Reflections on life, travel and leaving medicine (a six month review)

We embarked on this family adventure because we were looking for something: a broader education for the kids, a defining family experience, and an alternative to a job that I was finding increasingly exhausting. Why would anyone want to leave medicine? I’ve spent a lot of time over the last six months trying to figure out why I felt so compelled to leave the job that should have been my life’s work.

What medicine was

When I got into medical school I was ecstatic. The future was bright with dreams of challenging and rewarding work that was also well-remunerated. I could work part time and travel – maybe on the front lines in a foreign country with Doctors Without Borders. A big house, luxury cars and status weren’t important. I wanted noble challenges, adventure, a life that mattered.

In hindsight, medical school was bliss. We gripped our golden tickets as we entered what felt like an elite club full of smart, resourceful, benevolent people. Suddenly, I was motivated not just to perform well on tests but to really learn and understand. The long hours and challenging problems were a source of satisfaction, not suffering.

I read once that you’ve found your calling when a great need of humanity matches a great passion of the individual. When I found emergency medicine, it felt like a calling. I worked harder than ever. William Osler, the father of western medicine, said that “Medicine is a science of uncertainty and an art of probability.” The acuity, diversity, intimacy . . . somehow it all meshed with my circuitry. I could almost feel the buzz and glow of my nervous system as I assessed, diagnosed, treated, empathized, consoled, supported.

Over time the pipe-dreams of part time schedules and international medical work gave way to marriage and babies (a good trade), but I thrived on the challenges and felt both pride and privilege to be serving in that role.

What medicine became

Then slowly things began to change. I realized that the hardest thing about medicine was not missing knowledge, it was missing resources: knowing what patients needed but being unable to access those things (or else having to fight tooth and nail for them). How could this happen in Canada?! Constantly apologizing for long wait times, hallway admissions, disappointing experiences – none of which were in my control – ate away at me. At the same time regulatory college, government, and administrative powers picked and pulled at physician autonomy. Doctors should comply with policies that protect patients, but what if those policies are poison to that fundamental and sacred relationship?

Gradually my calling turned into a job. It’s one thing to work your ass off for a higher purpose. It’s another thing to work your ass off for money. A recent study revealed that the biggest factor in male happiness was not money, health or even a happy marriage, it was job satisfaction – specifically, the belief that one’s efforts are contributing to their organization’s growth. I was a cog in a grinding antiquated machine. I wanted to be a spark in an evolving entity.

Seeking balance

I tried to be proactive. I accepted leadership roles, joined teams. I worked out and ate well. I renovated our basement then became general contractor in the construction of our “dream home”. We moved. I renovated another house. I wrote personal finance articles, brewed beer, designed beer labels, made business plans and started (or nearly started) three businesses.

I kept on piling more things into my life because I felt unbalanced. ER work was on one side of the scale, everything else was on the other side. The hospital exhausted me more and more so I took on more and more outside of it. Sometimes the busyness was thrilling – “Look at everything I’m accomplishing!” – but something wasn’t right. It is possible to enjoy something that isn’t good for you – just ask a cocaine addict. I got headaches. I stopped sleeping. Socrates said, “Beware the barenness of a busy life.” In theory, I had a very “balanced” lifestyle. In reality, I was breaking the scale.

Opportunity costs

We are a restless species. There is a biological drive to act, to acquire, to be more, to have more. Maybe that was okay ten thousand years ago when there wasn’t a lot to grasp for, when rest was built in to the system because there was no choice but to wait for the next thing. Evolution likely selected for those who jumped into action when opportunities arose. The problem now is that opportunity is constant and ubiquitous. There is no rest unless you seek it out and harvest it.

The decision to sell our house and try out this family world travel thing was really just the latest – and most extreme – attempt to find balance. The irony is that to do this, we had to take almost everything off the scale – work, house, all the possessions that promise happiness but just weigh us down – this is what I needed all along.

