[Editor's Note: We know you visit The White Coat Investor to learn about investment strategies and planning, and we’ve always strived to teach financial literacy to physicians, high earners, and anybody else who finds their way here. But the COVID pandemic has also shined a light on physician burnout and its dangers. That’s why we feel compelled to run articles and columns like this one—to make sure white coat investors stay mentally healthy. We know mental wellness is what leads to a long, fruitful financial life, and we’ll continue to run pieces like this because combatting burnout has become such an important part of everybody’s financial journey.]
By Dr. James M. Dahle, WCI Founder
I have met a surprising number of doctors who feel trapped in medicine. It makes me sad that so many of the people who are primarily responsible for the healing of the sick and injured in our country don't actually want to do it.
Every spring, I see the bizarre contrast between the enthusiasm of pre-meds who just got accepted to medical school or the excitement of the MS4s who just matched into their chosen specialty and the thousands of practicing physicians who want to leave medicine ASAP. Something apparently changes over that 10-20 years, and I find it both fascinating and sad.
I don't know why that poll bothers me so much. I guess it makes me feel a little lonely. Or maybe like a sucker for continuing to work after financial independence. Like I'm missing something. But it is what it is. More than 1/3 of doctors would leave medicine right now if they could afford to do so and almost all of them are working more than they would prefer. We all thought we were Rick Hodes when we applied to medical school, but in reality, only one out of 10 feels “called” to dedicate even 40 hours a week of their life to it when we're getting paid to do it!
Many doctors feel trapped in medicine. Some of those doctors actually are, but the vast majority already have the keys to their cage. Today I'm going to discuss the four ways doctors get trapped, and what doctors can do about them.
Trap #1: Student Loans
I remember getting a check every month of medical school from the U.S. military. It was really nice and helped keep the wolf away from the door. However, when it came time to apply to residency, when it came time to get a “big boy job” after residency, and especially when it came time to go to the far side of the planet to care for those defending freedom, I confess to feeling at least a little bit trapped. Using a contract to pay for medical school like I did comes with a commitment. It is no different for those who pay for their schooling with student loans. When you took out the loans, you made some decisions about your future earnings. When it comes time to start writing the checks for a significant part of your net income, it's no surprise that you feel trapped by your prior decisions.
The cost of becoming a doctor continues to outpace the increase in income of doctors, especially net income, leaving more and more doctors feeling trapped in medicine by their student loans. With median loan burdens in the $200,000-$300,000 range, there are a large number of doctors owing $300,000-$600,000 by the time they finish their training. Combining a median physician income with a median physician debt burden isn't too bad, but combining a top quartile debt burden and a lower quartile income is a real problem.
Want to hear about a real disaster? Consider the thousands of U.S. citizen doctors—yes, many of whom attended Caribbean medical schools but a fair number who also went to U.S. MD and DO schools—who do not match every year. That number is going up as new medical schools open and medical school classes expand while residency slots remain nearly static. If you think it is bad to owe $400,000 while making $180,000, imagine if you only make $40,000 hustling at two jobs.
To make matters worse, medicine as a profession isn't anywhere near the bottom of the heap as far as debt-to-income ratios go. In fact, it may be at the very top. Dentistry, optometry, pharmacy, law, and veterinary medicine are all significantly worse. I fear that soon the only way a middle-class student can ever enter these professions is by taking advantage of either PSLF or IDR forgiveness programs.
Exiting Trap #1
So how does one get out of this trap? You get rid of your student loans. Voila! Trap gone. All a typical physician needs to do is live like a resident for 2-5 years after residency and send in the difference between those attending paychecks and a resident lifestyle to the lender. They should get out of this trap in less time than it took me to pay off my commitment to the US Air Force (four years).
If you're in a less fortunate position than the physician with the median income and the median debt, there are some other options. PSLF is likely the best one. IDR forgiveness takes much longer (20-25 years) and comes with a tax bomb, but is not a bad option for those with terribly high debt-to-income ratios or those who failed to match. Even living like a resident for 5-10 years isn't the end of the world.
Hard work and good financial planning are the keys to getting out of this trap.
Student loans and the many programs and options are challenging to navigate.
