patients, families, and communities, and I know without a doubt, the ripple effect and impact on our world will be endless.

Tammie Chang is a pediatric hematology-oncology physician and co-founder, Pink Coat, MD. She can be reached on Instagram @tammiechangmd and at her self-titled site, Tammie Chang, MD. She is the author of Boundaries For Women Physicians: Love Your Life And Career In Medicine.

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