When Service Becomes Sacrifice

There’s a version of leadership many of us gravitated towards before we ever stepped foot in our own practices or knew there was a name for it.

Put others first. Give everything you have. Serve your patients, your team, your community. When I was in chiropractic school this was communicated as a motto to live by — to give. to serve. to love. to do.

What no one added to those “how to live” goals? And trust that what’s left over will be enough for you.

It sounds noble. And for a lot of us, especially in healthcare, it resonated so deeply we built entire professional identities and businesses around it.

I did.

I was a new mom, six weeks postpartum, opening a practice because honestly? Work made me feel like a better mother. My son came to the office with me. We napped between patients. And I led with everything I had — heart, energy, time, body.

Five years later, I had a seven-figure practice, a full team, and numbers that looked like success from the outside. But I also had multiple surgeries from a body that had stopped asking nicely for me to pay attention. A marriage that had ended. Twelve and thirteen hour days I’d normalized as necessary to succeed. And one afternoon, I sat on my office floor and sobbed — not from grief, but from an emptiness I couldn’t hide from anymore.

That’s the story servant leadership doesn’t tell you.

What Servant Leadership Gets Right (And What It Leaves Out)

Servant leadership, as Robert Greenleaf articulated it in 1970 and Larry Spears later expanded, is rooted in the idea that the leader’s first responsibility is to the growth and wellbeing of those they serve. The ten characteristics Spears outlined — empathy, listening, stewardship, commitment to the growth of others, building community — describe a kind of leader the healthcare world genuinely needs. Especially in building successful private practices.

A 2024 systematic review in the Journal of Healthcare Leadership found that servant leadership is consistently associated with better patient outcomes, higher staff satisfaction, and reduced burnout among team members. A separate study examining nursing professionals confirmed that servant leadership behaviors buffer against the kind of hindrance stressors that erode a team’s capacity over time.

Servant leadership, when it exists in an organization’s culture, creates conditions where people grow rather than deplete.

But here is what the research rarely examines, and what practitioners in private practice almost never discuss: what happens to the servant leader themselves when there is no one above them modeling that same care back?

In a solo or small group practice, you are often the only one keeping this architecture in place. There is no upstream leader filling your tank. You can go to seminars and conferences and refuel your cup here and there. But it’s rare that we have our own input daily in the same way we provide it for our patients and teams. The service flows in one direction — and it keeps flowing — until one day it stops.

The Silent Struggle Beneath the Framework

I’ve worked with enough practice owners, and I’ve lived this enough myself, to know that the dark side of servant leadership rarely acknowledges itself.

It looks like staying late to see one more patient.

It looks like absorbing your team’s stress so they don’t have to carry it.

It looks like never quite getting to your own needs— your own lunch, your own massage or self-care, your kids’ school asking for volunteer hours.

It looks like sitting in your car before walking into your house and needing a moment — not to prepare, but to recover from the last twelve hours.

What’s underneath is not a lack of commitment. It’s actually the opposite. It’s a commitment so deep, so fused with identity, that the boundaries between “I care deeply about this work” and “I have nothing left” become invisible. It’s where we inevitably sacrifice ourselves, our relationships with our families and our own needs in the name of serving others.

There’s a name for this. I wrote an entire book about it — Selfless Syndrome: The Root Cause of Exhaustion, Anxiety and Hormonal Chaos in High Achieving Women — because I needed to understand it myself before I could teach it. Selfless Syndrome is what happens when a high achiever’s capacity to de-escalate stress never gets activated. While my experience has been that it is more common among women, those of us in healthcare are susceptible to this way of living and leading regardless of gender. When giving and serving become a chronic physiological state rather than a value expressed with intention. When the very thing that makes you an extraordinary practitioner and leader becomes the mechanism of your own undoing.

This is not a willpower problem. It’s a boundaries problem that get translated into the word no and holding boundaries feeling unsafe. And servant leadership, without adequate attention to the physiology of the leader, accelerate burnout and collapse.

The Leadership Realities None of Us Were Taught

Dutton and Spreitzer’s research on thriving at work identifies energy management as one of the most underutilized and most critical strategies for sustainable leadership. Not time management. Not hustle optimization. Energy.

