Girl Doc Survival Guide
Young doctors are increasingly in ‘survival’ mode.
Far from flourishing, the relentless pressure of working in medicine means that ‘balance’ is harder than ever to achieve.
On the Girl Doc Survival Guide, Yale professor and dermatologist Dr Christine J Ko sits down with doctors, psychologists and mental health experts to dig into the real challenges and rewards of life in medicine.
From dealing with daily stressors and burnout to designing a career that doesn’t sacrifice your personal life, this podcast is all about giving you the tools to not just survive...
But to be present in the journey.
Girl Doc Survival Guide
EP62: Dr. Kira Schabram on having a Calling
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A "calling" is defined as something that gives you personal, social, or moral significance. For me, and for many physicians, the practice of medicine is a calling. Those in pursuit of a calling generally are on one of three different paths: the identity path, the contribution path, and the practice path. Dr. Kira Schabram goes over her research in this area and talks about why the practice path is the one to be on. Dr. Kira Schabram, PhD is an Assistant Professor of Management at the University of Washington Foster School of Business. She received her PhD from the University of British Columbia, her Masters of Science from Concordia University, and both a Bachelors of Science and Bachelors of Arts from the University of California, San Diego. Her academic expertise centers on compassion, meaningful work, and teamwork. Here are links to two different articles about her work, one on burnout and one on meaningful work.
[00:00:00] Christine Ko: Welcome back to SEE HEAR FEEL. Today, I am really very much excited to have the opportunity to speak with Dr. Kira Shabram. Dr. Kira Shabram has a PhD, and she is an Assistant Professor of Management at the University of Washington Foster School of Business. She received her PhD from the University of British Columbia, her Master of Science from Concordia University, and both a Bachelor of Science and Bachelor of Arts from the University of California, San Diego. Her academic expertise centers on compassion, meaningful work, and teamwork. I will put links to two of her articles, one is on burnout, I think a very important read; as well as on meaningful work and how that can help prevent burnout. So welcome to Kira.
[00:00:47] Kira Schabram: Thank you. Thank you for having me.
[00:00:48] Christine Ko: I was wondering if first you might be able to share a personal anecdote about yourself?
[00:00:55] Kira Schabram: Sure. What often surprises people is the way I found myself in academia. This is my second career and entirely serendipitous. I was working in animal welfare, first in wildlife rehabilitation and then in animal sheltering. And like so many, I lost my job during the great recession and kind of had to build myself back up and realized at that point that one of the things I had experienced in nonprofits, burnout, wasn't really being studied. At that point, so this was in 2008, we had started studying meaningful work, but we'd really only looked at the positive side of it. So more engagement, more passion, all that. And then while all that was true, when I was looking around with my coworkers, we were all really burnt out and depressed. And so that's how I ended up in academic research. I'm still really passionate about animal welfare. My husband and I have recently adopted our 150th foster dog, so I suppose that's the fun fact about me. I am an animal person.
[00:01:51] Christine Ko: Wow. A hundred and fifty?
[00:01:53] Kira Schabram: Yeah.
[00:01:54] Christine Ko: Okay. I assume, though, that you adopt them and then you give them away?
[00:01:59] Kira Schabram: Yep. We are volunteer foster parents for various animal shelters, and so we take them to rehabilitate them, and then they get adopted, and then we move on to the next one.
[00:02:07] Christine Ko: Okay. Cause I, I've never had a pet, but I was thinking, I don't think she actually has 150 dogs.
[00:02:12] Kira Schabram: Oh no, definitely not. We have had too many at certain points in time, but not that many.
[00:02:19] Christine Ko: One of the first articles I read of your work is you were talking about work being a calling and related it to your animal shelter work. Your anecdote segues right into this question of what does it mean for work to be a calling?
[00:02:32] Kira Schabram: Yeah. So I'll give you a very brief historic definition. We've thought of work as a calling since about the Protestant Reformation, and we've usually thought of it in religious terms. That it is a spiritual or religious call to something that is deeply meaningful to you. Now, I will say that when I study work as a calling, for some people, that is religious, but that does not have to be part of the academic definition anymore. The definition that we use of work as a calling is work that imbues work with deep personal, social, or moral significance. That doesn't mean that you don't also need to earn a paycheck to survive or that you're not also interested in advancing in your career, but that a core reason for why you're doing that work is this personal, social or moral significance. And again, that can come from an outside source like religion or spirituality. It's that sense of imbuing what one does at work with personal, social, or moral significance.
