Seven years ago, as a medical student applying to residency programs, I began writing a version of this essay to articulate why family medicine felt like my purpose—or, as the Japanese would say, ikigai. At the time, I wanted to demonstrate that a career in family medicine not only aligned with my professional skills and interests but also offered the possibility of a dynamic, fulfilling life outside of medicine. Yet, I hesitated. Would an admissions committee value this perspective? Probably not, I decided. So, I scrapped that part of my application essay—only to return to it years later, as my understanding of ikigai deepened and evolved.

I once believed purpose was innate—something other doctors naturally possessed. They had clear career paths, an affinity for research, and an effortless empathy I often felt I was imitating. For years, I tried to replicate the career of my master’s supervisor, a renowned surgeon-scientist, believing that fulfillment lay in following their path. But the more I forced myself into that mould, the greater the tension within me grew. I enjoyed the art of clinical diagnosis, complexity, and longitudinal relationships, but deep specialization and formal research drained me rather than energized me.

It took me far too long to recognize this misalignment and I know I am not alone. Many physicians build their careers around external expectations rather than internal fulfillment, only to find themselves burned out and disillusioned, disconnected from their original sense of purpose. What I lacked—and what many of us lack—is a structured way to navigate these questions of meaning. What if purpose in medicine is not something fixed, but something that evolves? Over time, I have come to believe that it does.

Why physicians struggle with fulfillment

On paper, medicine appears to be one of the most fulfilling careers. Physicians save lives, solve complex problems, and serve their communities.

Yet, despite medicine’s outward prestige, many physicians feel adrift. Ironically, the very traits that make them effective—perfectionism, self-sacrifice, and resilience—can also be their undoing. The relentless pursuit of clinical excellence can come at the expense of personal identity. Systemic pressures—electronic health record burdens, productivity metrics, and the historical societal expectations of a doctor—can further erode our sense of meaning.1

A recent report from the American Medical Association found that roughly 50% of physicians experience symptoms of burnout.2 Studies indicate that when physicians struggle to align their work with personal values, they experience higher rates of emotional exhaustion and disengagement.3

For many, the question becomes inevitable: Is this all there is?

Framework for purpose: ikigai in medicine

The Japanese concept of ikigai, often translated as “reason for being,” offers a lens through which to reimagine fulfillment in medicine. Traditionally, ikigai refers to the small joys and deep sense of meaning that make life worthwhile, feelings rooted in everyday experience, community, and personal values rather than career success. Ikigai is embedded in a broader Japanese worldview that emphasizes balance, service, and harmony.4

In recent years, ikigai has been popularized in Western literature through a 4-circle model, intersecting what we love, what we are good at, what the world needs, and what we can be paid for.4 While this adaptation is not part of the original tradition, it offers a practical framework for reflection. I use it here with that understanding—not a full representation of its cultural depth—as a tool to help physicians reconnect with personal meaning in their careers. Rather than defining fulfillment through external achievements—publications, promotions, or prestige—ikigai suggests a more integrated approach. It lies at the intersection of 4 elements: What do I love? What am I uniquely skilled at? What does my community need from me? What sustains me financially? It is not a rigid formula, nor a single moment of revelation. Instead, ikigai is cultivated over time, through experience, introspection, and adaptation. It recognizes that one’s reason for being is not static: it shifts with life stages, career transitions, and personal growth.

Reclaiming purpose: applying ikigai to medical careers

If fulfillment is not found in traditional career benchmarks alone, where should physicians look? The ikigai framework suggests redefining success beyond professional achievements to include relationships, creativity, and self-care—not as indulgences, but as essential components of meaningful work.5

Ikigai is not about adding more to your plate; it is about redefining success to include the full spectrum of your life. Relationships, creativity, and self-care are not indulgences; they are the fuel that sustains meaningful work.5 Few find ikigai in their job description alone, and even the most rewarding careers falter when disconnected from personal values. This framework echoes the principles of self-determination theory, which emphasizes autonomy, competence, and relatedness, key factors that foster intrinsic motivation and well-being in health care professionals.6

Consider these examples: A surgeon who thrives in the operating room but neglects teaching might feel unmoored. A primary care physician who sidelines a passion for music loses a crucial source of renewal.

The challenge is not simply to work less but to work in ways that align with personal meaning. Meeting this challenge requires intentional reflection and, sometimes, bold experimentation.

Your ikigai lives at the intersection of who you are and how you contribute. This intersection can vary by specialty, career stage, and personal identity. Early-career physicians might focus more on honing clinical skills, while later-career physicians might emphasize mentorship or work-life balance. Understanding these shifting priorities helps to tailor ikigai to individual circumstances.

Strategies for cultivating ikigai

Energy audit. Tracking daily activities in 1-hour intervals over a week or 2 can reveal patterns.7,8 Categorize each activity as energizing (eg, teaching, direct patient care), neutral (eg, charting, meetings), or draining (eg, bureaucratic tasks). Identifying patterns can help you understand where adjustments are needed. For instance, if a substantial portion of your time is spent on draining tasks, it might be possible and beneficial to delegate, automate, or even remove “time wasters,” to improve professional satisfaction.9

“Eulogy” exercise. Imagining how you want to be remembered at the end of your life can bring clarity to your current priorities.10 This exercise forces you to step out of the daily grind and take a long-term view of what truly matters.

To start, imagine a close friend, colleague, or loved one delivering a eulogy about you. What would they say? More importantly, what do you hope they would say? This subtle shift in perspective often reveals misalignments between daily work and long-term values. If you want to be remembered as a mentor but spend all your time buried in administrative work, or if you envision yourself as a physician-writer but never carve out time to write, it is a signal to realign your priorities.

For some, the answer might be stepping into a teaching or mentorship role. For others, it might be scaling back on work hours to invest in family or creative passions. The goal is not to create a rigid roadmap but to ensure that your career trajectory is intentional rather than accidental. By periodically revisiting this exercise, you can ensure that your professional life remains aligned with your deeper purpose, avoiding the all-too-common realization that you have achieved success—but at the cost of fulfillment.

Experimenting with small shifts. Purpose is often uncovered through action rather than introspection alone.11 Physicians can experiment by exploring clinical niches (palliative care, global health, medical education) or taking on nonclinical roles (policy advocacy, mentorship, writing), or by prioritizing personal fulfillment (creative pursuits, volunteering, travel).

Take small risks. Try leading a teaching session, writing a short reflective piece, removing a burdensome aspect of your schedule. By embracing small shifts, physicians can find purpose through action, thereby creating a more sustainable and fulfilling career one step at a time.

Lifelong practice of purpose

Cultivating ikigai is not about overnight transformation. It is about iterative, intentional change—protecting small pockets of time for personal fulfillment, reshaping career priorities, and periodically revisiting the question: Is my work still aligned with my values? By applying the ikigai framework, physicians can move beyond mere career survival and toward a more sustainable, fulfilling life in medicine.

Footnotes

Competing interests

None declared

The opinions expressed in this article are those of the author. Publication does not imply endorsement by the College of Family Physicians of Canada.

This article has been peer reviewed.

Cet article se trouve aussi en français à la page 619.

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