If you need help, check out StudentLoanAdvice.com, a WCI company.
Trap #2: Lifestyle Expectations
You know what else traps doctors in the profession? The fact that they can't make as much money doing anything else. If you and your family are used to a lifestyle that requires an income of $200,000-$400,000, you need a very large nest egg to maintain that without working. You want to know why so many doctors are driven to create passive income or become entrepreneurs? This is a big part of it.
Like student loans, it is often fueled by debt. Big mortgage payments. A couple of big car payments. Maybe another mortgage payment. All of a sudden, you need $15,000 a month in net income just to live hand to mouth. That big house in the nice neighborhood comes with a high-flying set of Joneses too. Nicer cars. Private schools for the kids. Piano lessons and comp sports teams. Fancy vacations. Who wants to be that family in the neighborhood that people are hesitant to invite to do anything because they don't want to embarrass them (or impoverish them).
Exiting Trap #2
Once more, this is a cage of our own making. The exit is also under our control. Aaron Burr might have said, “Talk less, smile more” . . .
but doctors need to “Spend less, save more.”
For some reason, people think I'm “anti-spending.” That couldn't be further from the truth. One big reason we saved a lot of money early in our lives was so we could spend more later. I have zero problems with you buying a luxury, as long as you can afford to pay cash for it and you can reach your financial goals despite buying it. However, if one of your financial goals is to get out of medicine ASAP, it probably isn't compatible with spending $7,000 on a coffee maker or $130,000 on a Tesla. It might not even be compatible with going out to eat once a week, driving a new Honda Civic, or buying a brand new violin for your child. You'll have to decide for yourself.
In reality, barring massive student loans (see problem #1 above), no physician is ever really more than 10 years away from financial independence (FI). If you combine a physician's income with a truly middle-class lifestyle, there's enough of a gap there to create FI within a decade. Open the cage and walk out.
Trap #3: Lack of Ownership
Sometimes doctors love medicine or dentistry; they just don't like their job. They hate working for “the man” (usually corporate medicine or dentistry) who is “keeping them down.” Physician ownership of their practices has plummeted over the last couple of decades, and dentistry is trending in the same direction. Without a doubt, ownership has its costs and hassles. However, it also comes with its own rewards, including a generally higher income and far more control over your practice.
A recent survey by Geneia found that 69% of corporate doctors talk about work in a more negative way compared to 51% of independent physicians. It affects patient care, too—72% of corporate docs reported lower empathy for patients as a result of physician burnout vs. just 57% of independent physicians. All those numbers are obviously way too high, but they're definitely higher for employed docs. The annual Medscape burnout survey tells a similar story:
As you can see, 36% of those in solo practice are burned out compared to 48% of those in a “healthcare organization” (where they are far more likely to be employed).
Exiting Trap #3
Feel trapped in your job? Why not get (or build) a job where you feel less trapped? Self-employment obviously comes with its own stresses (not the least of which is making payroll), but that control and sense of building something, along with not having someone else dictating how you practice and which EMR you use, is worth an awful lot. In my experience, mid-career docs are far more concerned about control over their practice than income. Look for opportunities to move into partnerships, concierge models, and your own practice to feel less trapped in medicine. You'll also probably make more money, which helps with Trap #1 and Trap #2 above.
Trap #4: Fear and Identity
Many doctors, especially those who took the traditional path into medicine, have never had any other real job, much less another career. Being a doctor is a major part of their identity. They may have some interest in a non-clinical or even a non-medical career, but they're afraid. Afraid to fail. Afraid to lose a job. Afraid they'll hate the new career just as much. These two barriers might seem “soft,” but they are hardly insignificant.
Exiting Trap # 4
Having student loans paid off and a sizable nest egg certainly reduces the financial risk of leaving a clinical career or even medicine altogether. However, I think a far more significant factor is going cold turkey from a psychological standpoint. As regular readers know, I've been cutting back on the number of ED shifts I've been working for years now. I went from 15 a month (full time) to 12 for a couple of years and then eight for three more years. This year, I went to six, the minimum required to remain a partner in my group.