The goal

What is left is Linds, the boys, six backpacks, some bank accounts and this blog. We meet people and learn things and sometimes don’t do much of anything. It has taken some getting used to. The scale moves more when it’s lighter.

I’m quite sure no one would have been able to convince me to downsize my life like this, so I don’t think this post is going to change anyone else’s life. At best, I might have tried eliminating a thing or two, but it wouldn’t have been enough – and it’s uncomfortable at first when you’re so used to being busy. I had to stumble into this, like walking in a dark attic and bashing your shin on something you’ve been looking for for years.

Travel therapy

Out of the six of us, I think I needed this trip the most – and I’ve also had the hardest time adjusting. There were a few months where I felt really uneasy – you might say “out of balance”. All the things I had taken on had weighed too heavily, but they had also been familiar and grounding. If I’m not an ER doc, who am I? If I’m not busy, am I being productive? And the one I struggled with the most some days: If I’m living the dream, why am I not happy? One night I stayed up late pouring my angst into an email to a very wise friend. His reply:

You are in the midst of an adjustment disorder.  Inertia, familiarity, routine, what is known and predictable is comfortable.  Not necessarily good, but comfortable.  You have chosen, bravely, to confront and confound that and so not surprisingly you are uncomfortable.  Stay committed to it.  Feel it out.  Experience it.  You probably won’t do this again, so eat it up and revel in it, even if it makes you transiently unhappy.

I needed reminding that it’s ok not to feel happy because this is not about happiness. It’s about family and discovery and exploration. Things that are bad for you in the long run can feel good right now, and things that are good for you in the long run can feel bad in the present. Usually that means there is some adaptation that needs to take place. Ironically, this made me a lot happier.

But what about medicine?

I’ve never had a failed marriage, but I imagine leaving a career like medicine might be similar to the end of a dysfunctional relationship. You try hard for as long as you can to make it work until you run out of things to try. Leaving is scary and unsettling and exciting. It takes a while to find your feet again, to adapt, and even then there will be times of confusion when you might miss the good parts of that thing you knew had to end. But would things be different if you went back? Have you changed? Have they changed?

I thought medicine would give me the life of noble challenges, adventure, and meaning that I wanted – and it did for a while. Perhaps it will again someday – I haven’t ruled that out. But, if I’m honest with myself, as hard as it is to let go of that identity, it’s even harder to imagine going back. I have found challenge, adventure, and meaning again in a different place – out here. Sometimes your calling changes.

18 Comments

  1. Matt,

    I realize I’m Joe Blow from the interwebs and not a lifelong friend you left behind to travel, but your post resonated deeply, so forgive my casual familiarity. I’m an ER doc in the U.S. (a plenty dysfunctional system) recovering from burnout but still in the game.

    Today I grabbed coffee with a colleague from the ER, a friend who just had to opt out of a month’s worth of shifts because of acute health problems that prevent him from doing the job as he gets a workup for his symptoms.

    He confided that his wife resents his time away from the family, he can’t handle the stresses the way he once did, and that he feels other than work he has no regular sources of friendships. Assuming he returns to baseline health in a month or two, I asked what he thought he might offer his wife to make her less resentful of the job: It didn’t occur to him to work less, even though they are in a financially stable position and it was the answer she’d told him she sought.

    The poisoned apple we all ate caused us to conflate the job with our identity. Having invested so heavily in this bad stock of Physician, and seen it’s value drop precipitously, loss aversion prevents us from selling.

    Yours is a pretty radical approach to burnout – first by filling your plate further with commitments, then by simplifying and traveling to clear your mind.

    In the throes of burnout I sought escape through alternate avenues (fiction, a financial literacy conversion experience, blogging). I’ll admit I’ve fantasized about taking a year abroad. After reviewing the logistics, we opted to stay put during the school year and spend our summers traveling with the kids. It’s worked for us.

    I’ve also cut back drastically on my clinical commitments – which has had the unanticipated side effect of helping me fall back in like with medicine. Your mileage may vary.

