For the past 30 years, I’ve witnessed medicine evolve—new technologies emerge, new treatments are developed, and wellness programs are implemented—but one thing remains stubbornly unchanged: the relentless, often destructive, quest for validation. As I reflect on my career, I can’t help but see a parallel with the TV series Severance, where employees’ work selves—their “innies”—are literally separated from their personal lives—their “outies.” In our profession, our innie is the part of us that chases scores, titles, and external approval. The outie, the person who once chose medicine to care for patients rather than to merely compete, is often left to wither away under the weight of constant expectations and missing out on our lives and our true selves.

The more I think about it, the more I wonder: Have we, as physicians, programmed ourselves to feed an insatiable professional ego at the expense of our true selves? Is our drive to excel rooted in a deep-seated need to be seen as flawless, leaving little room for vulnerability or genuine care? And when things go wrong—as they inevitably do—do we know how to let our outie breathe? I can tell you that I too have suffered under this very addiction.

The programming: How we became addicted to scores and status

From the moment we set foot on the path to becoming a doctor, we are conditioned to pursue an endless series of metrics:

Grades: We’re told from day one that being top of the class, earning honors, and graduating with distinction is paramount.

Test scores: The MCAT, USMLE Steps, and other standardized tests become our measure of worth.

Match lists: Our specialty, our residency program—each placement is a milestone, a confirmation that we’re among the best.

Titles: Intern, resident, fellow, attending, and beyond. Even after we don the white coat, there’s an ongoing race to climb the hierarchy.

Letters after our name: MD, DO, MPH, MBA, PhD, FACP, FCCP—each additional credential is supposed to signal expertise, yet it often serves as another notch on an endless belt.

RVUs: The relentless pursuit of productivity numbers that validate how hard we’re working.

HEDIS metrics and patient satisfaction scores: Our performance isn’t only measured by what we do, but also by how our patients perceive us—sometimes more than our actual clinical outcomes.

Hierarchies: Whether in academic medicine, private practice, or hospital leadership, the question is always: Who is at the top?

At every step, we’re given a scorecard—a set of numbers and titles that define our success. The message is clear: You are only as good as your latest metric, and no achievement is ever enough.

In the early days of our training, this scorecard might have been exhilarating. It was about proving ourselves, about excelling in an environment where the competition was fierce. But as time went on, the chase became an addiction. Instead of nurturing the original calling to care for patients, many of us became entangled in a vicious cycle of outdoing one another. And when validation waned—when that next promotion or higher score didn’t materialize—we doubled down, pushed ourselves even harder, and sometimes even turned on our peers.

The fragility of our self-worth

The tragedy of this addiction is that it leaves us incredibly vulnerable. In medicine, failure is not only inevitable, but it is also a constant reminder that we are human:

We lose patients.
We make mistakes.
We face public criticism.
We watch our peers, sometimes less deserving in our eyes, surpass us.
We are treated as disposable cogs in a vast, impersonal system.

When our sense of self-worth is entirely dependent on being the best, on never faltering, every setback feels like a personal failure. And yet, our original motivation for entering medicine—caring for patients—gets obscured by this relentless need for external approval. I remember a time early in my career when I was praised for my academic achievements, and I felt invincible. But when a mistake occurred—a miscommunication with a patient that led to a minor but significant error—I was devastated. The error didn’t define my competence as a physician, but it felt as if it shattered the carefully constructed identity I had built around flawless performance.

And then there are the power brokers—the administrators, hospital executives, top RVU-producing physicians along with other decision-makers—whose metrics and policies drive this endless competition. They aren’t the ones who suffer when we fall apart; we are. Worse still, when we’re pushed to our limits, we often turn on each other, critiquing and undermining our colleagues who dare to step off the competitive treadmill.

Doc vs. doc: Why we are our own worst enemies

We often point fingers at external forces—administrators, insurers, bureaucratic red tape—for the burnout epidemic in medicine. Yet, a significant portion of the pressure comes from within our ranks. We are our own worst enemies. When a colleague dares to challenge the system, to redefine what it means to be a good doctor, we often react with skepticism or even hostility.

“Why would you leave a prestigious position?”
“You must not be cut out for the field if you can’t handle the pressure.”
“You’re wasting your potential.”
“The data must be wrong, I am a better physician than you.”

These comments aren’t merely idle criticisms—they’re symptoms of a culture that values competition over collaboration, external validation over genuine care. In response to growing burnout, institutions offer “wellness initiatives” and physician coaching programs. Yet, these interventions often feel like band-aids on a system that is fundamentally broken. True healing requires a deep, structural rethinking of how we define success in medicine.

Reclaiming our “why”: From competition to care

It’s important to remember why many of us chose medicine in the first place. Our “why” was rarely about outcompeting our peers—it was about caring for patients, about making a difference in people’s lives. Somewhere along the way, that calling became buried under layers of achievement metrics and hierarchical ladders.

I still recall the moment during medical school when I saw my first patient and how nervous I was in the moment. What would be my “bedside manner?” Would patients like me? Would I be any good at caring? My grades on the tests and exams were far more heavily weighted for my grades. I wondered about the human connection I forged with my patients. It sure seemed there was more to medicine, but my grades brought me validation. As time went on, the pressure to perform took precedence, and the simple act of caring became overshadowed by the need to be seen as the best.

