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“You should call me. I’ve been doing a very long time,” he said. 

He is one of the giants of our field. I have known him for 2 decades. Ever since I was a trainee, he has inspired me to be the best version of myself. I admired him on all levels: his intellect, his skill, his personality. I was elated when he reached out. Over the past few weeks, I had been active on social platforms on behalf of my new startup. We were raising funds and gaining momentum. This is supposed to be my second career. I am excited about it. 

I was surprised, however, to learn that he was active in the startup community. He is world famous, but somehow, no one knew about his two companies, and a few exits he had successfully managed. Intrigued, I asked him why his entrepreneurship is shrouded in secrecy. “They won’t be happy for you,”, he answered.

He was right. Ever since I came out with my burnout, I have had nothing but misery at work. The hospital service that I lead revolted against me, my mentors lost interest in me, and I was being gaslighted and ambushed at every opportunity. Naturally, I blamed myself. After all, what were the odds that these seemingly rational and scientific minded people were all losing their minds? 

I won’t deny, it has made me suffer greatly. I’ve been living in darkness and doubt ever since. Have I made the wrong decision? Will my legacy be tarnished by cowardice? Will I ever succeed at this new chapter away from medicine?

Yesterday I walked into my house feeling sorry for myself, after another dark day at the hospital, spent fighting political battles that I did not need. My toddler ran to greet me with a big hug. For the first time ever, this innocent loving hug brought me no joy. Such was the depth of the darkness in my soul. Immediately, I understood two valuable truths.

One- the people trying to ruin my life are ones who have not been hugged in quite a long time. The only way they can find joy is by casting their dark shadow over others.

Two- a job which makes you immune to a child’s hug is not one worth keeping.

I sat, with my child in my lap, and a tear in my eye. I remembered a story that my dad told me decades ago, about a Lion who grew old and became a mockery to the dogs. I never understood the moral until now. I am old and wounded, but I am still the Lion. They, are still the dogs.

B. Nerdicus

I’ve always wondered if this were true in fields outside of medicine. I would honestly not know, since I have never worked, or dreamed, or thought about anything else, other than medicine. Judging from all the inspirational posts on LinkedIn, I would assume that this paradoxical dichotomy might only be true in the medical profession.

Medicine (surgery) is a team sport. I believe this wholeheartedly. It does take a village to get a patient through a complicated hospital admission, rehabilitation, home care, and back to a meaningful and productive life. That is why successes should always be credited to the team, rather than the doctor. Over the last decade, our medical profession has successfully (and rightfully) shifted all the attention away from the “hero doctor who saved my life”, to the “team of hardworking individuals who saved my life.” 

The opposite, however, has not been true. While we celebrate our successes as a team, we find ourselves alone during dark times. When the complications, complaints, or lawsuits are served, they are served to the doctor. The team, keeps a careful distance, hedging their bets, awaiting the outcome. Does that not negate the whole concept of a team sport? It only takes a few instances of this paradox for doctors to recognize that the team thing in medicine is an illusion. It’s good for morale and marketing when we are thriving. It’s crickets when we are failing.

I suspect this is not the case in business. I suspect that team leaders are true to the team mentality, and everyone rises and falls together. In business, leaders are empowered to be leaders. They can make budgetary decisions, hire brilliant talent, and fire toxic people.  In medicine, we are asked to be leaders, without empowerment- a recipe for failure, burnout and disillusionment.

Whenever I am asked to send a headshot for a news article, I always send a picture of our team, which includes a dozen individuals. Curiously, this team picture rarely ever gets published. The person on the other end of the request will usually resort to finding and using an individual photo of mine. We live in a society that thrives on drama. A hero’s rise makes a good story. Their fall, an even better story.

B. nerdicus

Wow. So much for writing every week. Just looked at the date of the last entry and realized I have not written anything in 6 weeks. Why? The Kids. So, we might as well write about them today.

I am getting a lot of: “Wow, good for you for wanting to change careers…but what about the kids?” Initially, I dismissed this as superficial advice from people who care about me, but don’t know any better. I guess my friends want to make sure that I am not jumping ship without thinking about the other human beings whose well-being is my responsibility. As this question started to come up more frequently, it got me thinking: “What about the kids?”.

My friends are concerned that I might be giving the wrong example. After all, being a doctor is being a good role model. What am I telling my children if I suddenly quit my career? My immediate thought is: “Well, I’m not quitting!” I am making a career change. What comes next will involve hard work, and eventually, great success. Of that, I am certain. However, this is a risky maneuver, and failure remains a possibility.

I wrote about the fact that physicians really have never known risk throughout our entire career. Perhaps this is a good way of showing my children that well-being a risky affair, and that wanting to enhance someone’s emotional state comes at a price of comfort. Maybe it is good for them to see their father take some risk, although it might come at the expense of a less comfortable life . Maybe when my children experience this, they will not be afraid of change.

The next phase of my life will definitely involve moving out of our big, comfortable house in a suburb by the lake, into a smaller house, in the city, where I will be starting the next phase of my career. We might be moving to a country that speaks a different language. They might be needing to adjust a new schools, new friends, and a new existence, in a different language.

Many of my friends are concerned that this is “destabilizing,” for the children. I happen to think that uprooting them from a very comfortable lifestyle, into one that requires grit and readjustment might be a valuable lesson on how to pivot and land on your feet when life hits you sideways.

My friends and loved ones are also concerned, that losing income will negatively affect the kids. Will we still go on the annual ski trip? Will they still be members of the squash and Tennis Club? Will they still go to a posh private school?

Perhaps, yes, perhaps no.

