Rheuminations: The Evolution of Identity Over Time

This sounds incredibly stupid, but I never thought I would celebrate my 40th birthday. It’s not like I believed I would never reach the age of 40, but the idea that I would ever see that many candles on my birthday cake had always seemed remote, until maybe a month ago. In fact, by the time you are reading this column, chances are that remote reality will already be a memory. Regardless, it’s an opportune time to reflect on the concept of personal and professional identities, their evolution and growth over time, and the confluence of individuality that makes up our sense of collective identity. What does this 40-year-old rheumatologist mean? Let’s rheuminate!

Professional Identity Formation

Before anything else, let’s talk about a term that has been growing exponentially in the literature over the past decade: Professional identity formation (PIF).¹ PIF refers to the internalization of core values, behaviors and sense of purpose associated with a given profession. For physicians, especially rheuma­tologists, this process shapes not only how we practice medicine, but how we see ourselves in relation to patients, colleagues, institutions and society. Almost imperceptibly, as we acquire knowledge and hone our skills, we modify our perspectives and become slightly different people.

It may sound strange to talk so frankly about PIF, but PIF matters because it anchors us in our key sense of purpose. In rheumatology, which is marked by ambiguity and nuance, having a stable, evolving professional identity helps us navigate ethical and diagnostic dilemmas, communicate with patients with empathy and make peace with ever-present uncertainty. Without that identity, our work feels disjointed, counterproductive and even demoralizing.

It is vital to remember that PIF is not an accidental process that just happens.² Our professional identities can be intentionally crafted through reflective practices that start in training. Papers have been written that document and assess such activities as writing and small-group discussions to foster PIF, but this is likely just the tip of the iceberg. Whenever we engage in intentional reflection, we crystallize identity.

This also means that when we mindlessly go through the motions of being a rheumatologist without thinking about what we are doing, we are actually missing opportunities to form our identity. It sounds counterintuitive and heretical, but it is possible for a 25-year-old rheumatologist to have a more secure sense of identity as a rheumatologist than a 75-year-old one, especially if they are more devoted to, and more intentional in, exploring that sense of identity.