I'm far less vested in medicine as an identity than I was five or six years ago. Why? Because I had a gradual transition. I'm not really planning to cut back any more any time soon, but I can tell you that it would be way easier to do so psychologically than it would have been to leave medicine a half-decade ago.
Dave Ramsey uses a boating analogy when people want to go from employed work to self-employed work. He says don't make the jump until you get the boat close to the dock. What he means is that you want to minimize the cost, pain, and risk of the transition. The best way to do that when leaving a clinical career is to do so gradually. Pick up some part-time work on the side. Take Wednesdays off in clinic. Yes, there will be a pay cut, but you can still live just fine on 80% of your prior salary, especially as income from the new work starts coming in. Then, when the boat gets close to the dock, make the jump.
Check some stuff out. See how much you like it. See how good you are at it. See how much you can make doing it. Most of the time you can do all that without burning any bridges behind you. If things aren't working out, retreat. If they are, burn the boats and move into your new career and life.
Don't feel guilty about being a different person at 35, 45, or 55 than you were at 22. Nobody wants to be cared for by a doctor who doesn't want to be there anyway.
If you’re a physician who’s feeling burned out, The White Coat Investor can help. With our Burnout Proof MD program, we can assist you in getting back to the place, mentally and physically, that will allow you to be at your best and to make sure you continue forward with your financial plan. End the struggle and remember why you wanted to be a doctor with Burnout Proof MD.
What do you think? Why do so many doctors feel trapped in medicine? What can they do about it? Comment below!
We have been hearing this for a long time, and now during Covid you see tons of professionals in the other fields doing the same and retiring early. It is burn-out, had-enough, have-enough, paid-off-everything, time-for-myself, YOLO, grown-up-kids, and ending-the-rat-race etc reasons.
I feel that doctors live a very back-to-back-scheduled life that has been now experienced with back to back WebEx/Zoom/Meet calls. And, it is simply the feeling of burn-out and web-conf-fatigue that is setting in with lots of professionals (lawyers, accountants, IT field particularly, general contractors, engineers, project managers etc). I personally know at least 15 to 20 people that have pulled the trigger with 2 of them ending their career on 12/31/2021, when I know they have potential for pulling another 5 to 10 years easily.
Not only that, it is leaving a void in the field that is not going to be easy to fill, esp. with a younger generation that is also having an ‘early exit’ attitude. Blogs and websites that prompt “Retire Early” or “Take a very desired break” etc is prompting all kinds of individualist behaviours and decisions that is not so common from 1995 to 2019.
So, all in all, it is a trend, and it is not going to change for a few more years……
Ken
These are all such great points and I’ve definitely fell into each of these traps. For me, the most difficult and I think the biggest for most physicians is #4 – identity. Even just as a trainee I struggled with who I was outside of medicine because I pop it blinders on the other aspects of my life. Don’t get me wrong, learning to be the best doctor you can be in training is the goal – but you can’t ignore everything else! Starting off with a strong sense of outside identity is important.
I don’t see why anyone would continue to work with $20 million in the bank.
An annual withdrawal rate of even 2% on that would be $400,000 per year and would accommodate most lifestyles. Why work? What am I missing?
The fact that many of us aren’t working primarily for the money.
Why work?! Because the best things in life and the best pleasures in life most often come after hard, challenging work.
You want meaning in life? Pick up and bear a reasonable and honorable burden. You want happiness only? Be careful making this your only priority as one accident can change everything. Aim for meaning and enjoy the bouts of happiness more likely to come your way from time to time. Be responsible. Uplift others. Reduce suffering around you. Money should be a means to amplify these highest of values or nothing at all.
“I don’t see why anyone would continue to work with $20 million in the bank.
An annual withdrawal rate of even 2% on that would be $400,000 per year and would accommodate most lifestyles. Why work? What am I missing?”
Highly abbreviated list of people with far more than $20 million who are still working
Buffett, Munger
Lebron James, Steph Curry
Lionel Messi and Christiano Ronaldo
Federer and Nadal
Nancy Pelosi
Carl Ichan, I think James Simon finally retired but he had crossed the $20 million point decades earlier
Brian Moynihan, David Soloman
Tom Brady, Aaron Rodgers
Nick Saban, Bill Belichick
There are many other such people who are extremely well-known. I am sure you could easily add to the list. I have not even touched on entertainers.