What the organizational wellbeing literature has consistently found is this: leaders with regulated nervous systems make better clinical and operational decisions. Leaders operating from depletion are more reactive, less accurate, and more prone to the emotional exhaustion that eventually spills into their teams and patient care. And teams — whether we want to acknowledge this or not — mirror the physiological state of the person leading them.

Taking care of your energy is not self-indulgence. It is the prerequisite for the servant leadership you actually want to embody.

The 2022 JAMA Health Forum called burnout among healthcare professionals an “underrecognized threat to safe, high-quality care.” Not just a threat to practitioners. A threat to the care of the people we wish to serve. We’ve all heard the adages you can’t give from an empty cup or you have to put your own oxygen mask on before helping others. But that doesn’t stop us from trying.

So when you run yourself past empty in the name of service, you are not serving more. You are serving less — and you are doing so from a place that neither you nor your patients can feel good about.

Three Signs You’ve Crossed to the Dark Side

None of us wake up one morning and decide to become a martyr. It happens in increments, in small justifications, in a culture that celebrates sacrifice and calls it dedication.

But there are signs.

You’re always behind, even when you’re productive. Burnout and busyness feel nearly identical at first. The difference is that busyness resolves with rest. Burnout doesn’t. If you take a weekend off and come back just as depleted, pay attention.

You resent the people you came here to help. This one is hard to admit. But resentment in leadership is almost always a sign that boundaries were absent before they were needed. It’s not a character flaw. It’s a data point.

You’ve lost the thread of what you actually want. Not what your patients need. Not what your team needs. What you want. What fills you up. What you’d choose to do if nobody needed anything from you for a day. What you want your practice to look like. Your vision and connection to why you do what you do. If you can’t answer that, you have likely been overgiving for a long time.

The Reframe That We All Need

After the bankruptcy. After the years away. After the unraveling I didn’t plan but desperately needed — I came back to this work with a different question.

Not how do I serve better?

But what does it look like to serve from wholeness instead of depletion?

The answer wasn’t a different time management system. It wasn’t a new boundary script. It was a fundamentally different understanding of what leadership in my practice and business asks of me — and what I am allowed to ask in return.

Aligned leadership, the model I now teach and live, doesn’t ask you to stop caring. It asks you to care with your whole self in the room — not the version of you that’s been hollowed out by years of putting literally everyone and everything else first.

It honors service and self. Purpose and limits. Excellence and enough. Strengths and values.

The research calls this thriving. Positive psychology calls it flourishing. I call it what it actually is: the only version of servant leadership that’s sustainable enough to last a career.

A Question To Explore

Before I end, I want to leave you with something more useful than a bullet point list.

Think about the last week in practice. Not what you did for patients, or for your team, or for your business.

What did you do for you?

If the answer is hard to come by, that’s not something to feel ashamed of or beat yourself up about. It’s information. And it’s exactly the place where the work of becoming a rooted leader actually begins.

If this resonated, you might want to explore my book Selfless Syndrome — it goes much deeper into the physiology and psychology underneath the patterns we’re talking about here. You can find it on Amazon.

And if you’re a practice owner wanting to go further with the leadership conversation, that’s exactly what we do inside Grow Your Roots — the paid community (we’re talking very nominal) here on Substack where we don’t just learn about these concepts, we build a practice beneath the practice to actually embody change and transform our experience of practice.

Referenced:

Greenleaf, R. K. (1970). The servant as leader.

Spears, L. C. (2010). Character and servant leadership: Ten characteristics of effective, caring leaders. Journal of Virtues & Leadership, 1(1), 25–30.

Demeke, G. W., van Engen, M. L., & Markos, S. (2024). Servant leadership in the healthcare literature: A systematic review. Journal of Healthcare Leadership, 16, 1–14.

Dutton, J. E., & Spreitzer, G. M. (2014). How to be a positive leader: Small actions, big impact.

Dyrbye, L. N., et al. (2022). Burnout among health care professionals: A call to explore and address this underrecognized threat to safe, high-quality care. JAMA Health Forum, 3(5).

Westbrook, K. W., Nicol, D., Nicol, J. K., & Thornton Orr, D. (2022). Effects of servant leadership style on hindrance stressors, burnout, job satisfaction, turnover intentions, and individual performance in a nursing unit. Journal of Health Management.