[00:03:28] Christine Ko: Thank you for that definition. I do think of being a physician as a calling; I think a lot of physicians do think that, and so that definition makes sense that there's personal, social, or... what was even the last one?
[00:03:41] Kira Schabram: Or moral...
[00:03:42] Christine Ko: I was gonna ask you, since you said "or" ...it's just really any one of those three?
[00:03:46] Kira Schabram: We've often had this conversation, and the field hasn't really come to an agreement because there's always a tension around, must it be something that you're doing to make the world a better place? And the counterfactual that we often think about is: you have an artist who, you know, Emily Dickinson, who's toiling away, and no one ever sees their work. If it has no impact. And with Emily Dickinson, of course we found her work after her death, but if no one had ever found it, would that have been a calling?
[00:04:10] I tend to be someone who leans on the or. I think if it's personal, social, or moral, it's a calling. But I will also say that for almost all of the people that we study, it tends to be an and.
[00:04:21] Christine Ko: Yeah. It is interesting for someone like Emily Dickinson, if during your life or nowadays, even for any given person, if for whatever period of time, you don't really get any outward recognition for what you're doing...
[00:04:36] Kira Schabram: Yeah, if it's not the primary motivator, if the social or moral bit isn't as important to you, I think that would still be a calling. I think someone who's toiling on a craft, to me, that's still a calling.
[00:04:48] Christine Ko: Do you think it's necessary for work to be a calling?
[00:04:52] Kira Schabram: No, absolutely not. I'm a millennial, so I'm of the generation that has been taught extensively: go find your passion, go find your calling. I think of it as a double edged sword, and I should say that I'm the second generation of people studying this.
[00:05:07] So a lot of credit here goes to people like Amy Wiesniewski at Yale, and Jeff Thompson, Stewart Bunderson, who've really first established this. When I say double-edged sword, what I mean is very high risk, and it is very high reward, that if you find something that you are passionate about, that is your calling. We do tend to see higher engagement, higher performance, higher commitment, even higher life satisfaction and health. But, only if the expectations that you bring to the work with you are met. If your expectations are not met, all of those correlations flip. And Shoshana Dobrow at the London School of Economic studies musicians, and she studies all the ways that the calling is a siren song, that most professional musicians will not be able to find the work that they so desperately want because of laws of supply and demand. And so that can lead to a life where there's constant pressure on you, there's constant burnout, there's competition. And so, is that a good way to live? I don't know. And so I don't think we should tell people, in order to lead a meaningful life, you must find work that is a calling. What I think is a better way of putting it is that human beings need meaningfulness in their life. I believe that, and I think the empirical evidence backs that up, that meaningfulness can come from work. And if you are lucky that you see work as a calling and it meets your expectations, I think that can be a really wonderful thing. But if you find meaningfulness outside of work from your family, from your hobbies, your civic organizations, your church, I don't think we should judge that.
[00:06:37] And I think we've lost a little bit of sight of the fact that work can also be a means to an end. That it doesn't have to be an end in and of itself. And I'm finding that younger workers are having more open conversations about this. Do I want work as a calling? If so, great. Or, do I wanna treat work as just a job? And go home at the end of the day and spend time with the people that I care about.
[00:06:57] I think those are both very viable ways of having a meaningful life.
[00:07:01] Christine Ko: I love what you just said. It really resonates with me on multiple levels. From the broader, societal kind of angle, when you talk about work being a calling from that social standpoint, I think, broadly, workers in the healthcare system and the educational system think of what they do as a calling. [Yeah.] And yet I think the system, especially early on in COVID, just really failed the users of the system. Mainly children for education and patients for healthcare. [Yeah.] It had a huge impact I think on, still, I think, on people like me, I think, who think of what we do as a calling. It's exactly what you just said. When your expectations for yourself in doing your calling aren't being met, it is a huge mental load.
[00:07:53] Kira Schabram: From an organizational perspective, when we say that we failed, that failure wasn't accidental. Research shows that people who view work as deeply meaningful, who have a calling, are much more vulnerable to exploitation because they want to go above and beyond. So, when you say we failed, I think in a way it was by design. That those doctors are going to keep coming to work no matter how bad it's going to get. And that's really problematic. That's one of the concerns I have around framing work as a calling, as this end goal. Viewing work as a calling, and having those expectations met, is a viable way towards a happy and meaningful life. But yeah, there's a lot of risks that come with that.
