Last week, I wrote a post dismantling the arguments heaved upon physicians wanting to leave medicine. (I may have also admonished those doing the heaving).
In this post, I wanted to delve into 13 reasons medicine is so hard to quit. I divvied them up into four main categories, but you’ll see that there’s a lot of overlap.
For physicians who want to leave medicine, I’ll keep my message simple.
Medicine Is Hard
Like, freaking hard. You have to work at a superhuman pace gathering various forms of data (patient histories, nonverbal cues, the context in between the lines, physician exams, not to mention the bottomless abyss that is the EHR).
All the while, you’re processing all that data, determining the best course of action to try to help without causing harm, considering hypotheses and iterating with each new input, applying everything to the patient’s individualized situation, and distilling that all down into a coherent plan.
Oh, and then you have to take all those complex layers and educate about and convince the patient to enact the plan.
We haven’t even touched on the heavy stuff patients bring us—the unpleasant truths, the physical pains and functional limitations, the anguish, and heartache—all the facets of walking with our patients in their (and our) human experiences.
We are supposed to navigate all of that with empathy and professionalism.
Speeding along through distraction and interruptions never allows us any semblance of “deep work”—focused time to really dive in and do our best work—despite dealing with people’s lives. Despite the fact that one mistake made while wading through a vortex of tiny details could cause harm, irreparable damage, or even death.
We are held under threat to an inhuman standard of not erring, for if we do, we will pay dearly.
You get the idea.
We are some of the highest functioning, brightest, and caring individuals. And yet the system in which we endeavor has none of those features. So much so, that it constantly works against us, preventing us from caring for our patients.
This is what leads to moral injury: working in a system that purposefully hinders our ability to heal others—that grinds against our values and moral conscience.
But It's Even Harder to Quit
Is it any wonder physicians want to leave? In the first part of my last post, I shared several grievous stats on physician suicide. That is the extreme toll of our healthcare system: those tasked with saving lives take their own.
Awareness around this is critical, but so is recognition of those who don’t become a statistic—those who continue try harder to paddle just a little more furiously to keep their heads above water; those who remain, but want to leave.
Leaving medicine is nigh impossible for so many due to 13 reasons that I’ve loosely organized into four broad categories we will explore below.
"Denial Ain't Just a River in Egypt"
Mark Twain’s dad joke-esque play on words serves as the first category, denial, which includes the first two reasons.
1. It’s Not So Bad. Our brains crave our status quo because that which is familiar feels safe, even if familiarity means we’re punching ourselves in the face. Thus, we try to rationalize our problems away. We say to ourselves “every job is like this” or “this is normal.” We attempt to reassure ourselves.
Said every doctor everywhere.
2. It’ll Get Better When.… Our old friend arrival fallacy has resurfaced! (Did it ever really go away?) It helped us delay gratification time and time again especially through each stage of training when we told ourselves that things will get better when we’re a/an <insert the next level up in the physician training hierarchy>.
Maybe now as an attending, you’re saying things like, “I’ll be happy when I get another medical assistant” or “if I change jobs.”
This type of thinking traps us into repeating the same mistake over and over: outsourcing how we feel to the circumstances around us, instead of taking ownership of our feelings (remember, they come from our thoughts) and making sure we’re coming from an empowered internal state.
This does not run counter to #1 above because ignoring or downplaying something is different from addressing it intentionally.
Never Gonna Give You Up
The next five reasons relate to that which we don’t want to lose.
3. I’ve Already Come This Far. It’s another fallacy friend—this time of the sunk cost kind! Quitting is hard when you’ve dedicated a decade or more of your life intensely to something often at the expense of your health and relationships. Add on a six-figure sum of debt to finance that decade and it only becomes harder to let go.
After all, what was the point of all that time, effort, and money if you stop now? Sunk cost thinking feeds into arrival fallacies when we try to justify continuing on since we’ve already put so much in.
4. But I LOVE Medicine. I certainly hope that all of us who choose to remain in medicine despite all of the challenges with the healthcare system do so because we love what’s at the core of it—alleviating pain and suffering and promoting wellness through the beautiful interplay of science, critical thinking, and relationships.
But maybe, as mentioned above, the system doesn’t allow us to practice in a way that truly meshes with our values. It can seem that the only way to have a career in medicine is to partake in the options provided by the establishment. Thus we continue because it’s the closest (we think) we can get to doing that thing we love. Perhaps others view it as the price they pay for the privilege of practicing. (That alliteration was unintentional).
5. It’s a Stable Job with Good Income. Traditionally, medicine has been viewed as a career with job certainty and a good income. Heck, even my parents told me that medicine was recession-proof growing up. That may have been the case before the COVID-19 global pandemic, but nature has a funny way of turning our assumptions on their heads.
Needless to say that in 2020-2021 many physicians found their income slashed or themselves jobless counterintuitively during a medical crisis (okay, fine—more of a public health crisis).
But pandemic aside, our jobs are not as secure as we may think, what with private equity firms buying up medical groups and large organizations effectively becoming monopolies as they gobble up smaller competition.
Furthermore, payors and CMS can change rules on a (relative) dime that again can leave us holding the short end of the stick and without an income
6. The Prestige, the Glamour. Off the top of my head, I don’t know any physicians that went into medicine to be revered as healers or to enjoy an elite status bestowed upon them. Some in med school maybe hoped for a Grey’s Anatomy-like experience 
.