    My moments of sad have gradually abated as I’ve built a life that seems surprisingly sustainable, based on 6 shifts a month; enjoyed more regular sleep than I have in the prior 20 years; found other middle-aged dads with flexible schedules to hike with, hold a monthly game night and grab the occasional coffee with; and enjoy regular meals with my wife and volunteer in my children’s classrooms.

    Hopefully this travel period free from those traps that unfavorably tipped the scale will allow you to envision what a well-balanced life could look like and lay the framework on your return.

    It’s rare, brave (and frightening) to wipe the slate as completely clean as you’ve done. Appreciate your dissecting it all publicly for the benefit of strangers, at least this one, like those physician lecturers of old.

    Fondly,

    CD

    P.S. Osler also said, “The desire to take medicine is perhaps the greatest feature which distinguishes man from animals.” Gotta love that Canadian frontier sense of humor.

    1. Crispy Doc . . . where to begin? Your comment is so full of wisdom and sincerity I feel like I just read a well-crafted blog post. You are not Joe Blow. You’ve commented here before, I’ve read your (excellent) blog, we share those strange two letters (MD) behind our names . . . I’m pretty sure we’d have a good time together on a hike or game night 🙂

      It is a challenge to control our cognitive biases even when we know about them. The sunk costs of investing in physician-hood are hard to let go of and, as you say, the loss-aversion is significant. We doctors pride ourselves on our decision-making clarity, but it is a struggle when it’s personal. I feel for your colleague and can only hope that his health returns and his own answers reveal themselves.

      Your story is fascinating to me. It’s so humbling that people think what we are doing is brave when all I can think of is how much MORE bravery (and industry) it takes to rehabilitate a mature career in emergency medicine. Kudos to you. It sounds like a good life.

      A great big sincere thank you for your comment.

  2. Hi Matt,

    I have really enjoyed following your family adventures and life lessons for the past few months since I’ve learned of your blog.

    What has always drawn me to your blogs is a combination of your honesty shown in how much you are willing to share and how well you have been able to express yourself in your writings. I think this current blog is a great example of that! I enjoy my work as an anesthesiologist very much (19 yrs post certification), yet at the same time, I can also relate to some of the feelings you have about “life”.

    I look forward to every one of your posts (along with Lind’s and the boys’)!!!

    p.s. I’m on your mailing list and have received notifications of new blog entries (up to and including the boys’ updates) but did not get notifications when the 6 month updates for you and Linds were posted… Don’t know if it’s me or a glitch with the system.

    1. Hi Ken! I didn’t want to flood people’s inboxes with daily reminders for six days, so I just sent one out prior to Eli’s post. Perhaps I should send one out now that they’re all out there.

      Thanks so much for your comment – these things mean a lot to us 🙂

      1. But, but – please, always flood our inboxes. We don’t want to miss a thing, ha ha. I found this post just by accident when I was reading a more recent one that hit my inbox.

        I should get my child (who has wanted to be a doctor for several years) to read some of your writing before she gets to college age.

        I think in certain intense careers there’s a propensity to conflate one’s profession with one’s sense of self and identity. At one point after about 10 years in my industry for a single employer, the company (where I had a bright future) sold itself to a larger company. The new owners assured me repeatedly for a period of several weeks that I was going to stay onboard, at my usual high level of salary, benefits, influence, and authority.

        When I was given the news that they didn’t actually plan to keep me after all (news which they delivered 2 days before Christmas [insert tiny violin music here]), I went through some weird stuff for the next several weeks. I had brief, disorientating moments, from time to time in which I could, for just a few seconds, almost make myself believe none of it had ever happened. But really I was just going through denial, confusion, and anger – almost like grieving a death.

        You invested a huge amount of ‘self’ into being a doctor, and you’re still a doctor in many ways, even if you’re aren’t currently practicing. I can’t pretend to be qualified to offer anyone coping advice, but what worked for me was thinking back to my childhood, my youth, my early adult life: a time from before that profession. I had to keep reminding myself that a job is just a job. I am Me; I am not my profession. My profession can end and that employer and all others like it can close up shop, but I will endure and I will still be me. I will live on long after no one even remembers that company’s name.

