"I was planning my funeral": A qualitative study of junior physicians' experiences of self-sacrifice during the COVID-19 pandemic through the lens of physicians' social contract.

The COVID-19 pandemic placed junior physicians at the forefront of clinical care under extraordinary conditions, compelling them to navigate overwhelming workloads, and emotionally challenging and ethically complex situations. This qualitative study explores how these experiences shaped their perceptions of self-sacrifice, as interpreted through the lens of the social contract as expressed in foundational frameworks of medical professionalism, such as CanMEDS. Semi-structured interviews were conducted with 17 junior physicians at two emergency hospitals in Sweden, and the data were analyzed using reflexive thematic analysis. The findings reveal that junior physicians experienced significant physical and psychological strain, including fear of infection, exhaustion, and strain on personal well-being and relationships. While participants demonstrated strong dedication to patient care, they also voiced resistance to the implicit expectation of unlimited self-sacrifice embedded in professional ideals. These experiences not only tested their endurance but also re-shaped how they understood the balance between altruism, personal limits, and professional duty. Expectations of self-sacrifice are embedded during medical education, yet our findings suggest that these norms are both reproduced and critically questioned as physicians transition into practice, when they are confronted with the lived realities of clinical work. Importantly, the study indicates a contextual re-negotiation of how altruism and self-sacrifice are perceived, with junior physicians in this material challenging inherited ideals of heroic endurance. The extraordinary pressures of the pandemic appeared to accelerate this process, bringing these reflections to the surface earlier and more forcefully than might otherwise have occurred. The study highlights the need to balance professional commitment with sustainable support structures, and points to the importance of renegotiating the social contract between physicians and society in light of evolving professional realities.