Redefining Medical Professionalism: Why the Hidden Curriculum Is Burning Physicians Out
After weeks of turning this over in my mind, I've finally figured out what hasn't been sitting right with me: the way I learned what it means to be a professional.
No one said it out loud. But it was absolutely modeled to me, by attendings, by the culture, by the very air of the hospital, that being a physician wasn't just a job. It wasn't even a career. It was a calling, and callings don't have a clock-out time. Somehow, garden-variety professionalism wasn't good enough for us. Physicians held ourselves to a higher standard. We were supposed to eat, drink, and sleep medicine. And we wore that like a badge of honor, because it meant we were different: more dedicated, more altruistic, more serious than the people who left work at work.
Here's the comparison that really crystallizes it for me: a lawyer will bill their client for 7 minutes of thinking about their case while in the shower. Physicians didn't have constructs like that. Practicing medicine wasn't what we did. It was what we were. And there was no discrete bookkeeping associated with it, because you just don't keep meticulous track of the air you breathe.
The problem is that this version of professionalism was built on a foundation that no longer exists. And, for most of us, it may never have existed in the first place.
Because here's the thing nobody talked about when they were teaching us all of this: every single person modeling that all-encompassing physician identity was, almost without exception, a man. A man who, very likely, had a partner at home who was doing every single thing that wasn't medicine.
Doctor's appointments for anyone in the household? The non-physician partner handled it. Keeping the house, raising the children, making sure there were groceries in the refrigerator? That person. If something broke, that person figured it out (probably before the physician-partner even knew there was an issue). The all-encompassing professional simply signed the checks.
That's the hidden curriculum nobody names. The old professionalism wasn't just a philosophy; it was a staffing model. It required two people: one to be fully consumed by medicine, and one to absorb everything else quietly.
I'm genuinely trying to think of families I know — families with children, where a physician works to pay the bills, and their partner handles everything outside of medicine. I can't think of many. (Any?) And I say this as someone raised by a stay-at-home mom who poured herself completely into that role. (And with a deeply loving, but generally absent father who, by design, took work that required travel. It paid more, so my mom could stay home with me. As much as I hate to admit it, this was way back in the 1980s, certainly before the cost of living is what it is now.) The point is that the model is increasingly rare, and building a professional identity around it was always a gamble with someone else's time.
So that's why the old professionalism doesn’t work anymore. Medicine is too complicated. Life outside of medicine is too complicated. And anyone trying to balance both (while still holding themselves to a standard designed for a completely different world) is either quietly distressed by their inability to do so or burned out while still showing up to care for patients.
This is where my thinking connected to something I wrote last week about identity. I realized that medicine no longer felt compatible with my identity as a helper in the effortless way it used to. It used to be that just being a physician was being a helper. Now I have to work to protect that identity. I have to deliberately make space for the things at work that matter, which means letting go of other things at work, which means forgoing things outside of work to compensate, which means…
You see how this spiral works.
I've been sitting with the idea that AI might save us from some of this, offloading the low-value tasks that eat away at our time. And it can, genuinely. But I've also noticed something: it's very easy to use AI to clear out the things that don't matter, and then just fill that space with more things that don't matter. The efficiency gains evaporate. The problem isn't really a volume problem. It's a meaning problem.
Any real solution to the professionalism crisis has to make room for the things that actually give the work meaning. Because at its core, the new definition of what it means to be a professional still centers on meaning: on an internal drive to be better, to stretch toward the highest version of yourself. Not for the award. Not for the Press Ganey score. But for the deep, unshakeable knowledge that you showed up fully, in a way that only you can define.
Which brings me to validation. And this is where it gets a little uncomfortable.
When we farm out our sense of professional worth to external sources, we're taking a real risk. I can give a family my absolute best in a devastating moment, and they can still be angry with me. I can take the best care of a patient that anyone could have taken, and they can still document their disappointment somewhere on the internet. I can work my tail off and still not meet my wRVUs. External validation is real, and it matters, but it's not a reliable foundation for a professional identity. The only stable source of validation I have is knowing that I'm meeting my own definition of what it means to be a physician.
That's where the new professionalism lives: at the intersection of meaning and self-defined standards.
So what does that actually look like?
We've been doing this backward. We try to figure out who we are as professionals by looking at how we've organized our lives, and then we try to make the two fit. But that doesn't work. It creates the exact feeling of doing every single job badly. Not just the “physician” job, but also the “parent,” “partner,” “sibling,” “child,” “friend,” and “human being with hobbies” jobs. I don't know a physician who golfs every Sunday anymore. (And if you do, please email me. I genuinely want to know how you make it work.)
The move is to start from the inside out. First: What is my actual definition of being a professional? Not what I was taught. Not the hidden curriculum. Mine. Once you have that, you figure out what you need outside of work to show up that way.
What does this feel like for me?
If I need nine or ten hours of sleep to be a decent human being to my patients and colleagues the next day, then I need a hard stop on charting, emails, and Netflix the night before. Not aspirational, actual.
If a patient needs me after my shift ends, I stay to take care of them. But importantly, if the patient doesn't need me specifically and just needs the care of my similarly skilled colleague scheduled to take over my service, I hand off that task without self-flagellating for being a bad colleague.
If I need a life admin day every month, to make my own doctor's appointments, pay my bills, handle the ten thousand things that don't stop just because I'm on service, then I need to work with my schedulers to make that happen. And if that means escalating to get one mid-week day a month that doesn't count against my vacation time, I escalate. The case practically makes itself: it costs an institution close to a million dollars to replace a burned-out physician. Just give me a Tuesday.
This is where prioritization comes in. Deliberate scheduling. Time blocking. Getting honest about the difference between long-term goals that actually sustain us and the short-term dopamine hits we use to procrastinate on them. This is where boundaries live, as well as self-advocacy, and (yes, it’s true) asking for help.
This is how we reclaim our agency in a discipline that has, for a long time now, decided a great deal for us.
We went into medicine with our eyes open. We knew it would ask a lot. The “physicians as victims” narrative isn’t entirely accurate. And even where it may be, it does not serve any of us.
Here’s the reality as I see it: we still love this work. Or we did once, and most of us still have access to that feeling when we strip away everything that isn't actually medicine. The new professionalism isn't about lowering standards. It's about setting them ourselves and owning them while deliberatelybuilding a life around them, rather than discovering at 2 am that everything important has been passively crowded out.
That's how we keep going. That's how we keep practicing this discipline that we chose, and still choose, every day, to the benefit of ourselves, our colleagues, and the patients who deserve the most whole, most intentional versions of the physicians they trust with their care.