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Called to medicine: physicians' experiences of career calling.

Using consensual qualitative research methodology, the authors explored physicians' (N= 17) career calling experiences through semistructured interviews. Eight domains emerged: definition of calling, development of calling, calling's fit with career, maintenance of calling, emotional well-being, relationships, recreation, and future. Within these domains, 17 general and 40 typical categories emerged. Results suggest physicians' callings were influenced by others, met with both support and barriers, and chosen because of fit with interests, prosocial motivation, or religious/spiritual influences. Calling positively and negatively influenced emotional well-being, relationships, and recreation and was expected to continue after retirement. Counselors are encouraged to use a narrative lens to conceptualize clients' calling development, use job crafting techniques to support calling maintenance, and prepare clients for postretirement career calling development. Future research might examine when and why a medical calling's strength may change over time.

Keywords: calling, career, well-being, medicine, physician

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Career calling has been defined as an approach to work that is inspired by an external summons and provides a means through which one derives meaning and fulfills prosocial motives (Dik & Duffy, 2009). Research shows that a large percentage of college students and working adults experience a career calling (Duffy & Dik, 2013). More specifically, students planning to obtain more advanced degrees and working adults with higher degrees are more likely to feel called to a particular career (Duffy & Sedlacek, 2010; Wrzesniewski, McCauley, Rozin, & Schwartz, 1997). Espousing a calling has been found to correlate with a myriad of indicators of work and general well-being, including work zest, work and life satisfaction, work and life meaning, and commitment to one's career and organization (Duffy & Dik, 2013).

Considering the prevalence of calling across working adults and the positive relation between career calling and factors of well-being, researchers have begun to explore how career calling is experienced by and affects specific populations. For instance, qualitative studies have examined calling in samples of psychologists (Duffy, Foley, et al., 2012), zookeepers (Bunderson & Thompson, 2009), and working mothers (Sellers, Thomas, Batts, & Ostman, 2005). However, no known qualitative studies have explored career calling specifically among physicians. This is surprising considering that a calling is likely to be prevalent among physicians, and in light of research that showed that a calling is more common for those with advanced degrees and is salient specifically within the medical field, at least among medical students (Borges, Manuel, & Duffy, 2013).

Answering previous researchers' appeals to investigate how calling applies to various professions (Duffy, Foley et al., 2012) and the medical field (Westerman, 2014), we believe that physicians' experience of career calling merits particular investigation. At a time when physicians are greatly needed in the workforce, especially in primary care (Spinelli, 2015), physicians experience high stress and burnout, decreased job satisfaction, more quality of life (i.e., work-life balance) concerns, and more feelings of being scrutinized and powerless than at previous times within the health care system (Cohen, 2002; Goebring, Gallachi, Kiinzi, & Bovier, 2005; Johansson & Hamberg, 2007; Shanafelt et al., 2014). Research is needed to clarify their career experiences, identify ways to buffer these effects, and indicate how career counselors might support developing and practicing physicians.

Theorists propose that a calling can be of particular import to those in highly challenging jobs (Dik & Duffy, 2009). Research specific to the medical field shows that among medical students calling relates to heightened work and personal well-being (Duffy, Manuel, Borges, & Bott, 2011), and among physicians calling is aligned with greater resilience (Yoon, Rasinski, & Curlin, 2011). However, quantitative research to date has recognized only a few wellness factors associated with a calling to medicine, and only two variables (vocational maturity and life meaning) that might predict the development of that calling (Duffy et al., 2011). Qualitative research is needed to explore not only the extent to which a calling relates to physicians' well-being on and off the job, but also the context in which a calling develops. Moreover, Duffy et al. (2011) found calling to decrease from the 1st year to 3rd year of medical school, highlighting how one's sense of a calling can change over time. If a calling is related to physicians' work and general well-being, then qualitative inquiry is needed to identify how physicians might sustain their calling and expect it to develop over time.

To date, we know of no qualitative studies that have explored the breadth of a calling's impact on physicians' wellness. This seems necessary to inform calling-inclusive counseling for medical students and physicians. To fill this gap in the literature, the current study implemented qualitative methods to explore the context, development, and impact of having a calling for physicians. More specifically, the following research questions were investigated: How do physicians define their career calling? How do physicians' career callings develop? How does career calling affect physicians' current and future work? How does career calling affect the personal and social experiences of physicians? Our aim in answering these questions was twofold: to provide a more well-rounded understanding of physicians' calling experiences and to inform practical implications to support current and future physicians' career development and decision making, especially as they relate to the physicians' career calling.

