What it means to leave clinical medicine

Not too long ago, a circumstance occurred. I had experienced similar circumstances several times in my career. However, this time - my response was different. It was like a switch in my brain flipped: I was ready leave clinical medicine. It was time for the next chapter.

Wow! It was a moment of surprise.

Relief. Excitement. Quickly followed by a 'WTF?' Where was this thought coming from? There was no 'maybe I should consider a change'?

I was so sure that I was ready to leave that I was concerned. What was happening?

I had never before said to myself, let alone others, that I was ready to leave clinical medicine. Sure, I had joked with colleagues on bad days. We had brainstormed (in a very cynical way) what else we could do with our medical degree. But I was never serious. Or was I?

 

In this moment, I was very confident that there were several opportunities for me. When I allowed myself the opportunity to take a minute and listen to my soul, I knew what I wanted and how to get there. 

I was ready.  I was qualified.  I felt the passion.  I began the process to write my next chapter.

  

I began the process to write my next chapter. (Credit: Unsplash)

But then came the fear. My brain offered up all kinds of worst-case scenarios involving failing in one way or another. Failure. Slam on the breaks! RED ALERT. Having been immersed in healthcare for over 20 years, failure was not an option. I had been avoiding failure for as long as I can remember.  

Growing up in competitive figure skating, failure was not looked upon kindly. Then there was the dream of becoming a doctor.  The need for top grades in college.  MCATs.  Medical school. Residency.  Fellowship.  Attending.  Failure would mean not being able to obtain my dream.  In medical school, failure could mean not finishing. Look right, look left, someone will likely not be here at the end of this year.  As I moved on to treating patients, failure could lead to adverse outcomes or even death. 

So yeah, thoughts of failure immediately sent me into a sympathetic response.  FLIGHT.

Flight.  I knew how to deal with flight.  In retrospect, I had spent a lot of the last 20 years in flight.  Flight was much more comfortable for me than any thought of failure. 

U turn.

"The risk of failure is too high if I leave", I thought. "I am an oncologist.  I treat patients with

cancer.  That is what I do.  I just need to tweak things a bit." I had worked so hard to become an oncologist. I had sacrificed so much. I could not leave.

Then there were the golden handcuffs.

I had a great job, and I was financially secure. All the reasons my brain offered up to stay.  So much easier to consider than any possibility of failure.  Decision made.  I was staying.  But I was making the decision to stay each day from a place of empowerment. Or at least that is what I told myself and firmly believed. For a while, at least!

And then there were the golden handcuffs. (Credit: Unsplash)

I went about trying to figure out how to make things work for me.  To live my dream.  No more arrival fallacies for me.  I needed to address that voice in my head that kept telling me I was meant to be doing something else. I specifically remember looking into some opportunities that I could use to re-ignite some of the passion I had lost. To help fill the “something is missing” void. 

Then - Bam!

There it was again. The switch in my brain.

"I can’t do this! I don’t want to do this! I cannot make myself fit in this box anymore."

It was time for the next chapter in my life. 

A very good friend and coach said to me, “Debbie, you cannot fail.” We talked about worst case scenarios. She was right. I was able to see my worth and potential and walk forward with fear. I may have repeated that quote in my head 100 times a day but I allowed myself to walk with fear in the direction I knew I needed to go. 

I confidently applied for and interviewed for jobs that felt right. Jobs I was excited about. Not jobs people thought I would be good at or should consider.  I accepted an offer and I resigned from my clinical medicine job. 

As I have had some time to process, I have realized my decision to leave clinical medicine actually occurred about a year ago; at the intersection of burn out and existential crisis. I met a young patient who presented with a very aggressive cancer. I reviewed her history, pathology, imaging before I saw her.  Having been in oncology for many years, I knew what this disease course would look like. As I prepared to walk into the exam room to meet her, I had that sinking feeling in my stomach. This was not going to be good.

As I opened the door and laid eyes on her, this is when the switch flipped in my brain: I could have been her. It was too close to home this time.  I went into what I can only describe as an existential crisis.

Why? How? So not fair!

At the same time, I was covering for two colleagues who were out and my clinical load was much heavier than I was comfortable with.  I was spending too many hours charting.  I was squeezing my own clinic volume into less time.  I was overwhelmed and felt stuck.  I felt like I was letting everyone down, most of all, myself. I had been in the express lane to burnout and had finally arrived.

This was not the destination I had dreamed about as a much younger version of me.  What was I doing?  What was I sacrificing?  Why?  What regrets would I have if I was living my last few months of life? Many!

I can now clearly see the stages of grief described by Elizabeth Kubler-Ross (denial, anger, bargaining, depression and acceptance) that I have gone through over the last year. Grief of leaving what I dreamed about for so many years.

My first step was fierce Denial: I am a physician. I am an oncologist. I can fix this. I am just a little burned out. I did all things burnout. I do not regret this at all.  I needed to heal.  I needed support.  I needed to mature and truly learn to believe in myself before I could get to acceptance. 

When I wrote my last article about deciding to stay in clinical medicine, I was in Bargaining.

I am now at Acceptance.

Getting there has required me to let go of expectations of who I should be. To reconcile people pleasing and perfectionism. To make decisions through uncertainty and doubt. To reframe fear as a tool to growth.

I am excited about what the future holds. No, I’m not stepping over to the 'dark side'. No, I’m not sorry if I’m disappointing you. I’m choosing me: the authentic, imperfect human being. I am still a physician.

I will always be a physician.

This writing was originally published on KevinMD on August 19th, 2022.