In medicine, we are trained to act decisively in moments of crisis. We respond to hemorrhage, cardiac arrest, and trauma with clarity and speed. Yet when the crisis is internal (when the dysfunction lies within our teams, our leadership structures, or ourselves) many of us hesitate. We tolerate misalignment because it is familiar. We fear change more than we fear staying stuck.

This fear is not benign. It erodes morale, fractures communication, and ultimately compromises patient care. I have witnessed it in operating rooms, clinics, hospital wards, boardrooms, and leadership retreats. I have lived it myself.

As a trauma surgeon turned strategic facilitator, I now help physicians and health care teams navigate the complex terrain of organizational and personal transformation. What I have learned is this: change is not a single decision. It is a cycle. And most of us are trapped somewhere within it.

The physician’s change cycle

• Discontent: A growing sense of dissatisfaction emerges (whether with a role, a team dynamic, or a misalignment of values). Yet we “hang in there,” rationalizing the discomfort as a necessary part of the job. We suppress, tolerate, and adapt, often at the expense of our own integrity.
• Breaking point: Eventually, the discontent reaches a critical threshold. A blatant disregard, sentinel event, moral injury, or sheer exhaustion pushes us to the edge. The body may keep going, but the spirit fractures.
• Decision: A declaration is made. A resignation is drafted. A retreat is booked. A staffing change is implemented. For a brief moment, there is hope. The possibility of change feels energizing.
• Fear: Almost immediately, doubt creeps in. The unknown feels overwhelming. We question our judgment, our capacity, and our very identity. Both options (staying or leaving) feel untenable.
• Amnesia: The fear distorts our memory and shades ongoing realities. The original and ongoing dysfunction begins to look tolerable, even preferable. We romanticize the past and make excuses for perpetrators, ignore regular additions to the base problem, and suppress the pain that led us to seek change in the first place.
• Backtracking: We stay. We settle. We silence the part of ourselves that demanded more.

This cycle is not merely personal; it is systemic and cultural. When physicians remain in environments that no longer serve them, the consequences ripple outward. Communication falters. Interpersonal relationships erode. Psychological safety evaporates. Performance declines. Toxicity takes root. And all peers and patients, inevitably, feel the impact.

Breaking the cycle: two paths

There are only two ways out.

• Extreme pain: For many, change only occurs when the suffering becomes unbearable (after a breakdown, a lawsuit, a resignation, or a personal loss). The system only permits evolution through crisis.
• Self-honesty: The more courageous path is recognizing the resistance, the fear, and the identity attachment (the intersection of internal, external and existential barriers) and choosing change anyway. This requires humility, clarity, and support.

Strategic facilitation offers that support. It is not therapy. It is a structured, emotionally intelligent process using coaching, mediation, and educational methods that help individuals and teams move from inertia to action. It creates space for truth-telling, alignment, and repair.

If you recognize yourself in this cycle (if your team is stuck, your leadership is strained, or your career feels misaligned) know that change is possible. But it must be designed. It must be facilitated. And it must begin before the pain becomes unbearable.

Because fear is not a diagnosis. And inertia is not a treatment plan.

Shannon M. Foster is a trauma surgeon.