Method

Participants

Participants were 17 physicians (seven women, 10 men) who were faculty members at a midwestern medical school and self-identified as being called to medicine. Most participants identified as White (n = 15), and two participants (12%) identified as Indian. In terms of religious or spiritual affiliation, 11 were Christian, three were spiritual, two were nonreligious/ spiritual, and one was Jewish. Participants had attended both private (n = 9) and public (n = 8) medical schools, completed residency programs at university (n = 10), community (n = 5), or combined (n = 1) settings, and previously graduated from medical school over the following range of years: <10 years (n = 1), 11-20 years (n = 5), 21-30 years (n = 4), 31-40 years (n = 6), >40 years (n = 1). Ten participants specialized in nonprimary care, and seven worked in primary care. One participant did not specify his or her residency program type.

Procedure

After obtaining approval from the institutional review board, we sent an e-mail that described a study on career calling to all physician faculty members at a Midwestern medical school and asked for participation from physicians who "explicitly view their career as a calling." Eighteen physicians indicated initial interest, and they were further screened with the question "As a physician, do you view your career as a calling?" One physician withdrew from the study, because she did not feel that she sufficiently espoused a calling. The physicians were then provided with a more detailed description of the study and informed consent was sought. No compensation was provided.

Because this study was the first to explore physicians' calling experiences, consensual qualitative research methodology (CQR; Hill, Thompson, & Williams, 1997) was used to permit the "discovery" of the hypotheses and relations between die constructs (Hill et al., 1997, p. 518). Adhering to CQR's standardized yet flexible data-gathering method, a semistructured interview (available upon request from the first author) was developed to provide a framework in which participants could provide die rich context to their respective calling experiences. The interview questions were informed by the calling literature and addressed our primary areas of interest. Interviews were conducted by phone, lasted 30-60 minutes on average, and were audio recorded by a counseling psychology doctoral student with previous qualitative interview experience. The interviews were transcribed by undergraduate students trained in transcription and were reviewed by die interviewer to ensure accuracy.

Following Hill et al.'s (2005) guidelines, the research team (different from those who transcribed the interviews) discussed team-member characteristics that might inhibit objectivity of the coding process. The research team consisted of a doctoral student (25-year-old White woman) and three undergraduate students (20-year-old White woman, 21-year-old White man, and 19-year-old White man). Only the 20-year-old undergraduate student had a physician family member. The researchers explored their personal demographics, expectations, and biases that might impede objective coding. This discussion was used to hold themselves and each other accountable for minimizing the influence of biases on the coding.

Data Analysis

In accordance with CQR, the coding process consisted of three stages. First, team members individually read two interviews, identified domains (large topics that describe clusters of data), and met as a team to reach consensus about naming and merging domains. The researchers individually coded the remaining transcripts according to the previously identified domains and met as a team to reach consensus about which domain represented each data cluster.

Next, the team coded core ideas by identifying more concise descriptions of larger passages within each domain. Team members individually summarized the core ideas within the first two interviews and met as a team to reach consensus on the most clear and succinct core ideas for each passage. For the remaining interviews, the team met as a whole, and team members alternated providing core ideas for each passage while the remaining members added to or detracted from the description to reach consensus..

In the last stage, the team completed a cross analysis, whereby category names were created to represent the themes throughout the core ideas within each domain. The researchers individually identified category names for two interviews and then met as a team to reach consensus on categories. Individually, the researchers used these categories to code the remaining interviews, and the team met as a whole to reach consensus on which categories best represented all parts of the data. As more transcripts were coded, category names were adjusted to better match the overall data, and previously coded transcripts were revised accordingly. When disagreements occurred during each coding stage, intentional effort was given to share power equally among members while formulating and agreeing upon coding.

Finally, the frequency of categories across interviews was assessed. According to Hill et al. (2005), categories that appear in all or all but one interview are classified as "general." However, considering the current study's larger-than-average sample size (Hill et al., 2005) and guided by previous researchers' coding systems for larger sample sizes (Duffy, Torrey, Bott, Allan, & Schlosser, 2013; Knox, Schlosser, Pruitt, & Hill, 2006), general was used to classify categories endorsed by all or all but one or two participants. Categories were identified as typical if they appeared in more than half of the interviews (nine to 14) and variant if found in three to eight interviews (Hill et al., 2005). Throughout the data analysis process, an auditor ensured the validity and objectivity of the coding process. The auditor was a counseling psychology tenure-track assistant professor (31-year-old White man with research and teaching responsibilities) who had expertise in the area of career calling and CQR. He audited the domain names, core ideas, and categories after each stage of coding and provided comments that were integrated into the coding process.

