It has officially been one year since I walked out of the hospital and clinic on my last day as a pediatric intern. So what truly happened? Has this time provided me with better clarity and perspective on why I quit residency and left medicine altogether?
I have spent the past year struggling with personal identity because I let academics, career, and being a physician define who I was for so long. Not having that crutch forced me to explore other areas of my life and personality. I discovered so much about myself through more time spent with family and friends, time spent reading and learning out of pure curiosity, and time spent alone quietly reflecting and allowing creative inspiration.
All I can truly express are my personal experiences, but after some reflection I feel that some of them may be shared feelings among people unhappy in their careers.
Lack of Control
In medicine, for a large part of your career you lack control over the process. Yes, you may have a choice over where you practice, but the conditions are largely set by those at the top. Physicians in the U.S. are increasingly voicing discontent with the system. Of course I realized that during medical training I would be giving up control of my life in many areas in favor of a quality education that would carry me for years to come. However, the more that I worked in the healthcare system and observed even those in higher positions being swamped due to the demands of their jobs, I realized that my time may never truly be my own.
Call it naive that I never realized this sooner, but as I hit my mid-20s I re-evaluated the picture that I wanted for my life. I desired to be there to experience the parts of my life that existed outside of work. Perhaps call it an oversight on my part to enter such a demanding career, but when we are younger it sounds so admirable and easy to spend long hours caring for patients. I learned that however noble and satisfactory it may be on some level, it would destroy me personally. I believe that we should be working to make the lives of physicians much more manageable.
Anyone who works in an environment where they perceive, or actually have, a lack of control over their own life will experience a higher level of stress than someone who can “call all the shots” in their life. These issues are not unique to medicine. Having an unpredictable schedule, changing policies in your workplace, lack of opportunities for advancement, or being in a highly hierarchical system where you cannot voice your opinion can all lead to a lack of control and higher stress in your workplace.
Lack of a Creative Outlet or Time for Personal Interests
When you become busy, it is very easy to quickly shove aside the activities that you like to do for the tasks that need to get done. Some days I was lucky if I even drank, ate, or slept the minimal acceptable amount, so even contemplating taking time for myself for outside activities seems laughable. However, I have learned the hard way how important it is psychologically for us to maintain the hobbies and interests that make us feel like ourselves, and give us a sense of comfort and a creative outlet outside of our work.
The things that I used to love to do like make cute cards or presents, bake, interior decorate, make things with my hands, design on the computer, cook, sing, or even just come up with creative solutions to problems all fell away in favor of items that “needed to get done.” Even community projects and my sense of having meaningful impact on those around me were nonexistent as the time demands for residency made it hard to juggle outside projects that I had enjoyed so much in medical school.
Lack of “Me” or Down-time
Throughout my training, I was not dedicating enough down time to recharge. As an introvert this is something that is so vitally important. I spent so much energy “on” all the time that I felt disconnected from myself and completely exhausted. I was trying so hard to please everyone, be as helpful as I could, and serve my patients to the best of my ability, all at the expense of my own health and personal sanity.
The one thing that I did try to do was to create personal boundaries of not taking work home. This helped create a safe haven at home in one respect, but it also meant that I spent a lot of hours at work finishing notes that I could have otherwise taken home. Except for a couple of occasions, I refused to take my work home, which I think helped create mental separation, but did contribute to strange eat and sleep schedules, as I often did not take breaks until I was “done.”
Feeling of Being Trapped or Locked-in
I don’t know how to explain this concept other than feeling like a caged animal backed into a corner, scared and like any attempt to escape is futile. In medicine, you can often feel you are ushered through training assembly-line style. You feel that once you are on the “conveyor belt” you are committed to the process of being a newly minted physician and there is no turning back. Once in medical school or residency you feel trapped by the societal pressure, student debt, and the fear of the unknown should you leave. What else could I possibly do with a medical degree? How will I ever pay off my student loan debt? I will be leaving an even larger burden on my physician peers and my patients. Believe me, all of these thoughts and more went through my head as I contemplated leaving.
