You don't have to love medicine.
But you should get to choose it.

On professionalism, passion, and what medicine actually requires of you.

In this issue

• Why the expectation to love medicine is doing real harm

• The difference between passion and professionalism and which one actually matters

• What happens to your career when love is the only story you have

A few days ago I posted a question on LinkedIn. I didn’t expect it to strike the nerves that it did. Both with readers and with me.

I wrote that I stopped loving medicine three years ago, and that my patients never noticed. That I showed up, did the work, and to my own surprise still did it well.

Then I asked the question I'd had at the time.

Do you need to Love medicine to be good at it?

The responses were really interesting, people didn't agree at all.

Some were fully on board. Others pushed back hard. Some felt you genuinely need passion to keep going in medicine and that patients notice. Others said No, professionalism and strong values are enough.

There's no single experience of medicine, but there's a very real pressure to feel like there should be.

The responses told me how complicated this is for doctors how loaded the word "love" becomes when it's tied up in your identity, your income, and the story you told at every interview since you were seventeen.

I couldn’t really go into as much depth as I would have liked, but I think what is important is understanding your relationship to your career, so here’s my answer.

The myth we were sold

Medicine selects for a particular kind of person: high-achieving, conscientious, willing to delay gratification, good at performing certainty even when they feel none.

The selection process also, whether intentionally or not, trains you to perform love/commitment.

Every personal statement and interview I attended, the standard position was.. “ I love this” It’s what I was born for. Every deanery form that asks you to articulate your passion for the specialty, your commitment to the profession, your vision of what kind of doctor you will be.

You learn early that the right answer involves ardour. Devotion.

An undercurrent that this is not a job but a calling.

Which is fine, when it's true, and for many people, for long stretches of their careers, it can be.

But what happens when it stops being true? What story do you have left?

The problem isn't that doctors stop loving medicine. The problem is that when they do, they have no language for what comes next and are often judged for it.

Without the love narrative, we arrive at one of two conclusions:

Either something is wrong with medicine, or something is wrong with them.

Both conclusions can lead to the same place… paralysis, exit, or the t accumulation of resentment that eventually looks like burnout.

But as I found out, there's a third option, but it requires separating two things that medicine has collapsed into one.

Passion vs. professionalism

They are not the same thing

Passion is an emotion. It rises and falls with circumstance. It responds to fatigue, to grief, to the quality of a rota, to whether you slept, to whether someone was kind to you last Tuesday. It is real, and it matters but it is not stable, and in my opinion should not be the load-bearing structure of a career, (That isn’t to say it doesn’t make it easier or more rewarding).

Professionalism is different. It is a commitment. It says: regardless of how I feel about this work today, I will show up for the person in front of me with competence, care, and full accountability.

If love is the requirement, then a doctor who no longer feels it is, by definition, compromised.

Their absence of passion becomes a moral failing. The prescription is to recover the feeling, take a sabbatical, change specialty, remember why you started.

If professionalism is the requirement, a different question appears.

Not "do I love this?" but: "Am I showing up fully for the people I'm responsible for and is the system I'm working in making that sustainable?"

One question turns inward. The other turns outward.

The outward question is, I would argue, the more honest and more useful one.

The second opinion

Maybe the issue isn’t whether you love medicine or not.

It’s that we’ve been taught to use love as the benchmark in the first place.

Love is variable.
Professionalism is stable.

And when you build your career around something that fluctuates…

The time will come when you feel uncertain.

What this means for your career and your identity

For a lot of doctors, "I love medicine" isn't just an emotion. It's an identity.

It's the answer to: why did I do this, why do I stay, what am I if not a doctor who loves medicine?

When love fades and for many people, at some point, it does that identity becomes unstable. And an unstable identity tends to do one of two things: it either clings more tightly to what's familiar, or it collapses entirely.

Neither is particularly useful for making good decisions about your career.

The doctors I've seen navigate this most effectively are the ones who've found a way to hold medicine as something they do with skill, with professionalism, with genuine care for patients — without making it the whole answer to who they are.

That's not detachment or cynicism. It's actually the thing that lets medicine remain sustainable over a long career, because you're not asking it to carry weight it was never built to carry. It’s a bit like a relationship. Butterflies in the beginning, but ultimately you need choice and commitment to see you through the different seasons.

Professionalism creates room for the other things that give meaning to life:

Creative work, family, community, building something. The space to assess whether this role, this rota, this system, is actually working for you, without the asking feeling like a betrayal.

One of the commenters on my post put it well: the question isn't whether every doctor should be passionate. The better question is whether the system actually allows doctors to have a life outside medicine and still show up and practise well.

I think that's right and I'd add one more layer to it.

A choice only remains a choice when you're not depending on one thing to be everything.

When medicine is your identity, your income, your community, your purpose, and your passion all at once it stops being a choice. It becomes the only option.

You don't have to love medicine to be a good doctor. You don't have to love it to stay or hate it to leave, its not that black and white.

If you didn’t have to feel a certain way about medicine…
what would you choose to do with it?

One question to sit with this week

Until next time,

Dr Niks