Professionals are expected to justify their actions to clients, disciplinary committees and courts in multiple accountability systems. Although developed to reflect professional standards, is it possible that these systems induce proactive behaviours that counteract their goals and instead serve to protect the professional? This article examines the types of stimuli professionals acquire from the public and professional accountability contexts and how these stimuli motivate engagement in specific proactive behaviours. An interpretive grounded theory study was conducted; it included 31 in-depth interviews with physicians from eight hospitals. The study revealed that accountability systems trigger and motivate professionals to engage in self-serving, proactive job-crafting behaviours. Professionals simultaneously manage their perceived accountability pressures and their personal interests. Context-specific factors that motivate individuals to craft their jobs are identified, and we reveal four distinct stimuli–motivation–job-crafting patterns that are linked to specific performance episodes (i.e. work stages). Our findings emphasize the importance of taking specific work contexts (i.e. accountability) and work stages into account when studying job-crafting behaviours. This study contributes to understanding professionals’ motivations and behaviours in the context of accountability, which is essential, as the quality and safety of their work are matters of public concern.