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Pediatrician and certified coach Jessie Mahoney discusses her article, “What if we stopped sacrificing ourselves to practice medicine?” She explores the pervasive culture of martyrdom and self-sacrifice within the medical field that often leads to physician burnout and a deep yearning for greater peace and purpose. Jessie shares her insights from coaching hundreds of physicians, emphasizing that the issue is not a lack of resilience but a system that discourages well-being. The conversation covers her “7 Cs of transformative change”—Courage, Creativity, Calm, Compassion, Capacity, Commitment, and Community—as a framework for physicians to reimagine their careers and lives. Jessie also recounts her personal journey from feeling depleted to creating impactful wellness initiatives, including retreats and coaching, to help fellow physicians reclaim joy, meaning, and alignment. The key takeaway is: Physicians deserve to prioritize their own well-being, and by embracing self-compassion and intentional change, they can move from a state of sacrifice to one of sustainable purpose and fulfillment, ultimately benefiting both themselves and their patients.

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Transcript

Kevin Pho: Hi, and welcome to the show. Subscribe at KevinMD.com/podcast. Today, we welcome back Jessie Mahoney. She’s a pediatrician and a certified coach. Today’s KevinMD article is “What if we stop sacrificing ourselves to practice medicine?” Jessie, welcome back to the show.

Jessie Mahoney: Thanks so much for having me.

Kevin Pho: All right, so tell us what led you to write this article in the first place, and then tell us about the article itself.

Jessie Mahoney: So, what led me to write this article was actually a talk that I gave for pediatricians and adolescent medicine doctors who are part of a group lifestyle medicine group. They were really wanting to talk about how to make change and how to have a practice that you really want, and it was clear that so many people have this desire to practice medicine in a different way, in an authentic and aligned way, and they don’t know how to do it.

They don’t know how to get there, and there’s sort of this stumbling block wall. And so the talk that I gave for them was really about why: What are the thoughts in our brain that keep us from being able to do this and keep us from being able to use these incredibly smart brains that we have to build practices that are aligned, offer great care, and that sort of meet everybody’s needs?

The primary one that comes to mind is that we are supposed to sacrifice ourselves and be a martyr, and that it isn’t about what we want or what we’re interested in, rather than sort of thinking what in medicine we want and are interested in could actually bring the most benefit to the culture of medicine, our patients, and ourselves.

And so it started with that. But I have talked for a long time about this culture of self-sacrifice and martyrdom in medicine. When I graduated from residency, it was like if you weren’t a self-sacrificer and a martyr, you weren’t a good doctor and you didn’t care.

That was really the litmus test for who cared and almost deserved to be a doctor. But since that time—and I graduated right around the time that medicine switched from more private practice to managed care—this new model of medicine is not functional and it’s not sustainable.

It’s something that essentially just leads to burnout and leads to dissatisfaction. I see that as the primary thing that gets in the way of change. There are a lot of other things that get in the way of change, but it struck me that if you’re really looking at the linchpin, it’s really this idea.

I like to think that we’re here to give care and we’re here to take care of people, but not to be a self-sacrificing martyr. And if your intention and your drive come from that—which for every physician, it really does, that’s how we got here—leaning back into that can get us out of all this noise in our brains about judgment, what will people think, and what if I make a mistake? But this idea of sacrifice being a requirement really gets in the way of all of us practicing good medicine. One of the reasons I wanted to talk about it on the podcast, though, is that I’ve received several emails about this article. I mostly work with women in medicine because I’m a woman in medicine, except for the institutional work I do.

All these emails came from men, which really surprised me. And so this idea of self-sacrifice and martyrdom is really a universal concept that hits home for a lot of people, and many people in medicine want to shift or want to lean into a more authentic way of practicing, but are stuck on this idea of self-sacrifice and martyrdom.

And one of the things that came up in these emails, which is not really addressed in the article, is this subtle idea that because that’s the culture, we judge our colleagues about whether they’re self-sacrificing and being a martyr. And so we make it even harder to make a change, and we all tend to feel more stuck. I just thought that was a fascinating twist on something that I’ve talked about for a long time, so I thought it would be worth having a conversation here.

Kevin Pho: Talk to us about that culture of martyrdom and self-sacrifice. I think it starts all the way from people who want to be doctors, right? These pre-med students. My daughter is a pre-med in college, and that culture of self-sacrifice is already instilled in her from the very beginning. That only perpetuates and persists throughout medical training, internship, and residency. So talk about how much that self-sacrifice is already so deeply embedded in the culture of medicine.

Jessie Mahoney: I would say it’s deeply embedded in a lot of cultures, but medicine’s probably the “worst.” We have these unspoken rules that we’re here to serve—and serve comes from the root word “servant,” by the way. And so just to recognize that, I think we’re here to care.