That’s not to say that there is some degree of societal respect. It is generally well known that to become a physician requires discipline, intelligence, dedication, and hard work. And many physicians hold esteemed positions within their communities (in my experience, the smaller the community, the more esteemed the position).
Enjoying and benefitting from this recognition can make it hard to let go.
Have I really not Rick-rolled y’all yet? You had to have seen it coming from this section’s title.
7. A Physician Is All I Am. The process of becoming a physician requires so much effort and time (and most of us spend the majority of our time practicing it) that it’s not difficult to see why it becomes the defining feature of who we are.
If there’s a healthy dose of #6 above from the community, it only cements that monolithic view of ourselves.
However, if we looked at our values and priorities, then we’d see that we are so much more. Many of us are parents, spouses/partners, sons/daughters, siblings, DJs, Arrested Development aficionados, etc.
You can be a physician AND these other things. You ARE a physician AND these other things.
What Quitting Means About Me
Reasons 8-10 revolve around the narratives we tell ourselves when we make leaving mean something about us.
8. The Stigma of It All. I addressed this thoroughly in last week’s post, so I won’t belabor the point here.
Briefly, we talked about criticisms levied against and internalized by physicians that included breaking their oaths and abandoning patients, wasting society’s financial investment in us, and blaming the new grads and women for not being “up to the task” and/or “selfish.”
9. Feels Like Giving Up. I mentioned last week that we are not quitters. Moving on from something you’ve dedicated your life to up until this point can feel like giving up instead of moving on. Quitter is not a label we wear well.
I’d argue that those who stay unhappy and burned out are giving up on their lives in maintaining their status quo. To leave would be doing the hard thing but taking back control, the opposite of giving up.
10. I’m a Failure. As you recall in my post on perfectionism, we’ve been honed to be successful machines where our worth has been tied to our accomplishments. We don’t understand that we are inherently worthy, and it’s tough to unwind the hold that the “success at all costs” mindset has on us.
When we’ve dedicated so much of our lives to medicine and reached that outcome for which we’ve been delaying gratification, it can be that much harder to leave. We can feel like we’re letting ourselves and our village down.
Layering on the stigmas from #8, we can feel as if we are somehow deficient and not cut out for medicine.
Uncertainty, Thou Wicked Beast
There is a lot of overlap of these categories, and nowhere is that more apparent in this last category. These reasons are complex and trying to bucket them under one heading is challenging.
I’ll point out some of those overlaps as we look at the final three reasons, which are all related to insecurity stemming from uncertainty.
11. That Student Debt Elephant in the Room. With hundreds of thousands of dollars hanging over us like an albatross, many feel trapped in medicine. If they leave, they not only have to worry about how to provide for themselves and likely others, but also how to handle this albatross.
This ties in to #5 above.
Loan debt functions as an indirect version of golden handcuffs (typically viewed as something an employer does to disincentivize you from leaving) that can trap us in medicine when we want to leave.
12. Too Far Gone. At this point in our lives, having been so engrossed in medicine, many ask themselves, “What else is even possible for me at this point?” From college onwards, we’ve had a prescribed course of action to take to hit all the milestones on the way to becoming a physician. This plays into the sunk cost fallacy from #3 above.
There was little room or time to explore alternatives or even our creative sides along the way. The year I graduated med school, one classmate I did not know joined McKinsey, the consulting firm, in lieu of residency. I had no idea what that was at the time or why they did that. Reflecting back on it, I’m intrigued.
There are many options for nonclinical work that physicians can pursue ranging from physician leadership to medical writing to medical science liaising (I looked it up and it’s a word) to…coaching!
There are conferences (for example, those put on by SEAK) premised on helping physicians find nonclinical careers. And an acquaintance of mine, Dr. John Jurica, has a podcast dedicated to this very topic.
13. I Can’t Do Anything Else. Physicians often lament that they lack skills that would transfer to other careers. Really? You don’t have skills?
Sure, knowledge of the Krebs Cycle (who am I kidding, only Genetics/Metabolism docs remember that now) may not translate to other fields, but think of all the skills and qualities you possess that enabled you to become a physician in the first place. Yes, there may have been healthy doses of opportunity and privilege involved, but you’ve done hard things, and you can continue to do hard things.
You can learn quickly, think critically and apply knowledge, test hypotheses, iterate, communicate complex topics clearly and succinctly, put in long hours, etc. These are all very valuable in most other careers too.
Just because you’ve never considered what you bring to the table more generally than your doctoring skills doesn’t mean you have no skills. So stop telling yourself that lie!
Don't Shy Away from Hard Things
Well, there you have it: 13 reasons why quitting medicine is hard for physicians.
The point of this post and it’s predecessor isn’t to convince you to leave medicine; it’s to show you that it’s okay to do what’s in your best interest and illuminate some of the obstacles you may face keeping you in a situation you don’t want any part of.
A critical part of being a physician is allowing our patients to be fully human with us. But that’s challenging when our humanity is ignored.
Given how hard it is to do so, leaving medicine is an act of bravery—an act of honoring your self-integrity & humanity and recognizing your self worth. It takes courage to walk away.
But if it’s the right decision for you, then see #13 above: you can do hard things.
Remember: the system is broken. You are not.
Do you have another compelling reason that makes it hard to leave medicine? Let me know in the comments below!
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