In Reply to Auster

Auster contends that our discussion on the importance of “healthy personal and professional balance” for physicians represents an implicit acceptance of a rigid dichotomy between these two aspects of physicians’ lives. We differ on this point. In acknowledging our critical realist and sociopsychological orientation, we frame identity as a subjective self-definition that encompasses interconnected social identities that become more or less salient depending on the context and the centrality of the identity for the individual.1 Thus, we recognize the integration of multiple social identities in an individual’s construal of self. In characterizing the identity of the physician as uniquely merged to create a healer who is a healer in all spheres of life, Auster risks endorsing a form of physician exceptionalism that may inadvertently be dysfunctional for the health and well-being of physicians themselves. This characterization also fails to recognize the complexity of professional identity within the academic medicine system, where physicians may not just be healers or clinicians but also teachers, leaders, researchers, etc. Calls for personal–professional balance have emerged with good reason. There is increasing recognition that patterns of professional practice that require or glorify a singular focus on work, to the exclusion of meaningful investment in other life activities and relationships, may not support long-term physical or psychological health. This may become particularly evident for physicians during critical life transitions such as retirement. Our research conveys that there are multiple psychological and social rewards purveyed by the assumption and maintenance of a professional identity as an academic physician. Developing a “diversified portfolio of selves” whereby one can access these psychosocial rewards outside of professional practice is one way of coping and maintaining resilience in the face of identity threats that manifest when one plans (or is forced) to discontinue work.2,3 The potential to experience identity threats at major life transitions (e.g., retirement) is arguably a universal human experience. Indeed, there is a rich literature on the deep-seated psychological motives humans have for the maintenance of various social identities that cements why transitions that necessitate changes to facets of our identity can be so difficult.4,5 The extent to which various motives (e.g., sense of self-worth) are undermined by potential identity threats will undoubtedly vary according to the meaning ascribed to various aspects of academic physicians’ professional roles. On this latter point, we are in agreement with Auster. Betty Onyura, PhD Research and evaluation consultant, Centre for Faculty Development, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario, Canada; [email protected] Karen Leslie, MD, MEd Director, Centre for Faculty Development, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, and professor, Department of Pediatrics, University of Toronto Faculty of Medicine, Toronto, Ontario, Canada.

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