At several times on my path to medicine I felt and sometimes tried to voice a need to slow down. I wanted to take some time after high school to explore the world. I took a wonderful two week vacation to Spain and then returned and packed my bags for college. I wanted a break between undergrad and medical school but was advised it would be harder to “come back” than if I applied straight through. (note: I know plenty of kick-ass “come back” physicians). I wanted to take a break during medical school, but convinced myself that once I began training in my desired specialty area it would perhaps not be easier but more enjoyable.
Let me tell you that if, despite some wonderful parts of your job such as great patients or co-workers, you do not enjoy what you are actually doing 90% of the time, you will find it hard to find happiness in your position. I think this is why physicians are finding it harder to be satisfied in their careers, because they are increasingly being pulled away from the bedside to sit in front of a computer to review results and enter medical records. Many of them are more established in their careers and feel trapped or locked-in, unwilling or unable to take the risk needed to make a career move.
Fear of the Future
Along with the feeling of being trapped comes a fear of the future. If you feel trapped and unhappy in your current work conditions, it can lead to a fear of what your future may look like. Will I ever get to go on the vacations I want? Will I ever be able to balance work and family life? Will I ever make time for myself, or will work always rule my life? And ultimately the last straw for me, will I always have this many days where I am so unhappy, crying, and emotionally exhausted on my way home from work, wishing I was anywhere else in the world?
In the end, knowing myself, and what lengths a career in medicine may drive me to, the fear of what that future picture could look like is what led me to “get out.” I did not want to be the physician struggling to control her already underlying depression and anxiety because of the insane stress levels of her job. I did not want to be the statistic of the physician who turned to substances to cope with her job. I did not want to be the physician whose health worsened, or who suffered from a heart attack at a young age because she never took time to focus on her personal health. Ultimately, my deepest fear is that my career would lead me to be so unhappy that I would feel that self-harm and suicide were the only way out.
Some may think that this thought process is over-dramatic and that I could control many of these factors while still having a healthy career, but all I can say is that when those are the thoughts going through your head, your medical career and the life you otherwise want to lead are no longer compatible, at least not for the time being. I am sure over time I would have learned better balance, but I would always be the physician who would innately put others first, sacrificing myself along the way. The key lies in knowing yourself. Of course I would never advocate for anyone to leave their job, medical or not, without careful consideration. After all, I debated my decision for more than 4 months, seeking the advice of friends, family, and counselors along the way.
Hope for the Future
For the first time in a long time I feel a sense of hope, creativity, inspiration, and true joy. Despite the challenges I may be facing on a day to day basis, I am more content with myself than I have ever been before, because I feel that I am living as the most authentic version of myself. Gone are the days of pleasing others, working toward societal expectations, or defining my self-worth based on the “gold star” I receive from someone else. Now I relish the moments when I am walking alone in nature, deeply engrossed in creative pursuits, or actually making time to take care of my health.
Beyond the burnout I was experiencing, I do not know if a career in medicine truly would have sustained me long-term. One of the things that I have learned about myself in the past year is that I am talented and passionate about many things (a characteristic of multipotentialites or multipassionate people) and I may have never been suited in a highly specialized field like medicine for a lifetime in the first place.
Yes, there are many talented physicians who balance numerous areas in their lives well, but I never truly had an interest in the science of medicine so much as I did in the community or people that medicine served. I always enjoyed my interactions with patients simply because I enjoyed learning more about their lives and feeling that I was helping them in some way. Once the joy of interacting with the patient was gone, so was mine; and unfortunately for me, the majority of medicine is now practiced outside of the view of the patient. There is the occasional day when I reminisce on my times in medicine, but I am incredibly happy with my decision and the impact that it has had on my physical health, personal growth, and most importantly my mental and emotional well being.
For all my doctor friends out there who may be reading this, I am always rooting for you, and still a constant advocate for changes in the system that will improve both your lives and the lives of your patients. I admire your resiliency and strength in tackling your work every day despite the challenges it brings. Just don’t forget to take care of yourself along the way!