Physician burnout and compassion fatigue are on the rise.1, 2 Many factors have contributed to this phenomenon, including the COVID-19 pandemic, staffing shortages, and increased patient acuity.3-7 These factors are complex and require broad systemic reform to target root causes, such as job demands and resource allocation.2-7 Effectively addressing these system failures requires significant time and resources. Individual strategies can occur in tandem with organizational level changes and may be implemented more quickly to mitigate some aspects of burnout.1, 2, 7-9 Advice to clinicians on addressing burnout often focuses on the need to do more, often emphasizing self-care activities outside of work, such as exercise, quality family time, and mindfulness.8 This expectation can create more stress by implying that nonwork time should be dedicated to activities to enhance the capacity to manage stressors in the workplace. The primary message is that the antidote to burnout is doing more work outside of work. However, an alternative approach to addressing burnout at the clinician-level focuses on establishing healthier workplace boundaries. Boundaries provide a way to directly address burnout risk factors, which include overcommitting to job demands (e.g., providing emotional support to peers beyond one's capacity, attending meetings outside of work hours), limiting work-life balance, or difficulty managing boundary violations.1, 7-9 A boundary is a “psychological demarcation that protects the integrity of an individual” or helps “set realistic limits on participation in a relationship or activity.”10 Delineation of a boundary in the workplace is often a blurred line that falls differently depending on the individual and the context. Individuals have varying levels of comfort in establishing boundaries and context, such as power dynamics or scope of work, is also relevant. Individuals differ in how porous they allow their personal and professional lives to be, and these differences are often influenced by how they conceptualize who they are and how they define their relationships. For example, one hospitalist may view their personal and professional lives as completely separate, rarely sharing information about their family with colleagues to feel that each aspect of their identity has a specific time and focus. Another hospitalist may identify their personal and professional lives as inextricably intertwined, using stories about their families to connect with colleagues. Boundary-setting in the field of Hospital Medicine is uniquely difficult due to its broad and variable scope of clinical, academic, and administrative work. Often, the clinical role of a hospitalist is dictated by the edges of the scope of work of subspecialists—hospitalists manage what subspecialists do not, and this boundary differs based on the hospital, resources, and clinician-specific practices. Thus, the need for flexible boundaries is inherent in this career choice. Although the proceeding examples within this article primarily focus on defining individual boundaries, the presented framework also applies to these boundaries unique to the practicing hospitalist. Beyond individual factors, various contextual factors affect boundary setting across the lifespan of one's career. Relative power and privilege change throughout one's professional development. During training and early career, physicians are often finding their voice and identity within hospital medicine. The goals of this developmental stage are often to capitalize on building connections and engage in new opportunities with the aim of identifying interests and areas of expertise. This can lead to a compulsion to say “yes” to presented opportunities, often out of excitement but sometimes out of fear of tarnishing relationships or missing out on later opportunities.7 This balance of desire for career advancement and establishing a niche that fits one's goals and aspirations creates challenges to identifying when and how to say “no” to opportunities and thus establish boundaries.9 Conversely, mid-career clinicians are often recognized as experts and the established point person for various activities (e.g., lectures on specific topics). This expertise and its recognition may lead to more frequent requests for talks, mentoring, or writing opportunities that quickly pile on and may or may not be crucial for their own professional goals. A challenge of setting boundaries at this stage is letting go of responsibilities that no longer serve one's goals to make space for opportunities that better align with one's current trajectory. Although the power differential has changed for a person at this point in their career, it can still be difficult to establish boundaries due to firmly established reputation and relationships. Having a deep understanding of evolving career goals and discussing with trusted mentors can assist with boundary setting in this mid-career phase. Many clinicians have an innate desire to please others, be empathetic, and be a team player. While these attributes can be beneficial in a busy, stressful, and complex health system, repeatedly overextending oneself places a physician at high risk for burnout.2, 9, 11 The development of healthier boundaries around one's time and emotional energy can be challenging, especially when many of these self-sacrificing behaviors have become habits over