Editor’s Note: The waitlist for the Fall Alpha Coaching Experience (ACE) is open right now.  Joining the waitlist simply means you are interested in learning more about this coaching thing that is taking the physician world by storm.  It is free to join.

We are hoping to provide a free group coaching call exclusively for the waitlist to show you what coaching looks like, and there is even an opportunity to jump on a 1:1 call with me to help you determine if coaching is right for you. Click here to join the ACE waitlist.   

If you have ever talked to people on their deathbed about their life, you might notice that one idea continually comes up.  It isn’t that they wished they worked harder.  Or that they wished they played a little more golf.  People don’t say they wish they had a bigger home or faster cars.  

You know what they do say in one way or another?  That they wish they had been unapologetic about who they are and what they wanted in life.  That they had loved their friends and family and held them as their primary focus.   

Yet, this isn’t how we really live.  

Whenever time management topics or the concept of feeling overwhelmed come up, I commonly teach both on this podcast and to our clients in the Alpha Coaching Experience that “when you say ‘yes’ to one thing, you are saying ‘no’ to another.”  So, it is our job to get clear on what matters most to us.  And to then live a life that is built around these priorities. 

It sounds simple, doesn’t it?  Yet, our lives are a constant work of trying to get there.  Why is it so easy to say yes to so many things that make us say no to what matters most to us on paper?  That’s what I want to talk about today.  The roots of our unintentional priorities in medicine, and how these often extend from trying to make other people happy instead of relying on our own internal compass to point us in the right direction.

Physicians are Built on External Validation

Medicine is built with a mentorship model in place.  And this model results in a dependence on external validation.  Think about it.   

When you are a medical student, you look up to your residents, fellows, and attending physicians – hoping that they will recognize your hard work. Your strong knowledge base from your studies. And, your willingness to go the extra mile to help the team.  When they praise you, it makes all of the long hours and endless questions on rounds worth it.   

And it isn’t just about praise.  Your advancement through the ranks in the medical system depends on evaluations from these people.  Bad assessments could be a game-changer for going into a competitive specialty. One bad letter can prevent you from matching at all. 

When you become a resident, your need for praise transitions to the attending physician on your current rotation.  And, it doesn’t end there.   

As a practicing physician, you have likely become dependent on external validation.  It might look different, but it is still there. Maybe it now comes from your older and more experienced partners.  Online patient reviews.  Formal evaluations.  Or from other sources like the nurses or techs at work. 

External Validation Junkies 

The problem is that this can quickly turn physicians into external validation junkies.  Our entire self-worth can become attached to who and what other people think about us as physicians.  I’ve previously blogged about this physician self-identity crisis – when our identity as physicians becomes who we are as a person.     

The combination of your need for external validation and your identity being wrapped up in being a physician forms the roots of many things.  Most importantly, it plagues our priorities and values both at home and at work. 

When thinking through a decision, instead of asking whether or not it fits in our Hell Yes Policy, we think about what others will think about it.  Does your chair or medical director expect you to take part?  Is there a bonus that incentivizes you?  What will people think if you just say “no”? 

This is not the best way to make a decision that will reflect your true priorities.  Yet, it is how most of us do it.  

External Validation In Practicing Physicians

This external self-worth phenomenon shows up early and often in medicine.  

Why do you think that young faculty are asked to write the book chapter in a book that will not have their name on it?  Or to join the committee about something you care absolutely nothing about? 

The problem isn’t that people ask young physicians to take part in these menial tasks, it is that young doctors say yes – not because they want to, but because they feel an obligation to say yes. When you get at the root of why they say yes (even they though want to say no), it usually has to do with not wanting to disappoint someone else. 

If they say “no”, they risk not receiving recognition from the important stakeholders – or worse – they risk feeling criticized for their choice.  This can lead young physicians to say yes to a lot of things that would not land on their Hell Yes Policy, which takes time from the things that do.

Self-Worth for Physician Entrepreneurs 

These issues show up in other places, too.  For example, any physician entrepreneur who owns a successful online business has experienced this, too.  I’ll give you a personal example here.

At The Physician Philosopher, our mission is to help physicians who feel trapped in medicine master their money and their mindset so that they can practice medicine on their terms.  We do this through a ton of free educational content, including blogs and podcasts.  I’ve also written an inexpensive book on personal finance for physicians, and I’ve created online courses and physician coaching programs for those who want to take a dive deeper. 

I mention this because I’ll occasionally get a message about how terrible it is that I am profiting off of burned out doctors. This is usually from a doctor who is experiencing burn out themselves.

Back when my self-worth came from external validation, messages like this used to devastate me when I’d get a message like this.   

I’ve put thousands of hours into this business to help people, not to harm people.  I used to respond to these messages. I’d explain that more than 90% of our content at The Physician Philosopher is free. And that I take home a fraction of the revenue this business creates. The overwhelming majority of money is poured back into the business so that we can help more doctors find the personal and financial freedom they need to practice medicine as much or as little as they want.

Yet, all of these explanations came from a need for external validation. My self-worth was determined by what other people thought.  

When the Achiever’s Self Worth Hits Rock Bottom

I struggled with this for a very long time.  Most of my decisions were made from a place of having my self-worth completely wrapped up in my achievements and what people thought of me.   This isn’t surprising for someone who is a Type 3 with a Wing 2 on the Enneagram.

So, as I started to drown in my own burn out, I looked to external validation to provide that hit of dopamine to keep my head above the waters. I was an external validation junkie.  Eventually, this resulted in a slow fade to even worse burnout. 

It turns out that my focus was misplaced.  I was so focused on manipulating my external world to create my self-worth, that I forgot who I was at my core.   

I was so focused on what I needed to do to get what I wanted, that I forgot to focus on who I am as a God-fearing husband, father, and friend.  When I realized that my focus should be on who I am and not on what I need to do, it changed everything. 

Be Do Have Model 

Recently, I’ve come across the “Be Do Have” model that is prevalent in the online entrepreneur space.  I am not sure where this idea originated.  It could be as far back as ancient philosophy.

Epictetus famously said, “First say to yourself what you would be; and then do what you have to do.”

In other words, first Be. Then Do. And you’ll have what you want.  

Yet, most people focus on what they want to “have” in their life.  Then, they think backward about what they must “do” to get what they want to have.  And, finally, if they are wise enough they might get back to who they need to “be” in order to do the things that need to be done to get what they want to have.

So, most people operate in a “Have-Do-Be” model.  

Yet, this is a bit backward, isn’t it?   

This is a guaranteed way to make sure that your personal identity is determined by what you have and what you are doing, rather than your principled identity determining what you do and have. 

Your Roots as a Spouse, Parent, and Physician? 

What if we placed our main focus not on what needs to be done to get what we want, but on who we want to be. 

For example, if you are a parent, what do you want your kids to say about your parenting style when they leave the house?  If you are married, what would you want your husband or wife to say about how you loved them? 

Are you too busy pursuing external validation from other people that don’t matter? What do you think about yourself?  Who would you be without the awards, achievements, and accolades?  Would you still be worthy?  Would you be enough? 

When we go back to our roots.  To the main identities that matter to us most.  When we focus on what is most important to us… what we need to do becomes evident.  And what we want tends to be what we already have as we realize we already have everything that we need.

Summary

When you feel the pressure or the need for external validation, remember who you are.  Remember your roots.  And make decisions from what is most important to you.   

What makes it onto your Hell Yes Policy? Only when you are operating unapologetically from your true identity can you truly be able to say “no” to anything that doesn’t make you say “Hell Yes!”

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