I am a doctor. I am also an anxiety-driven perfectionist. Or maybe I have perfectionist-driven anxiety? Perhaps it stems from constantly striving for better grades and achievement awards to get into high school (top in the nation at the time), then college, then medical school, then residency – we all know the pressure of achieving a high STEP 1 score! (As a side note: Who remembers their STEP scores? They certainly aren’t going on anyone’s job application.)
Throughout this time in training and afterward, I have been repeatedly reminded of the drive to be the ideal physician. Can you picture this person in your own mind? You know – the one always available even if not on call, the one with a long list of publications (even one in Nature), the one with all the teaching awards, the one with grants and award funding. The one who makes it all appear effortless.
But where does this ideal physician come from?
In 1968, the outgoing president of JAMA published a one-page article titled “Attributes of the Ideal Physician.” In this statement, a lengthy list of attributes describing the “typical American physician” are listed in 18 separate paragraphs. In brief, these attributes include integrity, physical fitness, systematic science reading, participation in county/regional/state/national medical societies and subspecialty societies, “encouragement of his wife” in the Women’s Auxiliary, hospital administrative involvement, an interest in students and trainees, participation in research studies, public health planning including community health talks, respect for family and time to enjoy with them, and lastly: “unfailing good humor, tolerance, courage, patience, and wisdom.” Phew – definitely not brief, more like exhaustive just as a reader of this list. Yet this was in one of the largest medical journals that exists for our profession and was printed only half a century ago.
The acceptance letter for medical school is not the end of striving for achievement. In medical school, we are all striving to get into residency by creating the perfect CV and again a few years later if one applies for a fellowship. The applications are extensive and include many things: community service, excellent grades and test scores, research, publications, the perfectly crafted personal statement, and stellar references. You must demonstrate a strong work ethic, excellent teamwork skills, leadership, a deep empathy for patients. All excellent human traits, and all expected in each and every CV of more than 50,000 medical school and 40,000 residency applicants each year.
To stand above the crowd on a piece of paper, we strive to fill our time with achievements that look good in the moment. To fulfill the role as the “ideal physician.” Is the impetus to encourage medical students to create the perfect CV therefore impractical? The CVs of student and trainee applicants are filled with volunteer experiences, committee participation, and even research to demonstrate how they are each well-rounded individuals who deserve the spot in your program. Medical students often become the jack-of-all-trades. However, very few practicing physicians have CVs that continue to demonstrate the broad achievements of medical students and residency applicants. Often because the ability to balance all these commitments outside of work is unrealistic. Should we instead encourage students and trainees to develop passions that they will continue to pursue beyond the time they are dependent on a piece of paper to make it to the next stage in training?
Since that article was published in JAMA, and through some studied and much unstudied human trial and error, we have discovered that this ideal leads to burnout, depression, loss of family ties, and loss of physician lives. Thankfully, medicine has progressed and developed a multitude of career pathways for doctors. Traditionally, physicians working at a medical school were expected to divide their time between clinical care, student teaching, and research. Now, unless a person has set protected time for each area, a full clinical load leaves little to no time to pursue other areas while still maintaining a healthy work-life balance. However, a career in modern academia no longer requires a physician to achieve in multiple areas.
Academia has begun to incorporate a variety of career tracks – the main ones being clinical, research, and education — or some combination of them. Those skilled and passionate about teaching can focus their efforts within an educator track. Those who have an itch to research can do so in clinical, bench, translational, or public health arenas. And the clinicians who want to focus on patient care can. The differentiation of these areas creates job fulfillment and lessens the exhaustion caused by attempting to make up for your weaknesses. This also gives students and trainees the opportunity to work with mentors who are content area experts.
Although taking a step back after years of chasing achievement feels unnatural and like a step in the wrong direction, this redirect allows a physician to concentrate on strengths and passions. I encourage students and trainees to think beyond their courses and medical rotations to their much longer careers and lives after training. In the 21st century, becoming the ideal physician means being true to yourself. A physician achieving in a few areas of strength is a greater mentor and role model than a physician who spreads themselves thin by trying to do everything. For me that means a primary focus on research, time with family, and taking vacations. My good friend is a physician who is a natural educator, and by leaning into her passion, she has received frequent teaching awards.
A few years ago, my then 3-year-old came home talking excitedly about how her bucket had been filled or emptied based on various actions (usually of others in this young class) and her resultant feelings. Such a simple lesson that should be carried throughout life. First and foremost, self-care is essential to fill your bucket. Your CV can wait. Secondly, assess what else fills your bucket – time with family, hobbies, colleagues, projects, teaching, exercise, answering a burning clinical question, or maybe writing. Lastly, take a good look at what empties your bucket – long workdays, missed school events, answering emails late at night. Make sure you don’t drain your bucket trying to become an unrealistic ideal.
If you are ever looking for the attributes of an ideal physician, take a look in the mirror.
What about you makes you an "ideal" physician?
Dr. Eleanor Gradidge is a pediatric intensivist in Omaha, Nebraska. She is passionate about providing care to both her patients and their families. In her free time, you will find her enjoying the outdoors with her family in any way possible. Dr. Gradidge is a 2022–2023 Doximity Op-Med Fellow.
Illustration by Diana Connolly