Results

Across the 17 interviews, a total of 125 categories appeared that accounted for all frequency types (general, typical, or variant), suggesting diversity in the experience of calling among the physicians. Eight domains emerged within the interviews: definition of calling, development of calling, calling's fit with career, maintenance of calling, emotional well-being, relationships on and off the job, recreation, and future.

Definition of Calling

In explaining their definition of a career calling, one typical category emerged: participants defined a calling as a career to which one feels drawn or guided. Although not all participants noted the source of this drawing force, many stated feeling guided by an external source, such as a societal need or God. One physician shared, "It means that when you see a societal need that you have the ability to meet ... there's a sense of being drawn to that," whereas another physician explained, "I definitely feel that God has a plan for us and we are drawn into certain areas."

Development of Calling

All but two physicians stated that their callings were influenced by important people in their lives. More specifically, 15 physicians' callings were shaped by medical personnel. One participant shared, "I got to know a physician who was a surgeon ... he basically became a role model and sort of a hero to me. I think he was probably the most influential in choosing medicine." More than half of the participants were influenced by family members who were employed as health professionals and/or demonstrated values that informed the physicians' callings. One physician described,
   My mom had this role of imbuing [us] with social justice values
   that we all have now. You have to give yourself, you have to help
   the poor, you have to do something with your mind that helps the
   world, that kind of thing. She ... definitely thought medicine was
   the best [and] pretty much the only job that combined everything
   she wanted to teach us.


Additionally, the physicians reported both support for and barriers to pursuing their calling. All but one physician described receiving support for their medical calling, and two typical subcategories emerged: support from friends and family (characterized by a family of origin and/or current family [spouse and children]). Alternatively, it was typical that the physicians experienced barriers to their calling. Specifically, more than half of the physicians noted that others did not support their career choice. One physician explained, "I had the guidance counselor who said females shouldn't go to med school. I had some peers in undergrad who said that med school wouldn't seriously consider a stay-at-home mom in the application process." Another participant shared how she perceived a lack of support from her daughter:
   She comes running up to me, says she missed me, and [says], "Mommy,
   how long did you say residency was going to be?" I [say], "Three
   years," and her eyes get big. She suddenly understands something
   and says, "Mommy, that's half of my life." I go, "Oh my goodness. I
   guess so." There were some things like that that were not so
   supportive.


Shedding light on why the physicians chose to pursue medicine to fulfill their calling, several typical categories emerged. Twelve participants indicated that they chose medicine because it enabled them to fulfill their prosocial motivation to serve others. More than half of the participants chose medicine because it was a good fit with their interests, skills, and/or beliefs. Ten participants noted a religious or spiritual pull as influencing their choice to pursue medicine. One participant stated, "God's like, 'I've told you what to do here, and now I'm about to slap you upside the head for you to figure it out!'" The participants' rationale for fulfilling their calling through medicine reflected both external sources (drawn to serve others or follow a religious/spiritual pull) and internal origins (fit with skills). More than half attributed their calling to more than one of these rationales. For instance, of the 10 physicians who described an external source of their calling vis-a-vis their faith, seven also noted an internal pull because of fit between medicine and their skills, and four claimed an additional external pull to serve others.

Patterns also emerged regarding the timing at which medicine was realized as a career and a calling. It was typical that the physicians recognized medicine as a possible career path before college, but accepted it as their calling during or after college. It was also typical that the physicians took an indirect route to pursue medicine. Several physicians considered many careers and used a process of elimination to finally settle on medicine; others entered college planning to enter a different career, and still others obtained graduate training or work experience in different careers before realizing their medical calling. One physician reported,
   As opposed to a neon sign lighting up at the beginning of my
   college career, I would just take a step in a certain direction,
   avenues would open up, and then I would take another step. I was
   led on a path as opposed to, "Here's the direction you're supposed
   to go."


Calling's Fit With Career

How the physicians perceived their callings to align with or influence their day-to-day work was expressed within this domain. Generally, the physicians found their calling to fit with medicine because of two aspects of their work: helping others and teaching. A physician described how he answers his calling by healing and teaching through his work:
   I have the ability to do the most as a physician, but it's broader
   than that. There are other ways to help people without being a
   healer. Teaching is essential to healing, and it's also essential
   to assisting others to become healers or to become helpers.


Following suit, balancing multiple work duties was a typical pattern. One participant elaborated,
   The whole idea of making a difference really drives everything that
   I do, whether it be taking care of patients or even in my
   administrative roles. They've been somewhat strategically chosen
   where I don't waste a lot of time on things that I don't think are
   important and/or will make a difference ultimately in the life of
   somebody else.