As a child, I was taught that the goal of life is to get a respectable degree, followed by a respectable job, leading to respectable salary, allowing for a respectable life. However, I was not told that this might come at the expense of my own personal happiness and well being. I wonder if my parents knew better, I believe they might have not. However, right now, I know better. Is it not my responsibility to convey that to my children? Should they not know that the tranquil problem-free suburban lifestyle is a myth?

We keep hearing that “what doesn’t kill you makes you stronger.” Perhaps it is time to give this a try. So, I discussed this with my children. The 15 year old has requested that we should not move before he finishes high school and graduates from his current establishment. This is three years away, and aligns well with my timeline. The 13 year old doesn’t care. He’s quite excited about moving. He is a people’s person, and will not have any adjustment problems. The 10 year old is not having it. He does not want to leave our house, his school, or anything else behind. Many of my friends have come to his defence, but something tells me that this level of attachment is problematic on its own. I promised him that whatever comes next will be equal or even better in what we have now, but he is not having it. Perhaps he is as risk averse as I am. The five year old is too young to care. Knowing him, he’ll be just fine.

I suspect that my children will be okay. Although, it is also possible that they might suffer emotional trauma of epic  and irreparable proportions. They’ll have enough in their college fund for therapy, if needed. 

B. nerdicus

Have you ever wondered why, when burnout and suicide rates among medical professionals are so high, no one seems to leave the profession?

We have come a long way in recognizing that burn out rates have reached alarming proportions- we have studied the causes, measured the impact, devised plans to address this epidemic, but not once have we discussed exiting medicine. A quick Google search for “Getting into medicine” yields 3,130,000,000 results, while a search for “Leaving medicine” yields 561,000. You don’t have to be math whiz to understand that the proportion of people who are looking to leave is a a tiny fraction of those who want to get in…0.00018%, to be approximate. The fact that I was able to snap up this domain name for my blog is, in itself, bonkers.

So why is that? Why do doctors never leave? Here are some theories:

Sunk cost fallacy- We spend two decades of our lives training to become the doctor we want to be. Once we land the dream job, we realize a few years later that living the dream is also eating up our soul. We have spent so long training, and we don’t know anything else outside of medicine, so we forge on. Economists call that the sunk cost fallacy. The fact that we spent so much material and human capital to get to this point, doesn’t change the fact that the project has failed. We would actually be encouraged to leave as soon as we recognize this reality, because every minute spent in this situation is a minute wasted in not building our next reality.

We only know medicine- We are are so good at what we do, we therefore convince ourselves that we will never be as good as anything else. I’ve always admired engineers who pivot into finance. Everyone seems to recognize that “engineering brain” allows you to succeed in multiple other fields such as banking, management, and corporate leadership. It never occurred to me that “medicine brain” could be destined for success outside of our profession. Turns out I am wrong.

We become our profession- We are taught since early training that being a doctor is not a job, it is a vocation and a way of life. Somehow, medicine is like a religion, a noble existence that transcends materiality. While, the unfortunate reality is that medicine is like any other job: you study, you earn your letters, you go to work, you earn a salary. In other jobs, however, you have the opportunity to grow, pivot, and continue to evolve. In medicine, that’s it. When faced with the misery of stagnation, we convince ourselves that we need to continue to suffer for the illusion of the greater good.

We have never known risk- It has dawned on me recently that medicine is the least risky career choice among all professions. When you get into medical school, then you forego all risk of failing and being poor. Very rarely do people fail out of medical school, residency, or early practice. As a result, doctors are risk averse people. Our brain understands the following equation: work hard = become a doctor = guaranteed livelihood. Risk is not a variable in this equation. So when we are crashing an burning, and it becomes obvious to us that leaving medicine is not only viable option to remain healthy and happy, we recognize that this is a risky proposition. Since we have never known risk, we turn down the possibility of an exit. We are not alone, research has demonstrated that people prefer to remain in a certain unhappy situation over pivoting into an uncertain possibly happy situation.

Medicine is like Hotel California- “you can check out any time you like, but you can never leave.” Or, so we are told.

B. nerdicus

Today, the end begins.

For months I have been reflecting on my recent triple whammy situation. I am undoubtedly in the middle of a midlife crisis that is lasting too long for anyone’s patience. I have also come to the terrifying realization that I have peaked in my surgical career, and I am staring at, in the best case, a long plateau, and in the worst case, a slow and painful decline. Thirdly, and more importantly, I am burnt out, with nothing left to give, or to enjoy from this career.

Each of those situations is a life-altering challenge in its own right. Taken together, they spell out the end of a career. We could debate long and hard, as I have done over the previous months with friends and family, but the truth will always prevail. The sooner I admit this to myself, the sooner I can move on. I have always told people that life is like a book. You could enjoy the current chapter tremendously, but if you want to finish the story, you need to turn the page. By turning the page, you leave that chapter behind. Ideally, you would do that on a high note, before the reality of the situation becomes painful enough to taint all your future memories.

Everyone around me is shocked. I’ve heard it all- why waste a good career (who said anything about wasting?), what could you possibly pivot into (as if my intellectual capital was worthless outside of medicine?), retirement is for older folks (nope, definitely not retiring), are you out of your mind (highly likely, but maybe not a bad thing).

There’s so much to unpack here, possibly two and a half year’s worth of weekly blogs, which is what I intend to do. I don’t have a formal plan yet, but I owe it to myself, my family, and my medical career to make a careful and well thought out exit. For now, I am only holding myself accountable to the dates. Today I begin, and on December 31, 2027, I will hang my white coat. Why such a slow exit? Just in case it’s midlife crisis brain taking over important decisions. I figured if I am bound to regret this, I will see signals in the next couple of years, and I can kaybash the whole thing. 

I write this blog for an audience of one- me. If anyone else finds solace in it, then all the better. 

B. nerdicus

Coming Soon – Leaving Medicine, reflections on a career in healthcare