time. Root causes of these challenges are often deeply entrenched and may feel counterintuitive. In many training settings, overextending oneself has been functional and rewarded behavior. Additionally, medical training programs offer limited opportunities to develop or practice setting boundaries. The culture of many hospital systems is also normed around having very few boundaries and may be reactive to people who try to enact boundaries. Despite these challenges, healthy boundaries are essential for psychological well-being, clinician satisfaction, and the prevention and amelioration of burnout.8, 9, 11 Additionally, developing a culture of healthy boundaries promotes team cohesion and can indirectly benefit patients.11 Because boundaries occur within the context of a relationship, boundaries that are more challenging to develop and maintain often occur within the relationships we value the most.9 Therefore, our boundary framework incorporates strategies to maintain the relationship while protecting oneself from overextension. We created a three-step process (i.e., assessment of confidence, skill development, and maintenance) to improve clinician competence in setting and maintaining boundaries, informed by available literature.2, 9, 11 Before using this approach, one must decide when to say yes or no to a request and where to set limits. Engagement in self-reflection is critical before deciding whether to accept a new opportunity. Self-reflection requires time and space to consider how the opportunity may fit with one's priorities and current capacity. Table 1 provides specific questions to prompt reflection. It can be helpful to review these questions with a trusted mentor, a peer, or a friend or family member before making a decision.11, 12 There may also be situations where the answer to the request is not a simple yes or no. For example, an offered opportunity may be a once in a lifetime opportunity. In this situation, the question may be whether the opportunity could fit in with current commitments or whether other commitments need to be modified. Additionally, situations may arise where the request cannot be accepted alone but presents an opportunity to engage a junior partner or form a team. Does this opportunity fit with my top priorities? Is this my responsibility? Will it bring me joy? What will I have to take time away from to be available for this? How will I feel about my decision in 1 day? 1 month? 1 year? How easy is it for you to set boundaries? When is it hard to set boundaries? Settings? People? Internal factors? Role? What are your values? Personal? Professional? It may be more difficult to set boundaries with a supervisor or trusted friend who is also a colleague. Recognizing that being present at home with your family is a value that can help boost your confidence in setting a boundary such as not scheduling any meetings before 9 a.m. or after 5 p.m. Develop a hierarchy—easiest to hardest boundaries to set. Practice with the easiest to develop confidence and competence. Share your values with a colleague or mentor, asking them to help you set and adhere to boundaries. Practice using language to set boundaries that aligns with your values and is likely to be effective. After setting a boundary, check in with yourself. How did it feel today? How will it feel in 1 week? 1 month? How does setting this boundary give you the trade-off of time or energy to engage in something else that you value? If worried about how the other person perceived or responded to the boundary: Use a sentence to summarize what their wish/need is, which communicates you have heard them and provides an opportunity for them to feel connected to you. Briefly state your boundary (less of an explanation is better!). Use a sentence to summarize how your boundary aligns with a value you share with the other person (e.g., ensuring the patient gets the highest quality of care by being admitted to the most appropriate service line). Strategies to manage when others challenge or transgress boundaries: If possible, acknowledge a possible benevolent cause for the transgression (e.g., I know you were really worried about getting this work accomplished quickly). Briefly remind them of the boundary you already set. Indicate that you need to hold this boundary and offer minimal justification. The more you explain your boundaries, the weaker they become. Below are examples of language to try based on what resource you are limited by: Time: Thank you for considering me. Unfortunately, I do not have bandwidth at this time. If an opportunity related to XX (an activity that aligns with your values) arises in the future, please let me know because I would be interested in participating. Emotional energy: (Make a brief reflection to communicate that you have heard and understand what is being communicated.) This sounds really challenging. I'm glad you trust me enough to share this with me. And I want to make sure you get the support you need. (You can then either set a time when you have emotional energy to talk more, set a time limit of how much time you have to offer, or discuss other formal or informal resources to support the need.) Advice: I'm glad you value my feedback. I wish I were in a position to help you process this, but I think someone else might be better suited to advise you on this matter. (It is helpful to suggest someone if you have someone