In terms of how physicians perceived their called day-to-day work, multiple typical categories emerged. More than half of the physicians experienced their work to be intensive (labor intensive and time-consuming) and challenging (stressful or difficult). Additionally, the majority found it was difficult to fulfill their calling through their medical work (i.e., because of healthcare limitations, lack of time, administrative burdens). Despite these challenges, the majority of the physicians felt that their calling imbued them with a sense of responsibility to continue to use their skills to help others, and their activities exceeded the typical duties for a physician. One physician described,
   The thing that comes from the calling, whether it's in the teaching
   role, healing role, or in working with the staff, I feel that it's
   my obligation--my responsibility--to the people that I exceed
   what's in my physician description; it's not enough to do just
   enough.


Moreover, the majority of the physicians found that perceiving their work as a calling helped them stay motivated to do their day-to-day work. As explained by a physician,
   When someone takes your hand and says, "Thank you for coming into
   the hospital" or, "You've been so helpful," then you're reminded of
   the calling. [Those] are the times that will bring you back to it.
   The calling is why I stay on the job.


Two final typical categories emerged: multiple callings and interaction between medicine and religion/spirituality. Although all the physicians felt called to medicine, the majority also felt called to teaching, parenthood, research, administration, or other roles of interest. In addition, more than half of the physicians described how their religion or spirituality influences their called medical work. For some, prayer helped them remain calm on the job or prioritize tasks that were most congruent with their calling. For others, religious or spiritual values guided their daily work or were discussed with patients in hopes of improving patients' health. One physician shared,
   I think [my mission] ... is to help those who the system often
   doesn't want to help from a medical perspective, not just for
   social reasons, but to try to integrate faith into those
   experiences. I don't push people to believe anything in particular,
   but often they come to the realization that they need something
   more than what medicine can offer them.


Two thirds of those who described their faith as influencing their daily work also perceived their sense of responsibility to serve others as motivating their efforts. As such, many of those who felt an external religious/spiritual influence on their day-to-day work also felt an internal responsibility to fulfill their duties, pointing to both the external and internal factors influencing the called physicians' day-to-day work.

Maintenance of Calling

Two typical categories emerged in this domain: interaction with others and active medical practice. The majority of participants found the strength of their calling was sustained over time due to interactions with others, like patients, colleagues, students, and/or family members. A physician explained,
   The interactions I get with patients about their life-changing
   experiences are very rewarding, and that certainly fuels my fire to
   keep going in that direction. It's a relationship thing where I put
   some energy into it, and my patients do things that are amazing at
   times, and that gives me energy to keep going as well.


More than half of the physicians also described actively practicing medicine to sustain their calling. Actively practicing medicine was characterized by two subcategories, engaging in professional development and clinical practice with patients, however only clinical practice reached the typical level.

Emotional Weil-Being

All participants reported experiencing both positive and negative affect. A physician described how his calling affected his emotions, "Positively by far. I mean, it's a balance. There's really positive things and really negative things. But by and large, in the benchmark upstairs, it was way more positive than negative." Even though both positive and negative emotions were experienced by each physician, only subcategories of positive affect (enjoyment, satisfaction, gratitude, and feeling rewarded) reached the typical level. Comparing her level of enjoyment to that of physicians without a calling, a called physician described the following:
   I have had a lot more fun being a doctor than most people that I
   see. I see a lot of my friends who I went to residency with, and I
   don't think they have enjoyed their lives as much, because they
   have focused on medicine as a career, not as a calling.


Another physician noted feeling both satisfied and rewarded by pursuing his medical calling:
   I've always been happy and satisfied with what I'm doing. I
   questioned but never had any real questions as to whether it was
   worthwhile or beneficial. I've done a lot with it that I can be
   proud of. It's reassuring and rewarding feeling, like you've been
   able to accomplish something.


Many of the physicians also felt grateful for their callings, as exemplified by the statement, "I think [a calling] really gives you a sense of gratitude for what you've been given, what you've experienced, and a sense that your life has had meaning."

Relationships on and off the Job

This domain characterizes the physicians' relationship experiences once they began their medical careers (post-medical school). All the physicians described having positive interactions with others, which included colleagues (general), patients (typical), students, and/or family members. The physicians reported that some of these positive interactions were perceived as direct support for their calling. Specifically, all but one described feeling support from their workplace (institution, work environment, boss, or colleague), and more than half felt supported by their families. Beyond the source of support, the physicians noted a typical style of support, whereby others (i.e., patients, colleagues) expressed appreciation for their work efforts.

Additionally, more than half of the physicians experienced relationships in which they sought to or did inspire others. For instance, some actively inspired others to become physicians, to help others, or to better balance work and family life. One physician explained,
   I've had between 10 and 20 patients who have gone into medicine as
   a career who would probably say I had a major influence in that
   decision, and a couple of patients who have even named kids after
   me. I don't know how you'd measure that kind of reward.