There are even more others who have this amount, but are not household names. Many docs who practice in high income fields hit $20 million before they retire. Some well before they retire.
Not everyone wants to quit as soon as they can comfortably support themselves without working. Some people find other gratification in building businesses, out smarting the competition in investing or winning sporting contests. Some believe their work contributes to some greater cause that is important to them.
You forgot Elon!
It is interesting that you start the article by saying you feel lonely. It comes of as implying you are the minority who would continue to work full time if financially independent. Then later in the article you reveal you have cut down to 6 shifts per month. This would suggest you are in the majority who would cut down on work. Am I misinterpreting this contradiction?
I bet if you asked if people they would give their time for free to take care of patients without needing to be burdened by administrative requirements and charting, most would.
That is what most 18-22 year olds think they are signing up for, the untainted care of patients.
It’s not just a majority that would cut back on work. It’s basically everyone.
I was referring to the fact that 1/3 would walk away completely.
Unfortunately, caring for patients without hassles isn’t an option. Going half time (or even retiring completely) is.
The reason for me cutting back wasn’t really that I didn’t want to spend more time practicing medicine. I just didn’t want two full-time jobs. I’m still working on cutting back to full-time when you look at my total work time.
Yeah, I think most people on the FIRE train are also filling their time with other gigs/passions. Who knows if its 40 hours, but the individuals I know who left medicine have gone on to work on other things they are passionate about. Its not like people just go and sip martinis on the beach after FIRE — I think most will realize that is not a fulfilling existence.
The idea of working the same job for a lifetime seems unreasonable based on first principles. We are particularly bad at determining what our future selves will like in the future. This is called the end of history illusion (https://en.wikipedia.org/wiki/End-of-history_illusion). So the concept that at age 18 or 22 we will be able to pick a career that will bring both hedonic and reflective happiness for a lifetime is naive. This is worsened by the shaming of people to leave medicine because they are unfulfilled in their life.
The unique part of medicine is that once you take on that debt, you are trapped for 7-11 years of training plus the time to dig oneself out of that hole. Not many other careers require the same sunk cost and debt. Also the concept of highly motivated and intelligent people living “like a resident” for another 2-5 years after they have already done it for 7-11 years when their non-medical peers of equal intelligence and motivation have been living the dream for 9-16 years with lots of luxuries and indulgences is a difficult pill to swallow. Most cannot accommodate this. This also doesn’t include the comparisons of time worked in those years being double their intelligent peers. Weekends, holidays, weddings, funerals lost and never recoverable. With these in consideration (plus opportunity cost), it is easy to see physicians are significantly undercompensated, only to be burdened with doing jobs they didnt anticipate would consume their career. My partner, for example, takes vacation days to catch up on charting. Why would anyone want that job? There are traveling scrub techs who have vocational degrees making more money, not to mention traveling nurses.
What most people rely on in medicine is an ego elevation because they are helping people. It is the societal currency paid to doctors and really quite valueless once one has enough introspection to realize ego validation is empty and not exchangeable for all of that lost time.
Caring for patients without hassle is totally possible. It usually requires going to another country, but I have done it and it is soul filling. From my perspective, the US is only getting worse for doctors. There is more complaining than lobbying for better conditions. More studying burnout than fixing it. The saddest part, is that many docs dislike it so they go into admin and then are forced to meet budget goals and forget to fix the problems (or don’t care). Probably the biggest loss is the phenomenal doctors who leave because of these burdens.
I think there are lots of great points in your comment.
I can really only speak on this topic from my own perspective. In my case, there probably is some ego/identity involved in there somewhere. Not sure how big. But I think the bigger (and particularly unique) factor in my case is simply that I have this other thing in my life demanding a huge piece of my time and energy. That other thing supports a dozen families besides my own, affects the lives of literally hundreds of thousands, and frankly now earns us a lot more money than my practice ever did. So even though I don’t view that other thing as my career like I do medicine, I cannot ignore it either. So to be completely honest, I feel like in some ways that The White Coat Investor is keeping me from practicing as much as I would otherwise. Now, would I work full-time if I were FI and didn’t do any WCI stuff? Probably not. But I’d almost surely be doing more than 6 shifts a month. Probably in the 8-12 range. Who knows? Maybe I’d still be at 6. But unlike The Physician On FIRE I haven’t walked away from medicine yet and the reason certainly is not financial. Each year we give away a multiple of what I’m earning practicing. Money is fungible of course, but in essence, we’re donating my entire clinical compensation to charity each year.
