Physicians are renowned for their dedication to helping others. The problem is that their dedication has become synonymous with self-sacrifice and working for free.
Giving away time, energy, and expertise is simply “what good doctors are supposed to do.”
We work through lunch. We attend meetings during lunch. We respond to patient messages on our days off. We prepare lectures and teach without compensation. Leaders hold space for complaints and conflict and problem resolution after hours, usually off the clock, and often without even acknowledgment.
Working for free is expected and considered “professionalism” in medicine.
This piece is not about discouraging generosity or service.
Many of us find deep meaning in teaching, volunteering, and giving back. The problem comes when it becomes automatic, unexamined, and expected as unpaid work. Then it breeds resentment, burnout, and suffering.
Why we do so much work for free
Most of us do not even recognize how much time we are giving away.
We have internalized a culture that expects more and more from us. We do not even consider that we should be compensated for taking over for colleagues on medical or maternity leave or vacation. We do not question showing up to meetings on our day off. We lead departments and plan events on nights and weekends, outside of working hours, and we teach generations of students, residents, and fellows for prestige, but no pay.
We do all of this because we “believe in the work” and it is “important.”
Working for free seems noble, but it ultimately comes at a steep price. It contributes to burnout which has human costs to the affected physician as well as negatively impacts quality issues, collegiality, and retention. It also erodes our well-being and relationships, and the resultant lack of time and rest creates resentment and disengagement.
When we work so much for free we model unhealthy unboundaried behavior for trainees and peers. If we do not value our time how can we expect others to?
The habit of unpaid medical labor
Working for free is a habit. We have worked for free for so long we do not even notice. We are also people-pleasers and are afraid of disappointing others. We define being “a good doctor” by how much we sacrifice. We imagine worst-case scenarios and worry we will be seen as selfish or ungrateful if we say no. We believe we “should” be able to do it all. If we cannot it shows weakness. So we say yes. Very often we are not even asked to say yes. We are simply assigned free labor and it is assumed we would want to help.
Change starts with awareness
Where are you currently working for free? Which parts of the free labor and time you are donating aligns with your values and priorities? Do you feel drained, resentful, draining, or obligated?
How many hours do you volunteer each month? Each year?
When I sat down and tracked my unpaid teaching hours, I realized that I had volunteered over 2,000 hours of teaching, while simultaneously having a big leadership role and raising three children. I volunteered many more hours on top of this mentoring colleagues and doing after-hours unpaid leadership work.
The antidote to over-giving is intentionality
We can choose to continue saying yes when free labor is in alignment with an intentional and appropriately prioritized life. Teaching, leading, and mentoring is important and meaningful but in certain seasons of your life, if you made a conscious choice, it may not be your highest, most aligned priority.
Just because it has always been done this way does not mean it is right. If we do not question expectations in medicine they will never change. We do not follow outdated norms blindly when it comes to clinical care, but we do when it comes to expectations about physician contribution.
If you decide to continue to work for free, let it be a choice. Please do not expect the same of others and please consider asking for creative compensation.
Choosing alignment over expectation
I actually still choose to work for free. A lot.
I teach free yoga to physicians every week. I have taught over 300 free classes in the last six years. I also host a free podcast which has over 300 episodes. This is a lot of uncompensated work.
What is different? I am choosing to do this work from a place of alignment rather than expectation, without any sense of pressure, obligation, or fear of judgment. The work energizes me.
Which emphasizes the point. We do not necessarily need to stop giving. What we need to stop is working for free out of fear of judgment, obligation, or conditioning. Only then will we shift the culture.
When even one physician chooses boundaries over burnout, they create space for others to do the same.
Jessie Mahoney is a board-certified pediatrician, certified coach, mindfulness and yoga teacher, and the founder of Pause & Presence Coaching & Retreats. After nearly two decades as a physician leader at the Permanente Medical Group/Kaiser, she stepped outside the traditional medical model to reimagine what sustainable well-being in health care could look like. She can also be reached on Facebook and Instagram.
Dr. Mahoney’s work challenges the culture of overwork and self-sacrifice in medicine. She helps physicians and leaders cultivate clarity, intention, and balance—leveraging mindfulness, coaching, yoga, and lifestyle medicine to create deep and lasting change. Her CME retreats offer a transformative space for healing, self-discovery, and renewal.
As co-host of the podcast, Healing Medicine, she brings self-compassion and presence into the conversation around modern medical practice. A sought-after speaker and consultant, she partners with organizations to build more human-centered, sustainable, and inspired medical cultures.
Dr. Mahoney is a graduate of Dartmouth College and the University of California, San Francisco, School of Medicine.