However, the physicians noted their calling diet not always have a positive effect on their relationships. The majority of the physicians reported their medical calling had positive and/or negative influences on their family. A physician elaborated,
   It affects family life in a positive and negative way. Positive
   because when I leave clinic every day, I feel good ... and I bring
   that home. But ... it can also bring home some negatives ...
   which is people tend to work longer hours and [get] compensated
   less.


Moreover, 15 physicians expressed relationship balance difficulties, whereby time spent on the job detracted from the quality or quantity of relationships off the job. More specifically, relationships with family and friends were typically negatively affected. A physician explained,
   I think my intensity about serving through medicine has probably
   resulted in my not enjoying the relationships with my children as
   much as I could have. Because of the energies that my calling
   demanded throughout my career, it was necessary for me to be very
   deliberate about how I spend my time and with whom. The net result
   of that is my sphere of relationships outside my professional
   relationships is pretty small.


Recreation

All the physicians found their calling to medicine to influence their recreational activities. More than half of the participants chose to engage in medically related activities (e.g., volunteering at clinics or health charity boards) whereas others participated in activities distinct from their medical work in order to provide life balance (e.g., nonmedical activity or immediately gratifying activities). One physician described this balance:
   I know colleagues who spend virtually all their time immersed in
   some area of medicine. They just can't let it go.... For me, I
   need to have some balance and some diversity around my primary
   calling. It's just healthier. But I wouldn't pick any of my outside
   activities and make that my primary area and replace what I see as
   my actual calling.


More than half of the physicians also found their called medical work to interfere with their recreational life. One participant summarized, "I'm feeling my free time being encroached on ... I have less free time.... A work-creep happens."

Future

The physicians' expectations about how their calling and related work would unfold in the future was captured within this domain. Only one general category emerged: All of the physicians indicated they would practice medicine until they retired. One physician stated,
   As long as I'm physically [able] with no medical problems, able to
   work in the office and practice, as long as my vision is good and I
   don't have any kind of tremor, and I can use instruments to examine
   patients, I think I would like to practice until my 70s.


Three typical categories emerged: More than half of the physicians believed they would teach in the future (a way for many of the participants to pursue their second calling), would be involved in medicine after retirement, and would continue having a calling postretirement. One physician noted his desire to remain involved in medicine even after retirement, "As long as I'm physically and mentally able, I would have trouble stepping into retirement and not in some way continuing to do what I do." Many also explained that their calling to medicine would still exist after retirement. As described by a physician, "I don't know that you can retire from a calling."

Discussion

This study on physicians' calling experiences sheds light on how physicians' callings are defined, developed, and maintained over time; how their callings influence their medical work and personal lives; and how their callings are expected to evolve in the future. Although our study was not grounded in a specific theoretical framework, the findings fit well with career construction theory (CCT; Savickas, 2005), documenting individuals' career stories and how they adapt to the world of work to maintain a calling. The findings not only support and add to the literature, but also inform practical implications for counselors who work with medical students and physicians.

Definition of Calling

Consistent with the current state of the calling literature that continues to debate a singular definition of calling (e.g., Dik & Duffy, 2009; Duffy & Dik, 2013), no consensus definition of calling emerged in our study. Rather, the definitional component that reached the typical level was only supported by 10 out of the 17 physicians and indicated a sense of feeling drawn or guided to pursue a career. This description mirrors Dik and Duffy's (2009) definition, which underscores the external summoning nature of a calling. However, additional patterns also emerged that only reached the variant level. Less than half of the participants indicated that a calling is a career through which they help others, that fits their own skills or passions, or that is what they are meant to do. These variant definitions represent both internal (i.e., sense of fit or "meant to do") and external (i.e., pulled to serve others) sources of a calling and align with more recent studies that endorse both external and internal calling origins (Duffy, Allan, Bott & Dik, 2013).

Additionally, the majority of the physicians identified more than one source of their calling, and seven identified both internal and external sources of their calling in their definition. This finding challenges two notions: that a calling is triggered by one, independent source and that this source is either internal or external. Based on these findings, career calling may be more accurately defined as a career that originates from one or more sources which are characterized by a type of external summons and/or an internal drive. Future qualitative researchers are encouraged to more pointedly examine the source component of a calling to ascertain the average number of sources and prevalence of external versus internal sources.