So I wouldn’t say I’m doing WCI because I FIREd from clinical work (like “most people on the FIRE train”). It’s more like WCI (partially) FIREd me from clinical work. Or drug me away, kicking and screaming the whole way. To be honest, I’m the only one in the company (including my wife although she says I can do whatever I want) who still wants me working shifts. I transferred a patient to a WCI Forum member on my last shift. That’s always fun when the two jobs splice together.
Yeah I can totally see that feeling of responsibility. What you have done is incredible.
Our time is limited on this planet. You should be doing what lights you up the most. I think people will be most successful operating in this sphere and maximize their reflective happiness.
While you have created something truly special (which I recommend to a lot of people), the vast majority of the help you offered will remain here. Its as if you have built a large and beautiful structure and feel compelled to complete the finishing work. What you have created will stand strong and still help people, you can always let someone else fill in the less important remaining details of financial advice. If you leave aspects unfinished, others will come to fill it in (and you can always comment on their advice). Or if you have a topic you are particularly excited to write about, write it. I bet it will only heighten the quality. Anyways, just my 2 c.
Two things worth reading are this (https://tim.blog/2021/12/15/the-liberation-of-cosmic-insignificance-therapy/) and Jon Haidts The Happiness Hypothesis.
Thank you. I’m working to get to that point some day; still a long ways to go though.
Good stuff in here:
You might imagine, moreover, that living with such an unrealistic sense of your own historical importance would make life feel more meaningful by investing your every action with a feeling of cosmic significance, however unwarranted. But what actually happens is that this overvaluing of your existence gives rise to an unrealistic definition of what it would mean to use your finite time well. It sets the bar much too high. It suggests that in order to count as having been “well spent,” your life needs to involve deeply impressive accomplishments or that it should have a lasting impact on future generations—or at the very least that it must, in the words of the philosopher Iddo Landau, “transcend the common and the mundane.” Clearly, it can’t just be ordinary: After all, if your life is as significant in the scheme of things as you tend to believe, how could you not feel obliged to do something truly remarkable with it?
Hey, I’m just speed reading all your stuff and related comments and your responses because honestly it all sounds like bubble gum.
The advantage of speed reading is that I can quickly gauge your season.
I just want to comment, it seems that you think people entered and want to leave medicine for financial interests.
I think you’re fundamentally incorrect. I think doctors want to leave medicine because they’re smart and see the writing on the wall. Everyone wants to practice medicine and they hate doctors for actually being able to do it. We are in a palpable push towards government dispensed healthcare. In order for this to work, it requires devalued muzzled puppet doctors who say “hi I’m doctor hand up my ass…I’m here to “help” you —wink wink.
Naw dude, you couldn’t be further from the truth. Those of us who want to leave, are motivated by the fact that there is this untenable cloud of sycophant third party interests who want to suckle off the teet of the very basic health care relationship: doctor——patient. Period.
In youre mind right now you’re likely reeling saying a whole lot of but….but….but….but….. and that’s fine.
It’s people like you who take administrator positions because you don’t hold that relationship sacred.
In any case, no young man…you are not wise and you do not understand. Docs are leaving because they see something being trashed that you and your ilk couldn’t comprehend in a lifetime of lifetimes.
You on the contrary are the money focused dilettante. You just don’t have the generational perspective to see it.
I entered healthcare in 2004 because I wanted to go back to east Africa with something tangible and work on building health care infrastructure . My student debt has held me captive in the US for 12 years providing health care for a preponderance of rude, deliriously entitled, narcissistic life forms for whom I am nothing more than a mere speed bump between their idiotic life choices and their inevitable mortality.
