Adult Development for Women Physicians: Are You Living Your Life or Someone Else’s Expectations?

What if the life you've worked so hard to build isn't actually the life you want anymore?

You did everything right. You got the grades, went to medical school, completed residency, became a physician, and built a career.

You followed the rules. You exceeded expectations. You became exceptionally good at doing what was expected of you.

And now?

Maybe you're doing everything you're “supposed” to do, but something just doesn't feel right anymore.

That doesn't mean something has gone wrong.

What you want for your life and your own internal values may have shifted.

The psychological concept of adult development by Robert Keagan might apply here.  But most of us have never heard of it. 

We Learn About Childhood Development. But What About Adulthood?

Every physician learns about pediatric developmental milestones. Rolling over, sitting up, first words, first steps. We understand that children grow and change.

But somehow, we reach adulthood and start believing that the person we are today is the person we'll always be.

There's actually a name for this tendency: the end-of-history illusion. We can look back ten years and recognize how much we've changed, yet we tend to underestimate how much we'll change over the next ten.

Think about yourself ten years ago.

Are you the same person?

I certainly am not.

At 41, my life looked very different than it does at 51. I hadn't discovered coaching yet. I had a three-year-old. I understood myself, my emotions, and my possibilities in a very different way.

And I suspect that ten years from now, I'll be different again in ways I can't even imagine today.

We don't stop developing when we become adults.

We keep evolving.

The Conversation That Inspired This Reflection

Recently, several women physicians who had participated in Empowering Women Physicians reached out because they were coming to San Diego for a menopause conference.

I thought we'd get together for some hellos, hugs, and catching up.

Instead, we ended up sitting in a circle by the ocean, sharing stories about how much our lives had changed.

Some women had left institutions that were no longer healthy for them. Others had stepped into leadership roles, started their own practices, moved into telehealth, or created women's health programs.

They talked about who they were when they first joined EWP, what they were struggling with, and what their lives looked like now.

And what struck me was that they had all learned something incredibly important:

They didn't have to keep living according to someone else's expectations.

They could decide what mattered to THEM.

They could dream again.

And they could take action, sometimes one tiny step at a time, toward lives that felt more aligned with who they were becoming.

As I listened, I realized I was witnessing something that developmental psychologist Robert Kegan describes in his work on adult development.

The Three Stages of Adult Development

Kegan's framework helps explain how adults evolve in the way they understand themselves and the world.

Three important stages are the socialized mind, the self-authoring mind, and the self-transforming mind.

1. The Socialized Mind: “What Will Everyone Think?”

In the socialized mind, our decisions are strongly shaped by the expectations of the people and systems around us.

And physicians are EXCEPTIONALLY good at this.

Think about how we got here.

We learned what was expected of us, followed the rules, earned the grades, got the honors, and kept moving forward.

Medicine teaches us its own culture.

A good doctor never calls in sick.

A good doctor always says yes to another patient.

A good doctor stays late, takes extra call, and puts everyone else's needs first.

Nobody necessarily sits us down and teaches us all these rules. We absorb them by watching the people around us.

And we can become so accustomed to these expectations that we don't even realize we're following them.

We're like fish swimming in water, unaware that we're surrounded by it.

Now, the socialized mind isn't bad. Shared expectations help society and medicine function.

But problems arise when we're so busy meeting everyone else's expectations that we stop considering our own needs.

One question often reveals this mindset:

“What will everyone think if I ______?”

What will my partners think if I reduce my hours?

What will my patients think if I set boundaries?

What will my family think if I make a different choice?

Sound familiar?

2. The Self-Authoring Mind: “What Do I Want?”

The self-authoring mind develops when we begin creating our own internal compass.

We can recognize the expectations around us without automatically allowing them to determine our choices.

We start asking different questions.

What do I value?

What kind of life do I want?

What matters to ME?

I've experienced this in my own life when I decided to work part-time, become a coach, create a podcast, and even move to Puerto Rico.

Most people thought I was crazy.   They didn’t understand my decision to follow a different path. 

And that's okay.

Self-authoring doesn't mean you have to make dramatic changes though. It might mean negotiating a different schedule, setting a boundary, or simply deciding you no longer want to sacrifice yourself to meet an expectation you never consciously chose.

One of the biggest things that changes with a Self-Authoring mind is that you become willing to disappoint other people rather than continuing to disappoint yourself.

That doesn't mean you stop caring about others.

It means your own needs and values get to matter, too.

And yes, that can be uncomfortable.

You may be misunderstood. People may disagree with you. You may feel guilty doing something differently than you've always done it.

But discomfort doesn't necessarily mean you're making the wrong choice.

Sometimes it means you're growing.

3. The Self-Transforming Mind: “Can Both Perspectives Matter?”

There's another stage beyond self-authoring.

In the self-transforming mind, we can recognize our own values and beliefs while remaining open to other perspectives.

We no longer need everyone to agree with us.

We can hold our own convictions without insisting that our way is the only right way.

Imagine a physician who creates a practice that reflects her values. She wants a sustainable schedule, while her patients want convenient access.

Rather than assuming one side must lose, she becomes curious about how to design something that honors both.

This is a more flexible way of thinking that makes room for complexity.

And importantly, these stages aren't labels to use to judge ourselves or anyone else.

We may think differently in different areas of our lives, and transitions can take years.

The point is awareness.

Are You Living Someone Else's Script?

One of the signs that you may be ready for a shift is that you're doing everything “right,” but it no longer feels right.

You're meeting expectations, but you're exhausted.

You're succeeding on paper, but you don’t feel fulfilled.

You're living a life that made sense for who you were ten years ago, but it may not fit who you're becoming today.  It definitely may not fit who you want to be ten years from now.

And perhaps you've started asking yourself:

Is this really what I want?

It’s okay to ask that question without having to change everything.

You can examine your choices and decide you want to keep them exactly as they are.

That's self-authorship, too.

The difference is that you're consciously choosing your life rather than simply continuing because it's what you've always done.

A Simple Exercise: Question Your “Shoulds”

Here's something I invite you to try.

1. Write down three things you think you SHOULD do.

Choose things you're doing because you feel obligated, even though you may not want to.

Maybe you should work full-time. Take extra call. Volunteer for another committee. Keep doing everything at home yourself.

2. Ask yourself: Whose voice is that?

Where did you learn that expectation?

Was it your parents? Your residency program? Your colleagues? Your culture? Your own assumptions about what makes someone a good physician or a good mother?

3. Ask: If no one would judge me, what would I choose?

Not what everyone else wants you to do.

What would YOU choose?  If no one was looking and no one cared.

Then consider if there might be one small action you could take in that direction.

You don't have to quit your job or make a dramatic life change.

You can begin by noticing that you have a choice.

You Get to Keep Becoming

The women sitting with me by the ocean that day hadn't all made the same decisions.

Some changed jobs. Some built businesses. Some became leaders. Some redesigned their lives in ways that were meaningful to them.

What they had in common was that they had begun asking themselves what THEY wanted and taking action from that place.

And years later, they were living lives that felt more aligned with what they value at this phase of their lives.

That's what I hope for you, too.

Because you are not a finished product.

You get to keep growing, evolving, and becoming.