Development of Calling

Despite diverse views about the meaning of a calling, clear patterns emerged concerning how the physicians' callings developed. The physicians' callings were influenced by others (physicians and family members) and were chosen because of (a) fit with skills, interests, or beliefs; (b) prosocial motivation; and/or (c) a religious or spiritual pull. These findings highlight the social nature of a calling, whereby the introduction to one's calling might be influenced by others and a calling to medicine might be chosen because it is an avenue through which one can serve others. Interestingly, participants tended to recognize medicine as a career path before college, realize their calling to medicine during or after college, and follow indirect routes to medicine. Considering that gaining entrance to medical school requires high academic achievement, perhaps it was particularly important for this sample of physicians to identify medicine as a career path before college so that appropriate academic goals could be set. However, for called individuals who work in less competitive fields, realizing one's career path before college may not be as crucial, highlighting an intriguing research question about whether the timeline for realizing one's career and calling differs across individuals from varying careers.

For the called physicians, the awareness of their career before their calling suggests that a calling is not something that develops permanently at a young age; rather, it is more likely for career trajectories (even if indirect) to develop first and a calling to develop afterward, allowing time for self-exploration and educational or career-related experiences before the realization of one's calling. This qualitative finding not only aligns with previous quantitative research that shows that career clarity predicts calling and calling relates to high self-exploration, but it also points to possible directionality of the self-exploration-calling relation (whereby self-exploration might precede a calling; Duffy, Douglass, Autin, & Allan, 2014; Hirschi 2011). Finally, all of the physicians perceived both support for and barriers to pursuing their calling. Considering this finding is consistent with previous qualitative calling studies (e.g., Sellers et al., 2005), researchers are encouraged to move beyond the question of whether both supports and barriers influence a calling and instead address which types of supports and barriers are most influential.

Calling's Fit With Career

Mirroring studies that repeatedly show physicians' work to be stressful (e.g., Dewa, Loong, Bonato, Thanh, & Jacobs, 2014; Goebring et al., 2005), this study's participants considered their called work to be intensive and challenging. Many encountered the additional difficulty of feeling unable to fulfill their calling through medicine because of limitations within the medical system, which parallels frustrations reported by called medical providers in previous research (Curlin et al., 2006). However, the physicians also reported that calling was linked to positive work experiences, like feeling motivated, surpassing the average physician's duties, and feeling responsible for using their skills to help others. These findings suggest a two-sided effect of having a calling, which Bunderson and Thompson (2009) coined the "double-edged sword" (p. 52); called physicians may not be immune to work stress and may feel additional stress because of unfulfilled daily calling experiences but, alternatively, may experience heightened work motivation. Many physicians also perceived their day-to-day medical work to be positively influenced by their religion or spirituality (i.e., increased relaxation, connection with patients, or clarification of meaningful work duties). Although previous qualitative research on a Christian employee sample has noted how prayer or spirituality is used to increase peace on the job and clarify one's called work (Oates, Hall, & Anderson, 2005), this is the first study to suggest that the intersection of religion/spirituality and work may be applicable and possibly beneficial to a sample of not only physicians but also employees with varying types and degrees of religious or spiritual faith.

Maintenance and Future of Calling

Considering the potential benefits of espousing a career calling (i.e., heightened life meaning, job satisfaction, life satisfaction; Duffy, Allan, Autin, & Bott, 2013; Duffy, Bott, Allan, Torrey, & Dik, 2012), results that highlight how to sustain a calling over time merit particular attention. Aligning with previous research (Duffy, Foley, et al., 2012), the majority of the participants reported that interacting with others helped to maintain their callings. Adding to the literature, the physicians also noted that actively practicing medicine (especially through working with patients) helped to sustain their callings. Although causality cannot be inferred from qualitative data, these results might suggest the importance of engaging in calling-supportive relationships and direct medical work with patients for physicians who seek to maintain the strength of their callings over time.

Regarding the future of the physicians' callings, they anticipated that not only would their practice of medicine continue until and after retirement, but so would their callings. Feeling called to be a physician was expected to continue to motivate medically related helping behaviors as the physicians navigated postretirement career development. This is a particularly timely finding considering the aging and upcoming retirement of baby boomer physicians and in light of results from the Physicians Foundation survey (2014) showing that 9% of physicians intend to retire in 1-3 years and 39% intend to accelerate their retirement (Spinelli, 2015). Researchers have begun to address how to conceptualize career development into retirement (i.e., Lent &: Brown, 2013); however, a research gap exists in terms of how to conceptualize the development of a calling and its influence on paid or unpaid work after retirement, highlighting an exciting avenue of needed future research.