And so it’s the language. You have to sacrifice to get into medicine; I will actually say that’s required. And it isn’t that sacrificing here or there is, in and of itself, a problem. We always make sacrifices as we’re negotiating life and competing priorities, but we need to recognize that that’s not the litmus test of good medicine or being a good physician.

And so the unspoken rule is really that we have to practice and serve and learn and study to the point of depletion. We actually know from neuroscience that that point of depletion is not where we learn the most. If you’re in medical school, that’s not where you learn the most. It’s not where you have the most creative solutions.

Medicine requires creative solutions, and this idea of sacrificing is very depleting. In contrast, you might do the same studying from a point of, “I love medicine. I find pathology and immunology fascinating,” and then you’re not as depleted. And so to me, it’s literally the language that we’re using about it and the litmus test of judgment around it that is causing the problem.

Because I would say to be a pre-med, it does take some sacrifice. To be a resident, it does take some sacrifice. Now, certainly, we can change the culture, but it isn’t that sacrifice is bad. It’s really this idea that that’s what makes us healthy and that there’s shame if you want things to be different or don’t want to do that.

From neuroscience, you actually know that shame keeps us out of learning and growth and being the best doctors we can be. And so it’s actually this sort of negative spiral that’s really contributing to burnout. And could we, all the way back—I’m thinking to your daughter who’s a pre-med—but all the way along, create a culture where we can love medicine and still be healthy humans, and that good medicine is not equated with sacrificing yourself? It’s equated with caring for yourself and others.

Kevin Pho: I want to get back to the room where this article was drawn from, that talk that you gave with all the other physicians who were there. Give us a sense of some of the stories that you heard. What kind of practices were they in? Why did they feel stuck? Tell us what that climate was like in that room and what these physicians were specifically looking for from you.

Jessie Mahoney: This room had a very specific climate in that these are people who are all part of the lifestyle medicine world, which is a world where many people are heading because they want something more from medicine.

They want medicine to be more about health than illness. And so these are folks, generally, who work in employed positions and who want to be able to bring in more health and wellness, nutrition, and stress relief, and figure out how to have a practice that feels creative but feel stuck.

They feel they can’t do it. They don’t have the resources. They’re in their scarcity mindset. They might be afraid they’ll fail. They don’t want anybody to be disappointed in them, and they don’t want to make a mistake. They think there’s a right way and a wrong way to do it. And so they’re kind of in this spot of stuckness, thinking, “I would like to do something different, but this practice that I’m in potentially doesn’t have room for it.”

Sometimes it does, and we just aren’t sure how to ask. But it’s really that sense of, “I really want to do something more. This isn’t why I went into medicine, but I don’t know how to get there.”

Kevin Pho: All right, so we talked about the climate and the issues. Now, tell us about some of the interventions. How can we dig ourselves out of this culture of martyrdom and self-sacrifice, knowing that it’s so embedded or entrenched in our culture? What are some of the first steps that you recommend and counsel for physicians?

Jessie Mahoney: Part of it is actually noticing that that’s how you think and that your brain is constantly dropping into this idea that “I have to do that in order to be accepted and welcomed and thought highly of,” which is really important to us in medicine.

In fact, we have a lot of trauma about being judged in medicine. If you go back to med school and residency, and even in our practice, we tend to judge each other harshly. And if we get judged, our mind thinks something bad can happen. And so the first thing is to notice that you’re coming from that place.

The second thing I actually say is really about calm and doing that nervous system work because you can’t change and move forward from this fight-or-flight reactivity, this cortisol bath, which is where we all are. So the idea is we have to take not only good care of ourselves but also of our nervous system.

Learn tools to breathe—that’s one of the simplest ones—but learn tools to unwire a little bit to have a better-balanced nervous system because that’s the only way you’re going to successfully move forward. You can push yourself, but then you run out of willpower, which is always what happens in medicine anyway.

It absolutely takes courage. I think many people think that it’ll just be easier. It’s actually the harder path to forge your own path, and you have to recognize that it takes courage. Most of us like being courageous, but we don’t step into it. And so you have to understand that it’s not the easy pathway; it’s the harder pathway.

It can be the more rewarding one. And then I also like to think capacity is another one. Your nervous system has to have capacity, but you also have to slow down. You have to have space and time to think. Many people want to do this on top of everything else they’re doing.

Very often, we need a pause. I’veseen most people be successful when they take one. It could be a sabbatical, it could be taking a few hours a week to focus on this and think about it, or it could be doing a short retreat, but you need some kind of space where you’re not depleted and below empty because you can’t make choices. And that’s actually when you have martyred yourself: you’re depleted and below empty. Most of us actually stay in a system and in positions that don’t work for us when we’re in that state. And it’s a little bit self-fulfilling, right? We martyr ourselves, and then we feel stuck, and that’s all we can do.

I think the other really important piece is community. Very often, we want to do this by ourselves. And so having the support of just sharing physical space with people and having the conversation helps. When I was giving this talk to a group of people who all felt similarly, that opened up the possibility of having the conversation.