[00:08:33] You've spent your whole life thinking that going into medicine is your calling, and now hospitals are saying, you have to be on the front lines. You have to put your own health at risk. You have to work these extensive hours. And again, seems to be by design, that, well, if the work is so meaningful for you, then you shouldn't be doing it for the money.
[00:08:48] So there's these tensions that come in that I think we really need to acknowledge.
[00:08:51] Christine Ko: Going back to what you said about exploitation, that really resonates with me too, because there is this tension for me. I do find a lot of meaning in my work, and I do feel it's a calling. At the same time, it is like this very double or triple edged sword because sometimes I'm like, since I think it's a calling, whenever there... there's X, Y, or Z at work, and it's bothering me, I should just quit because what's the point?
[00:09:16] Kira Schabram: Now would be a good time to talk about one of our studies that we did. We did a study of animal shelter employees because that's a domain I know quite well. And we were interested in understanding why people would quit their calling. Because our understanding at that point in the literature was that people wouldn't quit their calling. That no matter what it takes, you're gonna keep going.
[00:09:32] But animal shelters saw fairly high turnover rates, as does teaching, as does nursing. So people will quit their calling. And so we tried to figure out why and what happens to them. And we did an interview study where we followed these former employees, and what we found is that there seem to be three different paths or three different ways that you can treat your calling. I'll sum those up.
[00:09:54] One was an identity path. This is who I am, this is who I've always been. What we find is when people view the work through this identity lens, they tend to isolate themselves from other people. They tend to think no one else gets it. Yes, sure. These other people care also, but they don't care as much as I do. I have a sense of calling. Because they perceived others as not caring as much, they started volunteering for harder and harder work. So they would volunteer for euthanasia shifts. They would volunteer to foster more and more animals, and very quickly, they would burn out and leave. Many of them within five months to a year.
[00:10:32] The second path we had was what we call the contribution path. It wasn't about who they are. It was about the impact they wanted to have. They wanted to have the biggest possible impact. So again, they come into these shelters, very optimistic, very quickly realize, wow, things are not going well here. We don't have the resources. But if I could rise into a leadership position, I could change things. And so they tried to get into those leadership positions. They become frustrated by the system, not as quickly as people on an identity path, but very quickly; one to five years, they start to feel defeated, and they decide, I need to make a bigger impact somewhere else.
[00:11:09] The reason I point out those two groups first is, before we went into the study, we were sure that the people who cared the most would last the longest. And we just didn't find that. We found that they were either broken by the system or defeated by the system, and they would then leave. And in the case of identity, people would move on to what they described as "easier" calling work.
[00:11:27] So they became pet photographers or pet trainers. So they could be around animals, but they didn't have to deal with all of the welfare stuff. The people on the contribution path often went back to school. And they became nurses or teachers, ways that they thought they could have a bigger positive impact in the world.
[00:11:43] Then we had a third group of people that have been in animal shelters, not only for 10, 15, 20 years, but they have risen into those leadership positions. You know, we interviewed someone who ran the Hurricane Katrina evacuation efforts. We talked to people who are doing legislative issues at a national level, and what we found is that two things stood out with those people.
[00:12:02] We called that the practice path. Number one, they did not see themselves as unique. They saw themselves as part of a community of practice. And so they didn't constantly feel the onus to take on everything. Instead, they were there to learn from others and then also to delegate and train others. So I think that's one really important bit about if you view work as a calling, make sure that doesn't isolate you, that instead you realize that there's lots of other people out there with that calling, and that the only way to do this sustainably is to be part of that community.
[00:12:32] The second thing they did is they knew when enough was enough, they would clock out at the end of the day. They would play in volunteer orchestras. One person said, I have a fishing boat. My husband's a firefighter. He also has a calling. We both go to that fishing boat, and we do not talk about work.
[00:12:45] So the other thing that they did is they could shut it down. And so in essence, giving yourself permission to work fewer hours; or if you're working these long hours, at least not to think about it when you're not at work, seems imperative in order to make this sustainable. If you don't do those things, you will quit your calling, and you're going to be really unhappy about it.
[00:13:04] So the people who left felt like it had been a failure. If you wanna stick around, be part of a community of practice and make sure that it doesn't take over your life.
[00:13:13] Christine Ko: That will end our first conversation. We will continue this conversation with a Part 2 to center on burnout and what to potentially do about it. Thank you to Dr. Kira Schabram for joining me.