Relationships On and Off the Job

Bringing attention to both the light and dark sides of a calling, this study found that being called to medicine had both positive and negative impacts on relationships. The called physicians reported having positive work interactions, feeling supported by others in their medical work, and receiving appreciation for their efforts. Although causation cannot be inferred, it may be that having a calling contributes to positive on-the-job social interactions, which might be an additional benefit of viewing one's medical work as a calling. However, mirroring studies with other samples (i.e., Bunderson & Thompson, 2009; Sellers et al., 2005), we found that being called to medicine detracted from the physicians' relationships outside of work, whereby the majority of our participants had difficulty fully engaging with family and friends because of their focus on their medical callings. As such, feeling called to medicine may be related to positive relationships on the job, but weakened relationships outside of work.

Emotional Weil-Being and Recreation

Finally, physicians' callings were found to relate to a mixture of positive and negative emotions and to influence their recreation. Although all of the called physicians experienced both negative and positive affect, which aligns with previous findings (Duffy, Foley, et al., 2012; Hernandez, Foley, & Beitin, 2011), this is the first study to identify specific emotions that reached significance: joy, satisfaction, gratitude, and feeling rewarded. This finding suggests that physicians with callings are not protected from negative affect related to their medical work; however, they may be likely to experience common positive emotions like joy and gratitude. Lastly, the physicians' callings were found to affect their recreational activities. The physicians engaged in medicine-related activities for fun or nonmedical activities to counterbalance their medical callings, pointing to how each physician found a work-recreation balance that felt right for him or her. The physicians also noted how their callings negatively influenced their recreation. Similar to a qualitative study with zookeepers who indicated that their work spilled into their leisure time (Bunderson & Thompson, 2009), our study found that the physicians' medical commitments interfered with their ability to partake in as many activities outside of work.

Practical Implications

This study informs important implications for how to better support the well-being of not only physicians who are called to medicine, but also premedical and medical students who might espouse a medical calling. First, considering the centrality of calling to each of the called physician's careers and life trajectories, it is recommended that calling be introduced in counseling to help clients more fully conceptualize their career paths and identities. Before the first session, clinicians might administer the Brief Calling Scale (Dik, Eldridge, Steger, & Duffy, 2012) to assess the degree to which clients are in search of or perceive a calling. These results can provide clinical information about calling's current role in the client's career trajectory and can create a platform from which to explore the client's definition of their calling or search process for that calling. For clients who are called physicians, the Living Calling Scale (Duffy, Allan, & Bott, 2012) may be of additional benefit because it addresses the degree to which they are living out their calling; these results can guide career counseling goals (i.e., to help clients maintain or improve their ability to actualize their calling).

With these results as a starting point, counselors are encouraged to draw from CCT (Savickas, 2005, 2011) to help clients construct their career narratives, an approach that aligns with the sample's description of their calling's development. CCT proposes that clients benefit from narrating their own life stories to clarify life roles, values, life meaning, and identities and then coconstructing the next chapter of their career development with a counselor to identify how their life stories inform their career paths. To identify a client's life story, the counselor might use the Career Construction Interview (Savickas, 2011) to guide exploration about the client's typical roles (describe early role models), interesting action settings (discuss favorite magazines or TV shows), current scripts (retell a favorite story), and self-regulation tools (state a favorite saying). Interestingly, the called physicians described similar influential life events as informing the development of their callings: important individuals who influenced their medical calling, the decision to choose a medical calling because of a fit with their skills/interests, and the support they received in pursuit of their calling. Integrating CCT with the present findings, exploration of the aforementioned areas may help clients more clearly conceptualize the life story that may inform their calling.

Building on this technique, counselors might explore additional areas to help premedical or medical students who are in search of their calling. Given that the current participants also typically chose medicine as their calling because they were able to serve others and/or answer a pull from their faith, counselors might explore (a) whether clients' life stories have involved prosocial values and/or religiousness or spirituality and (b) how this might manifest in work (for those who value prosocial motives or having faith). Although causation cannot be inferred from the present study, it may be that each of these areas of exploration might aid in the intentional selection of a career path that may have the potential to later develop into one's calling. Additionally, considering that almost all of the physicians reported benefiting from having support for their calling from family and/or friends, counselors might help clients identify and increase their support systems as they pursue their career paths that may be or may turn into their calling. Finally, clients in search of a calling might be encouraged to remain open to becoming aware of their calling later in their career trajectories, as informed by the finding that the called physicians typically realized their callings during or after college and took indirect routes to that calling.