else in mind.) What changes have you noticed since setting boundaries? What are the themes in boundary setting? Are there certain people who require you to set more boundaries? Are there categories of boundaries that feel easier/harder to set? Do you have any worries/distress around setting boundaries? Once one has decided to set a boundary, we propose a three-step process: (1) assess baseline comfort and confidence in enacting boundaries, (2) develop boundary setting skills, and (3) reflect on how the boundary aligns with one's values, reassessing and revising as needed to ensure boundaries are maintained. We provide an overview of these steps and a guide in Table 1. Assessing baseline comfort and confidence requires an honest reflection of challenges and barriers to developing boundaries. These challenges may be associated with past experiences, where setting boundaries was discouraged or punished. They also might relate to one's personality, current stressors, or lack of practice. Setting boundaries may be easier with some people than others (e.g., authorities, colleagues, patients, or families). Shifting one's focus to the reasons why setting this boundary is important can help generate the strength required to establish and/or maintain a boundary. Specifically, clinicians should identify the values (e.g., keeping one's personal and professional life separate, taking on new tasks that align with one's interests/goals, sharing specific aspects of one's personal life to connect with colleagues) that they would honor by implementing such a boundary. Inherent in these values is an understanding that boundaries make explicit the invisible trade-offs we are continually making. For example, making the choice to commit to participation on a committee that meets in the evening after typical work hours will require an additional trade off of personal time. Informed by these reflections, physicians can then identify which boundaries will be the easiest to implement and which will be the most challenging. The degree of difficulty in setting boundaries might be informed by various factors, including the category of boundary, person(s) involved, context, and current emotional capacity. Given that many physicians lack professional development and mentorship around boundaries, this is likely an underdeveloped skill that requires scaffolding. Table 1 provides sample language that physicians can use to jumpstart this process. Starting with a reflective statement achieves dual aims: acknowledging that one understands what is asked or desired and developing a point of connection to support the relationship between the physician and the other person(s). Effective language to then set boundaries is brief, does not include a justification, and reflects underlying values. This skill development also requires strategies to identify when boundaries are needed and how to respond when boundaries are challenged or violated. Establishing and enacting boundaries is a skill and, like all skills, requires practice. Boundary setting requires specific strategies to maintain competence and confidence. Reflection on how one has been impacted by implementing boundaries is critical. This impact may initially lead to feelings of discomfort.8, 9, 11 Over time, one can expect to feel more competent in asserting boundaries and experience lower levels of burnout and workplace stress.5 This occurs alongside the realization that establishing and maintaining boundaries requires less cognitive and emotional energy because boundaries have become more integrated into one's workplace interactions. Finally, boundaries should also be examined regarding their alignment with the clinician's values, as they may require reassessment and revision as stressors change. Burnout is largely driven by systemic factors and mitigation requires a comprehensive approach; however, individual strategies can occur alongside institutional changes.2, 7 Developing and implementing boundaries represents a key strategy to promote clinician well-being and protect against burnout.2, 7, 9, 11 The need for hospitalists to be flexible in a work environment with ill-defined boundaries creates specific challenges for hospitalists to navigate. A sustainable, long-term solution requires an intentional, nonreactive approach. Our framework offers a structure and process for hospitalists to follow to develop their individualized approach to setting boundaries and appreciates that the approach differs based on various contextual factors. By conceptualizing boundary setting as a skill, we also offer practical steps to develop competence. However, change is challenging, especially when changes that benefit the individual may create problems for others or the broader system. Therefore, we recommend that, like all skill development, the process of developing comfort and competence in boundary setting occurs with the support of a trusted peer or mentor. Mentors can not only help mentees make decisions about when to set boundaries, but they can also help avoid or react to downstream effects of boundary setting, such as backlash or hard feelings. Finally, the core components of our framework are applicable to other healthcare workers. Broader implementation of this framework could enhance a culture of healthy boundaries and decrease burnout across the entire healthcare team.9 The authors declare no conflict of interest.