Would you be willing to sacrifice of your income to help free me of my financial burden of ridiculous student loan debt which ballooned because I navigated med school with two children and entered residency right at the moment Obama and all the other “champions of the poor and disenfranchised” decided it would be a good idea to end the economic hardship deferment, thus ballooning student debt, and guaranteeing a 30 year physician work force while they gutted US healthcare…
Yeah sorry young buck. Your analysis is poorly informed.
If you’d like to help contribute to my fund to pay off my student debt. Debt which is held by the government (after intentionally pushing private lenders out of the student lending realm), with interest rates set BY the government, that I pay off from my discretionary income AFTER income tax…which for anyone else is called double dipping……..yeah please reach out friend! Every bit helps me immensely as I continue to provide foster care, adopt children, and plan towards providing care to “health care void” areas around the globe.
But understanding that you likely won’t answer this post, or contribute to reducing my student loan debt…
Let me leave it at this:
You are fundamentally incorrect. People are not leaving medicine because of finances and wanting to pursue the life of perpetual leisure.
They’re leaving because they’re sick of the moral injury of watching a bunch of trash bag human beings (business administrators and politicians) take the big boy steering wheel of “healthcare” while those of us who practice the ART of medicine and are oath bound….are administered over by people who are not.
Plain and simple young buck.
Much love to you man. Don’t worry son, you’ll get there one day.
Who are you talking to and why are you calling me son and young buck when I’m older than you are?
I think you need to slow down and read more because you don’t seem to understand my position on any of this. At any rate, if you don’t like my stuff, don’t read it. Free country and all that.
Good luck with your student loans. Let me know if you need any help figuring out what to do with them (and no, our scholarship isn’t available to attendings. It just helps medical student reduce their student loans).
Personally I have experienced trap #3, with 2 bad experiences with big Health organizations. Many physicians work for them because there is a false sense of security, when in reality we are just selling our soul to the devil.
Beware of the admin(s) du jour that suddenly decide to make some changes to improve the company bottom line and change your working conditions.
Feeling trapped is also a state of mind. Two years ago I felt completely trapped in my radiology job and complained about it on a daily basis. Ask my husband, he’ll tell you. I got a lot of coaching and my mindset has shifted significantly, so much so that I went through a coach certification because I believe in it that much. We can certainly change our circumstances to pay down debt, find jobs that suit us better, etc, and those are important pieces of the puzzle, but an examination of mindset and learning to think in ways that serve us better is a big part of it as well.
“Dave Ramsey uses a boating analogy when people want to go from employed work to self-employed work. He says don’t make the jump until you get the boat close to the dock.”
What a great quote. I didn’t realize that I’ve been doing it the past year, but it fits. Thankfully in anesthesia, I can drop calls and day shifts similar to EM.
Thinking back, many of us decided to become physicians during high school or college. That was at least two lifetimes ago! I was a completely different person back then. How could I anticipate what I would want my life to look like in my 40’s? I am so grateful for paying off debt and over-saving early to have better choices today. We want a new challenge and something different to learn and grow. For so many of us, medicine isn’t fulfilling this need anymore. And you know, this is normal!
I struggle with #4 – the identity piece. Although with careers in law and finance, I’m not wedded to being a physician. Thanks for showing there are many paths in life, and they don’t always have to start and end in a clinic, the hospital, or OR.
For sure. I really don’t blame anyone who gets to 35 and realizes they don’t want to be a doctor any more. I agree we’re all different people at 35 or 45 than we were at 25, much less 18.
I’m not sure it’s just “identity” or even “habit” or even “sunk cost fallacy.” I think many of us recognize that we’re really good at something that really does make a difference in the lives of others. And we really did go to medical school because we wanted to help other people. Thus, it’s hard to walk away from helping other people, even when you no longer need the money and even when there are other things in your life you would also like to do.
Two books I’ve read recently that do a great job exploring these points – 4000 Weeks by Oliver Burkeman and The Practice of Groundedness by Brad Stulberg.
I cannot recommend them highly enough. We only have a finite amount of time on this spinning planet. And yet, we waste SO much of it…
Thanks for the recs. Am reading 400 weeks now, will check out the other book as well.