Physician clients who are already living out their calling might also benefit from CCT's interventions and the present study's findings. CCT's strategy of building adaptability (characterized by career concern, control, confidence, and curiosity; Porfeli & Savickas, 2012) may strengthen clients' abilities to navigate the often unpredictable narrative that occurs to fulfill one's calling. For instance, as clients navigate how to sustain their calling over time, counselors might help clients strengthen their adaptability (i.e., confidence, control) by introducing interventions that increase their ability to maintain their calling. Guided by the present findings, which showed that called physicians sustained their callings by engaging in social support at work and clinical practice, counselors might introduce job-crafting techniques (Wrzesniewski, LoBuglio, Dutton, & Berg, 2013) that physicians can use to build their social support and medical practice. Specifically, by using relational crafting (changing how or with whom one interacts; Wrzesniewski et al., 2013), physicians might increase positive work interactions by organizing forums for fellow called physicians to discuss and support each other's callings. By using task crafting (altering work duties or attention allotted to tasks), physicians may protect or increase work time that is dedicated to direct patient care and, in turn, sustain their callings over time.

Counselors might also assist called clients in building adaptability by increasing their ability to handle the stressors of medical work. As informed by the current participants' description of their work as intensive and challenging, counselors might consider helping clients identify means to lower their work-related stress levels. Counselors might normalize clients' frustrations about feeling unable to actualize their callings (e.g., because of health care limitations or time constraints), explore how a client's calling directly relates to day-to-day duties (which physicians in our study described as motivating), and identify ways to balance time at work and time with family, friends, and in recreation (an obstacle for most physicians in our study). Research shows work-life imbalance relates to negative outcomes such as burnout (e.g., Barrack, Miller, Sotile, Sotile, & Rubash, 2006); as such, improving work-life balance might support physicians' health on and off the job. Moreover, counselors might explore if and how the faith of religious or spiritual clients can be intentionally incorporated into those clients' work life, because many physicians in our study found it improved their called work experience. Finally, the majority of the physicians in our study indicated they would continue medical work and their calling until and after retirement. Here, counselors can help called physicians build curiosity and plan for their later-career development by exploring how clients can continue to fulfill their calling through paid and/or unpaid work after retirement.

Limitations and Future Directions

The results of this study must be considered in light of several limitations, which also inform directions for future research. First, given the relative homogeneity of the sample, researchers are encouraged to examine calling across physicians who are more racially and geographically diverse and who work in varied medical settings. Second, considering many of the participants identified interactions between their faith and calling and most perceived their calling to fit with their work because of the ability to help others, researchers might expand the current research by exploring how a calling is experienced by employees who identify as atheists or who work in industries that less directly serve others (e.g., financial managers, construction workers). Additionally, findings from this study were based on interviews conducted at one time point. However, researchers suggest that a calling's strength may change over time and can be endorsed along a spectrum of strength (rather than simply having or not having a calling; Dik & Duffy, 2009). Future researchers are encouraged to interview called physicians at varying points in their careers to identify when and why a calling's strength may change and investigate whether the strength of one's calling relates to different degrees of proposed outcomes (e.g., work commitment, work-life balance, anticipated calling after retirement). These findings might begin to answer the question of whether the proposed effects of having a calling are related to the presence of a calling or the strength of that lived calling. Finally, following recommendations to assess whether calling's proposed outcomes differ between those who perceive a calling versus a job (Duffy & Dik, 2013), future research might quantitatively examine whether physicians who perceive their work to be a calling rather than a job experience significant differences in the work, life, and well-being domains introduced in the present study.

Conclusion

This study is the first to qualitatively examine the career calling experience of physicians, a population that, although likely to espouse a calling, is also expected to experience high work stress, burnout, and quality-of-life concerns (Shanafelt et al., 2014). Through semistructured interviews with 17 called physicians, general and typical patterns emerged that not only describe the definition of a career calling and development of a medical calling, but also shed light on how calling fits with a medical career; is maintained over time; influences emotional well-being, relationships, and recreation; and is expected to evolve in the physicians' future career trajectories. These novel findings inform practical implications for counselors who strive to help premedical and medical students as well as physicians who seek to identify or fulfill their callings in medicine.

Received 09/24/15

Received 03/20/16

Accepted 03/25/16

DOI: 10.1002/cdq.12086

Elizabeth M. Bott, Ryan D. Duffy, Tara L. Braun, Kevin P. Jordan, and Joshua F. Marino, Department of Psychology, University of Florida; Nicole J. Borges, Boonshoft School of Medicine, Wright State University. Correspondence concerning this article should be addressed to Elizabeth M. Bott, Department of Psychology, University of Florida, PO Box 112250, Gainesville, FL 32611-2250 (e-mail: ebott@ufl.edu).

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Author:Bott, Elizabeth M.; Duffy, Ryan D.; Borges, Nicole J.; Braun, Tara L.; Jordan, Kevin P.; Marino, Jos
Publication:Career Development Quarterly
Article Type:Abstract
Geographic Code:1USA
Date:Jun 1, 2017
Words:8847
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