Physicians who survive life-threatening illness often clash with their own patient identity

Physicians who survive a life-threatening illness or medical event frequently experience a psychological clash between their professional and patient identities, and institutional leave policies and leadership sensitivity play a decisive role in whether they successfully return to clinical practice, according to a qualitative study published Sept. 9 in JAMA Network Open.

The study, led by Angela M. Ellison, M.D., of the Department of Pediatrics at Children's Hospital of Philadelphia, used narrative inquiry to conduct semistructured interviews with 22 physicians who had experienced a life-threatening illness or medical event while in active clinical practice and who subsequently attempted to transition back to work, whether successfully or not. Participants ranged in age from 43 to 77 and represented seven specialties across 16 institutions, including pediatrics, internal medicine, family medicine, emergency medicine, physical medicine and rehabilitation, anesthesiology and surgery.

Interviews asked physicians to narrate their experience with illness before probing specific aspects such as how their institution affected their experience or how the illness affected their professional identity. Researchers analyzed the transcripts using a holistic narrative approach and mapped each story onto Freytag's five-part story arc structure — exposition, inciting incident, rising action, climax and denouement — to trace how participants' sense of self shifted over the course of their illness and recovery.

The analysis identified five recurring tensions that emerged from the collision between physicians' professional and patient identities: loss of authority or control, the dismantling of an assumed sense of invincibility, identity questioning and reformation, medical knowledge functioning as both a benefit and a burden, and institutional practices acting as moderators of the return-to-work process.

Researchers found that participants consistently described their professional identity — training, specialty and career trajectory — before ever introducing their status as a patient. Once diagnosed, many continued to narrate their own condition in clinical language, presenting themselves in case-presentation terms rather than as patients receiving care. One participant recalled being told directly by hospital staff, "It's weird to be a patient in the hospital where you are a doctor."

That dual positioning created distinct vulnerability, the authors wrote. Care teams sometimes assumed physician-patients already understood their own diagnoses and truncated standard explanations, while colleagues who had recently been students or trainees were, in some cases, now delivering the physician's care. Several participants described feeling pressure to return to work sooner than medically advised, driven by a professional identity built around productivity and control.

Institutional response emerged as a critical variable separating positive from negative outcomes. Some participants described colleagues who anticipated their needs before being asked; others described being asked to resign from a medical faculty position for not seeing patients, or being told they were the only one who had ever attempted to return from their diagnosis.

The authors concluded that health care institutions should shift from procedural return-to-work policies toward relationship-centered approaches, and specifically recommended simulation-based return-to-work programs that let physicians refresh clinical skills in a low-stakes setting while also addressing confidence and identity concerns. They also called for institutions to build legitimate non-clinical pathways for physicians unable to resume full clinical duties, rather than framing modified roles as consolation positions.

The study's authors noted several limitations, including a retrospective design subject to recall bias and a sample that, while spanning multiple institutions, specialties and regions, did not include the perspectives of colleagues or institutional leadership.

The findings arrive amid a broader reckoning within health care over how systems support — or fail to support — physician retention even outside the context of serious illness. Separate industry research has repeatedly found that leadership responsiveness and cultural factors, not compensation alone, tend to drive whether physicians stay in their positions. That dynamic mirrors what the JAMA Network Open authors describe: institutional sensitivity, rather than formal policy alone, often determines whether a physician's return to work succeeds.

The study also lands alongside ongoing efforts to reduce the practical and legal obstacles that have historically kept physicians from seeking support during health crises. Recent regulatory changes have opened space for hospitals to offer mental health and wellness programs to clinicians without running afoul of fraud and abuse statutes, reflecting a growing recognition that physician well-being infrastructure needs to expand alongside the workforce pressures driving burnout and attrition. Ellison and colleagues argue that structural fixes like these are necessary but insufficient on their own — institutions, they write, also need to attend to the "existential disruption" physicians experience when a core piece of their identity is destabilized, even temporarily.