Doctors and The Circle of Control

The concept of Covey's Circle of Control has been the topic of a lively and engaging series of LinkedIn posts from Helen Bevan recently. I left a comment, but it also made me think about how doctors might navigate the circles of control, influence and concern.

In Covey’s model, issues are organised into three circles. The outermost circle of concern includes things you care about but can’t directly change; the middle layer is the circle of influence, covering things you can’t control but can affect indirectly, and at the core is the circle of control, containing the things we can directly "own" and do something about. By noticing which circle an issue belongs to, you can focus your energy on things you can control, let go of what you can’t change and act where you have influence.

So far, so good. Doctors need to know where to expend their precious time and energy. But doctors don't operate as lone players: they are intricately part of an inherently complex system, especially those in leadership positions. Even in failing, overburdened health systems, most doctors strive to provide the best possible care they can. The personal and professional consequences of not doing so are great, particularly for senior doctors, who shoulder the greatest accountability. Yet systemic and organisational issues are largely out of their control, very much in the circle of concern.

The concept of the circle of control means letting go of things that we cannot change, to focus energy on the things we can. This means choosing how you think and behave, but for senior doctors, much of the day-to-day grind is out of their control, no matter how much hard work they put into their circle of control. It also means having sufficient psychological safety to actually let go of things you cannot control.

What does sit in our circle of control is our intrinsic motivation towards doing something and our choice of how much effort we put into it. And that is inherently related to our beliefs, our values and our sense of purpose.

Senior doctors possess significant power of influence in healthcare (Oliver, 2022), but if their values and those of the organisation and system don't align, they are often left working to extrinsic motivators. Some, like financial rewards, are positive "pulls" towards something but many are negative "pushes", such as the fear of sanction or punishment.

The evidence supporting the benefits of intrinsic over extrinsic motivators and employee performance is plentiful and doctors are no exception (Tung et al, 2019; Zhou et al, 2025). We all do better when motivation comes from the circle of control outwards.

If you are a senior doctor operating in a system where there is a major values conflict, and it requires you to compromise your core values, it's time to consider your options.