Title: From Validation to Vocation: Reclaiming the Essence of Medicine

By Mick Connors, MD

For more than thirty years, I have been granted the opportunity—and the obligation—of observing the evolution of medicine. From the surge of medical innovations and superior therapies to the emergence of physician wellness initiatives, transformation has been a continuous theme. Yet, lurking beneath it all, one damaging reality has persisted: medicine still operates under an unquenchable thirst for external validation.

We pursue scores. We pursue job titles. We pursue letters that follow our names. Most tragically, we let that chase overshadow the very essence that inspired us to pursue medicine in the beginning.

This internal struggle resonates with the TV show Severance, where employees’ professional and private identities are bifurcated. In medicine, numerous individuals experience a similar division—our “innie” personas are engineered for accomplishment and accolades, while our “outie” personas, once fueled by genuine empathy, become neglected and diminished.

The Engineering: How Medicine Became a Metrics-Driven Discipline

From the moment we step into medical school, we are immersed in a framework that assesses success through measurable accomplishments:

– Grades: Our abilities are evaluated through rankings and accolades, rather than compassion.
– Test Scores: Examinations such as the MCAT and USMLE serve as measures of our value.
– Match Lists: Approval is obtained by landing a position in the most esteemed residency programs.
– Titles: Intern, resident, attending—each title is another step on an endlessly climbing ladder.
– Degrees and Credentials: MD, PhD, MBA, FACP, among others—initials crafted to impress but frequently disconnected from genuine patient care.
– RVUs and Metrics: Our productivity and empathy are quantified through billing codes and patient satisfaction assessments.

These metrics foster an environment where self-worth is derived from outside rather than within. What starts as encouragement gradually morphs into an addiction.

The Compulsion for Performance

At first, this pursuit might seem liberating—affirming our place within a high-pressure environment. However, as time progresses, the excitement diminishes, prompting us to strive harder, accomplish more, yet feel increasingly unfulfilled.

When promotions elude us or patient outcomes falter, our sense of self begins to disintegrate. When your identity is tied to performance, any decline feels like a setback. That delicate sense of self allows little room for vulnerability, introspection, or development.

Even worse, we may turn against each other. Instead of supporting colleagues who challenge the system, we question their commitment. We have evolved into a profession that alienates its members for daring to step back from a detrimental status quo.

The Endless Burnout Circuit

A considerable amount of physician burnout arises from this toxic relationship with approval. Systems created to assist (wellness seminars, resilience training) often miss the underlying issue—this compulsion for validation. Instead of achieving meaningful change, we push ourselves harder, conceal our struggles beneath our white coats, and regard any indication of imperfection as failure.

Far worse, we instill within ourselves the fallacy that we are irreplaceable and therefore cannot afford to show humanity. When doctors encounter mental health issues, errors, or even personal tragedies, they are often judged by those who comprehend the pressures the best.

Colleague vs. Colleague: A Cultural Reflection

The lack of institutional empathy is just one part of the picture; the deficiency of peer support is another. Our culture encourages us to celebrate flawlessness and scrutinize divergence. We deride colleagues who prioritize family over fellowships. We belittle those who switch specialties or seek part-time roles. Our instinct is to uphold the facade of strength—ours and others’—but by doing so, we weaken the collective.

Mending the Divide: Reclaiming Our “Why”

Many of us entered the field of medicine with noble objectives: to heal, to console, to advocate, to learn. We did not embark on this journey to become mere data points or to compete against each other on a metaphorical scoreboard.

I remember my very first patient—the anxiety I experienced, the wish not to utter the wrong words, the longing to excel in both medical practice and kindness. That purity of “why” was swiftly buried under the clamor of grades and rankings. But it was genuine. Reviving it is not only feasible—it’s imperative.

Transforming the Cycle: A 12-Step Recovery Plan for Physicians

If medicine were akin to an addiction—specifically to applause, authority, and perfection—we require a structured recovery pathway. Here is a 12-step framework crafted for those eager to rediscover gratification through authenticity, rather than accolades:

1. Acknowledge We Have a Dilemma
Recognize the impact that external validation has exerted on our internal serenity.

2. Embrace the Idea That Fulfillment Is Innate
Understand that true satisfaction arises from connection, not competition.

3. Choose to Break Away
Make a deliberate decision to realign with purpose instead of performance.

4. Conduct an Honest Self-Assessment of Our Motivations
Contemplate the genuine reasons that drew you to medicine—and note the extent to which you’ve strayed from them.

5. Embrace Imperfection