The lost tribe of medicine

I can remember opening my medical school acceptance letter. I was, of course, excited to go down a lifelong career pathway, but also, felt joy at knowing that I was accepted into a tribe of international doctors that would welcome me anywhere in the world, who spoke a common language and had a common culture and ethos. A sense of community and belonging is important to mental health. 

During the pandemic, many of us became more isolated than before. Community, which these authors define as a group of individuals who share a mutual concern for one another’s welfare, has proven challenging to cultivate, especially for those working virtually. To learn more, they conducted a survey with the Conference for Women in which they asked nearly 1,500 participants about their sense of community at work before and since the pandemic and found it has declined 37%. When people had a sense of community at work, they found that they were 58% more likely to thrive at work, 55% more engaged, and 66% more likely to stay with their organization. They experienced significantly less stress and were far more likely to thrive outside of work, too. People can create community in many ways, and preferences may differ depending on their backgrounds and interests. The authors present several ways companies have successfully built a sense of community at work that leaders can consider emulating at their own organizations.

Research has shown that when employees feel that they belong to a team or organization, they will not only tend to perform better, but also experience higher levels of engagement and well-being. But our feeling of belonging at work has become challenged over the past year as we’ve shifted away from in-person interactions and found ourselves relying on video calls and screen activities to stay connected.

Here is the painting I passed under on my way to class for the first two years at Jefferson Medical College

Here is a painting I passed in the halls at the University of Pennsylvania

Here is the painting I passed in the halls of Philadelphia General Hospital

Patrick Hanlon, is his book "Primal Branding", defines a brand as something people feel something about. He goes on to state that believing is belonging. When you are able to create brands, like the medical profession, that people believe in , you also create groups of people who feel that they belong.

Primal branding is about delivering the primal code. Unlike the four elements of the code in DNA, though, there are seven: the creation story, the creed, the icons, the rituals, pagans, the sacred words and the leader.

Researchers have lumped tribes into 5 stages

The reality is something else. Unfortunately, in many ways, the medical tribe has become fractious and unaccepting. The results are burnout, depression, suicide, disenchantment and fragmentation of power.

Examples include:

1. Medical education and training that some have described as abusive

2. Turf wars

3. Jealousy, greed and resentment for those who want to upset the apple cart, potentially threatening the cash cow and status quo

4. Marginalizing disruptive doctors

5. Subconscious or implicit bias against colleagues based on race, gender or other factors.

6. Hostility between MD and non-MD "providers"

7. Pushback against scope of practice creep

8. Specialists v generalists

9. Grunts v physician executives and administrators

10. Conflicts in interprofessional relations and care teams.

11. Racism. Is your doctor a racist?

12. Gender pay gaps

Here are 10 reasons why doctors don't play nice with others.

Plus, all doctors have multiple affiliations and are more engaged with some than others. For example, they have varying levels of engagement with their employer, their specialty association or their local, regional or national medical association. Most tend to go where they are treated best and drop or ignore the others. Mentors,sponsors,coaches and colleagues help with burnout.

 Many of us recall with fondness, particularly those who have served in the military, those times we shared with "foxhole buddies" e.g residency training, project teams, shock and trauma units and circumstances, like following mass killings or natural disasters, when the community comes to together. Even the doctor's lounge is a thing of the past because the real estate is "too valuable" and doughnuts and coffee costs too much.

In many places , doctors have lost their sense of community and attachment to the tribe. The dark underbelly of medicine has damaged the brand.

Fareed Zakaria, in his book, Age of Revolutions, offers an explanation derived from the Dutch, English and French revolutions and how changing times breed a crisis in meaning that results in the collapse of community.

We are experiencing the same thing during the 5th Industrial Revolution powered by artificial intelligence and the backlash and inevitable conflicts between liberals and conservatives, open society v closed, the past v the future, and "the revenge of the tribes". People create technology that then transforms people for better or worse.

While peer-support programs serve a vital role, they tend to only address the tip of the iceberg of the distress and disconnection experienced by many physicians. Going beyond peer-support programs, it is important to create processes for intentional professional connection, so no one delivers care alone.

We live in a world that seems more divisive and polarized than ever, and it’s common to describe this phenomenon as tribalism. But Michael Morris, professor at Columbia Business School, says that term is often misunderstood and that tribal instincts can in fact be very positive influences in society and at work. He uses the lens of cultural psychology to explain the deep-seated instincts behind the human need to join and identify as a group. And he breaks down how team managers and organizational leaders can leverage tribal instincts in positive ways strengthen workplace culture. Morris is the author of the new book Tribal: How the Cultural Instincts That Divide Us Can Help Bring Us Together.

Doctors have lost their sense of belonging. They don't need a therapist. They need an anthropologist.

Arlen Meyers, MD, MBA is the President and CEO of the Society of Physician Entrepreneurs on Substack