There is a resident doctor on TikTok named Julia who is also a raver. She posts about her training, and her weekends, dancing, festivals, après ski, living a full and visibly joyful life outside the hospital. The comments on her videos are glowing. “I would love to have a doctor like you.” “You seem like a real person.” A lot of patients are not looking for a self-sacrificing doctor who has no life. They are looking for someone present, grounded, and whole. Someone relatable.

And yet the medical culture Julia is training inside has spent decades insisting there is only one way to be a doctor: medicine as calling, as something requiring constant sacrifice. On one side of the debate, older physicians decrying work-life balance in the Wall Street Journal, asking where the calling went. On the other, a growing chorus arguing we should retire the calling narrative entirely because institutions use it to exploit physicians. (Saints do not negotiate for work-life balance, after all.)

Both sides are missing something. The calling-versus-job debate is a false binary, the way many things are before we examine them more closely and realize they are more like a spectrum. What I have come to believe, from my own career and from the physicians I coach, is that the more useful framework is not one-dimensional at all. It is a matrix. Two questions. How called do you feel by this work, in any given season of your career? And how satisfied are you: How much do you like what you are doing? These are not yes-or-no questions but scales. Your answers place you as a point on a plot, somewhere in one of four regions. And where that point sits tells you something specific about where you are and what you might need.

A matrix replaces false binaries with honest coordinates. We have learned this in other cultural conversations, where moving from binary to spectrum thinking changed who got to belong. In medicine, the same shift changes who gets to be honest about where they are, and who we make space for in the profession. In the face of a doctor shortage, that is not a small thing. The matrix plots two axes: satisfaction on the vertical axis (high at the top, low at the bottom) and sense of calling on the horizontal axis (low at the left, high at the right). The four quadrants this creates, The Calling, The Craft, The Wound, and The Wall, each describe a distinct relationship between a physician and their work.

The calling: Called and satisfied

Intrinsically motivated, deeply meaningful. Time disappears on rounds. You think about your patients when you are not with them. You would do it for less, or for free. Many physicians start here. Some stay here their whole careers. This is real and it is worth protecting. Coaching question: What does it take to sustain this, and am I happy with what it requires of me?

The craft: Job and satisfied

Medicine is not a calling, but you are good at it, you like it, and you have a full life outside it. Sustainable, healthy, and deeply undervalued in the conversation about what makes a good doctor. This is not a lesser version of the calling. For many physicians it is a more honest and more durable one. Coaching question: What does a full life look like for me, and how does medicine fit in?

The wound: Called and suffering

Medicine feels like a vocation, but the system will not let you honor it. The gap between what you feel called to do and what you are permitted to do is painful. Prior authorizations blocking the care you know is right. Bureaucracy at every turn. This is demoralization: a crisis of meaning caused not by losing your calling, but by being systematically prevented from answering it. It is a specific and acute kind of suffering. Coaching question: What agency do I have, no matter how small?

The wall: Job and suffering

Medicine does not feel like a calling, and you are not satisfied. The paycheck is the only remaining justification for showing up, and some days it does not feel like enough. Perhaps you are still there because you feel trapped, by student loans, financial obligations, or fear. This is a state of dull and draining depletion. Coaching question: What is one small step I could take toward getting unstuck?

I have lived in three of these quadrants. In residency I was firmly in the Craft, good at the work, full life outside medicine, singer-songwriter in a band. I did not need medicine to define me. Then I found palliative care, and something shifted. The work cracked me open. Suddenly I was in the Calling. I felt genuine awe witnessing and serving my patients’ life stories.

And then the system made it impossible to do the work the way I needed it done. I was in the Wound. The calling intact, but actively thwarted. This is when I pressed pause on my career; I took an unapproved, unpaid sabbatical and came back at a fraction of my former schedule on terms I negotiated myself. That experience informs the coaching work I do with physicians at their own crossroads.

Wherever you are on this matrix, there is a pause point available to you. If you are in the Wound or the Wall, I would recommend considering one. The Wound needs time to heal. The Wall needs space to see clearly. But a pause is not reserved for crisis. The pause point is wherever the current arrangement stops being enough for you. What you do about it is entirely up to you.

The calling debate, at its core, is about identity and permission. Do you have to experience medicine as a vocation to be a good doctor? No. Does it matter which quadrant you are in? Absolutely, because your position is diagnostic information about your current conditions, your fit with your work, and what you need next.

Christie Mulholland is a palliative care physician and certified physician development coach who helps physicians reclaim their sense of purpose and connection in medicine. Through her work at Reclaim Physician Coaching, she guides colleagues in rediscovering fulfillment in their professional lives.

At the Icahn School of Medicine, Dr. Mulholland serves as associate professor of palliative medicine and director of the Faculty Well-being Champions Program. Affiliated with Mount Sinai Hospital, she leads initiatives that advance physician well-being by reducing administrative burden and improving access to mental health resources.

Her recent scholarship includes a chapter in Empowering Wellness: Generalizable Approaches for Designing and Implementing Well-Being Initiatives Within Health Systems  and the article, “How to Support Your Organization’s Emotional PPE Needs during COVID-19.” Her peer-reviewed publications have appeared in Cancers and the Journal of Science and Innovation in Medicine.

She shares reflections on professional growth and physician well-being through Instagram, Facebook, and LinkedIn. Dr. Mulholland lives in New York City with her husband, James, and their dog, Brindi.