Barry Egener’s daily schedule is packed. An internal medicine physician in Portland, Ore., he spends more than 30 hours per week in clinical practice, teaches at his group’s residency training program, is the medical director of Portland’s Foundation for Medical Excellence, and serves as a peer reviewer for five medical journals. It was 8 a.m. on a Monday when we spoke to him, yet he’d already had two patient consults.

But Egener isn’t heading toward burnout. To the contrary, 20 years into practice, he says he draws largely on the tenets of professionalism to continue to feel good about being a doctor. To some harried physicians dealing with an unforgiving healthcare economy, “professionalism,” a concept they first learn in medical school, may seem a quaint, academic notion that simply does not work within a modern practice. To Egener, however, “trying to maintain those values in the face of the pressures of everyday medical practice is how I prevent myself from burning out, and also how I maintain good quality care for my patients.”

What does he know that you don’t?

“First, do no harm.”

Before you dismiss Egener as a workaholic freak of nature, it may be helpful to explore the idea of professionalism within the context of modern medical practice.

Christine Cassel, an internist and geriatrician who is also the president and CEO of the American Board of Internal Medicine (ABIM) and the ABIM Foundation, jokingly refers to the core principles of professionalism as “the high-falutin’ values that medical students enter school with and that we very efficiently beat out of them in four years.”

Indeed, the concept of professionalism is defined for medical students repeatedly; they are taught to put their patients’ interests above all others, including their own, and that altruism should be at the heart of all patient encounters.

But many young doctors become hardened by residency programs known for their grueling hours and crushing patient loads. Then they enter private practice. The lofty tenets of professionalism quickly become a distant memory. Now their prime concerns are securing fair pay for their work, squeezing in more time for patient interactions, achieving a work/life balance they can live with, and retaining control over their decision-making capabilities when they are questioned by third-party payers.

Professionalism? Why should they consider themselves professionals when it often seems no one else does?

One-third of physician respondents to a recent Physicians Practice poll said that they would choose some other profession if they had a chance to do it over. That’s no surprise, says Cassel: “Feeling that you’re not living up to the professional values you were taught can lead to great cynicism and disillusionment. Doctors are left wondering, ‘What is this game I’m in, anyway?’”

Although widely thought to be so, the famous directive, “first, do no harm” is not explicitly stated in the original Hippocratic Oath. Still, it has long been considered a tidy summation of a physician’s primary duty to place their patients’ welfare above all other considerations. It is, therefore, the oldest, and perhaps still the best definition of professionalism within a medical context.

But Hippocrates certainly never had his medical directives second-guessed by insurers unwilling to pay for treatments that he considered medically necessary. He never begged bean-counters for payment. So today’s physician cynicism is understandable. But is it necessary?

The professionalism paradox

So then what exactly is professionalism? Egener defines it as “a large concept that includes things like altruism, integrity, [and] a commitment to excellence of practice.” But, he acknowledges, “It can be challenging to maintain within the everyday practice of medicine.”

Not a surprising answer from a physician whose work week frequently exceeds 60 hours. But Egener maintains that truly applying the tenets of professionalism as they are generally understood actually works to his benefit.