I actually work with a lot of women physicians in groups where, all of a sudden, they don’t feel alone. They recognize that there are paths, and seeing other people do it makes it less scary. And so I think that is just a really helpful way of thinking about how you can support yourself. You can do a retreat or you can do a coaching group, but you can also have a community of your med school friends who maybe support you or who’ve been through things. But I think recognizing that we don’t have to do it alone is key. We’re so used to doing it alone and feeling isolated, and feeling isolated triggers the danger signal in your brain. Then it’s much harder to do it; your capacity drops.

And then it’s also just really a commitment. It is hard, and you don’t know how to do it until you’ve gotten to the other side. The recipe in medicine, our recipe for success, is to follow these boxes. And when you’re trying to step out of this self-sacrifice, martyrdom culture, there’s not a checkbox for how to do it. You’re really forging your own path.

And so it just takes reminding yourself constantly that people aren’t necessarily going to agree with you. You might be the person who goes first, the one who sort of does it on their own. And so you really are often the person in your practice going first.

But you’re modeling for others what healthy medicine can look like. Because I think even as I say it here, that old, deep-seated thought comes up: “Well, someone’s going to think that I don’t think we care about patients or we don’t want to do what we’re supposed to do.”

And it’s not that. I actually think that by not sacrificing and by not martyring ourselves, we actually care more. It will create a culture of medicine that’s sustainable. That’s the highest bar. And I don’t think that means you have to leave medicine or you have to have a direct primary care practice. You could just change the culture in your practice. It’s a caring culture that cares for the caregivers, for you and your colleagues, and for the patients. That’s a very different energy than self-sacrifice. And it would be sustainable if we were willing to take the risk to jump into it. But it definitely feels risky in our current culture.

Kevin Pho: So to your first point, there’s a certain amount of irony that the current path of martyrdom is actually the more difficult path but is ultimately less rewarding.

Jessie Mahoney: Potentially, they’re both difficult. I think sometimes we think, “If I leave, it won’t be difficult.” Well, they’re both going to be difficult. It’s just a matter of which “difficult” you want to work through and where you want to end up.

Kevin Pho: In your article, you ask a question as a starting point: “What would love do?” Right. So, talk more about that question and how physicians can use that as a starting point.

Jessie Mahoney: This is my favorite question. I see medicine as a really loving, caring culture. And so if you feel like “love” is a little mushy, you could replace it with “care,” OK? But it’s really this idea that it’s an activating energy, and it’s making decisions from an energy of love or from an energy of possibility and hope—which are all encompassed in love—rather than making a decision from fear or frustration, like, “I can’t do this anymore.”

The way of asking it is really asking yourself, “What would love do?” And then for me, “What would love do for my patients? What would love do for my colleagues? What would love do for the culture of medicine?”

And you can see as you ask this question, it wouldn’t be to self-sacrifice and martyr, right? And so it gives you this real access to creativity. Of like, well, what kind of a practice would love create? Or how might love tweak my 15-minute visit to bring in things that make me feel alive or bring in some joy or bring in some connection or hope, even for patients?

I think it allows us to step outside of the box. I think everyone wants to move through the world, hopefully nobody in medicine from a place other than love. I do sometimes say, because I use this language in coaching and in my writing a lot, that in some cultures, love would self-sacrifice and martyr.

So I always make the point that if that’s true for you, maybe use the word “peace” or use the word “care.” What would peace do? How would peace move forward? What kind of practice would peace build, or what kind of practice would love build? You can tweak the language if your background immediately says, “Well, love equals self-sacrifice and martyrdom.”

And it’s kind of interesting that those two overlap for many people. I really do think if you think about love for yourself, what would that do? We tend to never consider that. And yet, physicians are some of the most brilliant minds and the most caring humans. So if we acted from this place of authenticity and care for ourselves, I think we could bring so much more to the world.

Kevin Pho: We’re talking to Jessie Mahoney. She’s a pediatrician and coach. Today’s KevinMD article is, “What if we stop sacrificing ourselves to practice medicine?” Jessie, as always, let’s end with some take-home messages that you want to leave with the KevinMD audience.

Jessie Mahoney: I think the message is that different is possible and that self-sacrificing and martyrdom is not sustainable. And so sustainable medicine, which I think of like a green and sustainable planet, is really the highest bar. That would really come from practicing from a place of love, caring, peace, and a sense of coming alive rather than our litmus test of being self-sacrifice and martyrdom.

I think the last message would be that it has to start with you. I think we wait for the culture to be accepting of it, but it’s going to take individuals standing tall and leaning into what they want to bring to the world of medicine, rather than this old culture of being in a place of depletion being the highest bar.

Kevin Pho: Jessie, as always, thank you so much for sharing your perspective and insight, and thanks again for coming back on the show.

Jessie Mahoney: Thanks for having me.