        And of course, one day I will retire and I won’t be in this profession at all, but even then I will still be me. “I am not my job,” is something I told myself a few hundred times until I started to know that it is true.

        It all worked out in the end. I’m now working for my good friend/former boss (from the old company, even) at a similar but different employer where everything is better and the future is even brighter.

        The other huge help in that disorienting transition was that I started getting up before everyone in the house to take long daily walks alone, to keep fit and to pray.

        Best of luck, keep us posted, and thanks for sharing!

  3. Hi Matt,

    Your posts are both inspirational and insightful. You speak to the challenges of a career in medicine, but you might as well be speaking to the challenges of nursing, policing, accounting, finance, etc..
    You are not alone in experiencing the feeling of a ‘passion’ becoming a ‘job’. Yours is a story that I have seen and heard many times over. Most people are not able to articulate their dissatisfaction with their chosen or defaulted path as well as you have so clearly done. They may not recognize their unhappiness or lack of fulfillment in their careers. You know as well as anyone that the fallout from this can lead to some very destructive behaviours.
    Perhaps your future might include a leadership role in helping others to navigate the mine field of challenges that their profession will throw at them.
    Thanks for sharing your adventures and your personal story. It gives us an opportunity to see the possibilities that we can bring into our lives.

    1. Thanks for the great comment, Mike. I think about these issues a lot and agree completely that they are not limited to physicians. I’ve talked to teachers, lawyers, police officers, nurses, engineers, etc. who describe almost identical feelings of frustration and exhaustion. I wonder what is going on.

      How can I help? – this is a question I ask myself all the time. I don’t think I have enough knowledge or credibility yet, but I think helping other professionals get through burn out in one piece – maybe even better than before – would be incredibly rewarding. I don’t have an image of what that role would look like, but perhaps it will reveal itself with time.

      Thanks for the vote of confidence, Mike 🙂

      1. Hi Matt,
        I arrived here thinking “who is this guy who’s taken over BTSX?”
        And then I read this post.

        Thanks.

        Engineer. 2016 burnout victim. “Retired” early on July1, 2017.

        Perhaps sharing the stories (like the ones I’ve seen here) will permit us Type A’s to see that what they’re experiencing is a relatively normal response.

        Thinking about how to describe my experience in a proper way.

        Regards,

        Tom

        1. Hi Tom, glad you found our little blog and thanks for your comment. I wonder why we feel the need to explain ourselves at all – but I know I do too. Perhaps it’s because we need a narrative we can tell ourselves, to understand what happened, to assure ourselves we won’t let it happen again. More this than a justification to others.

          The part of your comment that really struck me, however, was the description of “burnout” as a normal response. I resist the term burnout because of the connotation that it is a defeat. No. What I did was a rational choice based on years of reflection and exploration of alternatives. Some people don’t have so many options. Others don’t realize the options they have.

          In case you’re interested, here’s another post you might find useful: https://big-family-small-world.com/lifestyle-withdrawal/

          All the best, Tom.

  4. Thanks so much for this post and for your transparency. I am a Canadian doc too right now at a cross road looking at opportunity costs as you have depicted above. I teach residents and have met 3 in the past year already planning their egress from medicine within 5 years of graduation (just enough to pay debts).. Sadly I think many doctors should or want to leave but don’t have the courage to take the chance. Cheers. Rosa

    1. Thanks for the note, Rosa. I’ve seen this trend in new grads too – just a few years out, exhausted and confused as to why medicine can not be the long, rewarding career they’d envisioned. When the problem is so widespread, clearly there is something systemic going on. This is why I don’t like the term “burnout” – it focuses attention on the individual, rather than the system. We (patients, doctors, and politicians) need to fix the system.

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