I wish I had optimistic comments about getting back to when being a doctor meant taking care of patients, rather than filling out forms on a computer. The problem is that medicine is so large and expensive that it is run by insurance companies and the government. They are perfectly happy to waste doc’s time pushing paper. In fact, many of the “solutions” involve even larger shares of time spent documenting encounters and less delivering care.
In my happiest times, I think that the increasing demand caused by our ageing population will reach a point where the shortage of docs will force changes. But the bureaucrats will fight it tooth and nail. I don’t have much hope that those who spend their time learning how to care for patients will beat those who spend their time learning how to enlarge the bureaucracy.
We are approaching or already in a staffing crisis throughout medicine. Not only are there a number of physicians leaving medicine for varied reasons (or with plans and working toward early retirement), but perhaps this is even more significant with our nursing colleagues. No doubt burnout from COVID has played a significant role, but in our health system we have a tremendous nursing need. Operating room nurses are offered high pay throughout our city and many are switching to agency/traveling nursing and I read articles of many nurses leaving medicine entirely. There are endless issues within healthcare and in my mind greatest by far is the failure to care for the caregivers. There is an urgent and existential need to structure the system to support these most essential members, whose absence leads to whole system collapse. Perhaps not many clinical staff desire to lead medicine, but more clinicians leading medicine could help. I can’t help but think who is going to care for patients? Our mothers, fathers, brothers, sisters, children, children’s children, etc. I agree with your observation of the stark contrasts in the attitudes of those entering medicine. This week I had a medical student shadow me and it felt recharging to see their enthusiasm and amazement at what I do daily. The solution cannot consist solely of this individualistic approach with early exit and early retirement from physicians and nurses. I do not judge someone leaving medicine. Of course, changing the system feels impossible. Maybe we need to pull the alarm? Call a code blue for healthcare? More articles and even discussions on the local level, within hospital systems, of the crisis. This is not a problem with “provider resiliency” or “provider burnout.” Will not be fixed with more mindfulness training, meditation, or burnout awareness and trainings. It has been and ever will be a broken and faulty healthcare system that needs changing. I believe the fiery desire, caring, and sense of calling exist within those physicians and nurses entering medicine. Unfortunately gets stifled with time. Need to retain those we’ve got and foster a better future for those replacing us.
You will never feel trapped in a job or role that you love.
Great points as always. I agree completely with all stated above, but the novel point here is Identity (in my opinion). I think identity, in a post-COVID era, is becoming more of a significant factor. Like many other professions, I too have witnessed colleagues take part in the “great resignation.” Some were financially free and this seemed an appropriate choice as burnout dug its claws in. Some were fed up and “jumped to the next boat” probably too soon (to keep the reference going) and were left barely treading water.
I think so many of us in the healthcare field spend much of our lives working tirelessly to become physicians, we don’t know how to identify ourselves as anything else! I witness this both as we deal with burnout and as we approach retirement. I have unfortunately witnessed this in my father. He was a dentist of >40 years in a small rural area in the Southeastern US and upon retirement, he did not know how to identify himself as anything other than a dentist. He entered retirement struggling with this identity crisis, dealing with his newly discovered free time by sitting and watching television. The sad part is he has incredible financial freedom that he worked almost half a century for! To not see him thrive because he lacks identify post-dentistry is a travesty.
I think as COVID marches on this identity crisis will become more prevalent as healthcare workers try to break from medicine. For those who venture to do that, I agree that your success will be largely based on your financial preparation. With that said, thank you all for the hard work you do.
Stay motivated!
TheMotivatedMD.com
The issue of identity interests me. I retired from medicine after 23 years at age 52. But from the beginning I always felt like I was making myself fit where I didn’t really fit. I never liked having to answer the question of what I did.
I have wondered if others that retire early identify less with being a physician as a core part of who they are?
It was a great career that I don’t regret, but once I was able to provide for my family without continuing the costs were too much. I actually hoped that once I didn’t have to practice, that I would find that it was what I wanted to do.
As I told my patients. “I was too young to have to retire, but I would have vocation still. I just might not get paid for it.’
Yea, it’s funny what happens at FI. Some people like it more and some like it less. You don’t really know if you’re practicing for the money until you don’t need the money.