Breaking the cycle: A 12-step recovery plan for physicians

If we are to heal from this addiction, we must treat it like any other addiction—with a clear, structured path to recovery. The 12-step approach, long used in the realm of substance abuse, offers a powerful framework for us to reclaim our identity and redefine success.

Step 1: Admit we have a problem.
Recognize that our self-worth is overly dependent on external validation. The cycle of chasing scores and titles is unsustainable.

Step 2: Believe that real fulfillment comes from within.
Understand that no amount of accolades or metrics can replace the intrinsic value of compassionate care and genuine human connection.

Step 3: Decide to break free.
This isn’t about leaving medicine; it’s about liberating ourselves from the tyranny of the scorecard.

Step 4: Take an honest inventory of our motivations.
Reflect on why we entered medicine. Was it to care for patients? To make a difference? To learn and grow? Or did we get sidetracked by the race for recognition?

Step 5: Make peace with imperfection.
Accept that mistakes and setbacks are part of the human experience. They do not diminish our worth as physicians or as individuals.

Step 6: Support rather than compete.
When colleagues take unconventional paths or challenge the status quo, instead of tearing them down, ask: What can I learn from them? How can we grow together?

Step 7: Accept that the system will not always validate us.
Understand that the system is broken and that external validation is fleeting. True worth must come from within.

Step 8: Make amends—to ourselves.
Forgive ourselves for the years we sacrificed parts of our identity for the sake of achievement. Reconnect with the person who entered medicine with a passion for caring.

Step 9: Redefine success.
Envision what success looks like when it’s not measured solely by RVUs, titles, or patient satisfaction scores. How can we celebrate outcomes that matter—healing, compassion, and genuine connection?

Step 10: Keep questioning the system.
Commit to challenging the metrics and structures that have long dictated our worth. Real change requires continuous introspection and action.

Step 11: Find joy outside of medicine.
Develop hobbies, nurture relationships, and cultivate interests that remind you that you are more than your work. Let your outie thrive.

Step 12: Help others break free.
Support your colleagues in redefining success. Share your journey and encourage others to seek validation from within rather than from an ever-demanding system.

The path forward: Redefining success in medicine

So what does success actually look like for a physician who is determined to break free from the validation trap? It’s not about climbing an endless ladder of achievements or amassing titles and numbers. Instead, it’s about reclaiming our original “why” and ensuring that our identity isn’t consumed by our work.

A successful physician is not merely the one with the highest RVUs, the most prestigious titles, or the longest list of credentials. A successful physician is one who:
Knows their worth beyond their job title. They recognize that being an MD or DO is a part of their identity, but it is not the entirety of who they are.
Leaves work at work. Their “innie” does not define their whole self. They engage in life outside the hospital—nurturing relationships, hobbies, and passions that enrich their existence.

Handles setbacks without an identity crisis. When mistakes happen or criticism arises, they know that these do not define them. They learn, grow, and continue to care for their patients.

Supports colleagues rather than competes with them. They celebrate the success of others and understand that collaboration, not rivalry, is key to personal and professional growth.

Questions the status quo instead of blindly playing the game. They refuse to measure their worth solely by metrics and instead advocate for a more holistic approach to success.

Finds fulfillment beyond external validation. They derive satisfaction from making a genuine difference in patients’ lives, not from the fleeting praise of a performance review.

This vision of success is not flashy. It may not earn you a spot on the cover of JAMA or a wall filled with plaques, but it offers something far more valuable: peace of mind, authenticity, and the joy of truly caring for others.

Whining is not winning—it’s time for action

Recognizing that we’re addicted to validation is important, but it’s only the first step. Whining is not winning. If we simply complain about the system while continuing to adhere to its destructive rules, nothing will change. Instead, we need to take decisive action—a 12-step approach to our validation addiction that can transform how we practice medicine and how we live our lives.

Imagine a community of physicians who, instead of competing over scores and status, come together to support one another. A community where the original calling to care for patients is celebrated, and where the pressures of external validation are met with a collective commitment to redefine success. This isn’t a dream—it’s a necessary evolution if we are to preserve not only our sanity but also the integrity of the medical profession.

Maybe it’s time to stop chasing validation and start chasing something real—a meaningful, sustainable career that honors both our professional achievements and our human worth. The journey won’t be easy, and the system won’t change overnight. But if we begin by redefining what it means to be a successful physician, we might just create a future where our outie can finally flourish alongside our innie.

Final thoughts

In the end, the challenge before us is not simply to excel according to external metrics but to reclaim the core values that drew us to medicine in the first place: compassion, care, and a genuine desire to make a difference. Let’s embrace a 12-step approach to break free from our addiction to validation—because when we do, we not only transform ourselves but also pave the way for a healthier, more humane medical culture.

If my journey from relentless competition to a more balanced, patient-centered approach has taught me anything, it’s that our true worth isn’t measured in scores or titles—it’s measured in the lives we touch. And in that light, whining is not winning. It’s time for action.

Mick Connors is a pediatric emergency physician.