Setting Yourself Up for Success
So hopefully at this point you’ve allowed yourself to ask The Question (“should I quit residency?”) and found that there were no Arbiters of Medicine appearing at your door to shame you. Whew! Now you can start the real work. In this section I’ll provide guidance on how to set up your environment to maximize your ability to find your answer.
Step 1 – Get Support (if you need it)
If you’re feeling depressed, anxious, or burnt out this is a great time to get help. Find a therapist and/or psychiatrist. Hopefully your program has a system in place to connect you.
You can also ask to take a Leave of Absence (LoA). There are two situations where this would be particularly important:
- You are mentally unwell and unable to function as a resident. This is not uncommon, so don’t feel bad. Once you are approved for FMLA, you should see if you are eligible for disability coverage, it may cover some or all of your salary while on leave.
- You have gotten to the point where you are very seriously considering quitting and need space from residency so you can properly answer The Question. You should find the answer when you’re feeling well, not while you’re actively burnt out. You shouldn’t make a lifelong decision based on an acute feeling.
At this point you may be thinking that you’re screwing over your fellow residents by taking leave. That’s definitely tough to come to terms with. I don’t know the culture of everyone’s program, but if #1 or #2 above are genuinely true, you need to seriously consider taking leave. You need to take care of yourself. Our medical training system takes a serious mental toll on so many residents, so that same system needs to take responsibility when a resident needs time to get better. It shouldn’t fall on you as an individual to figure out coverage. Also, I would argue that your co-residents would probably rather you take time off now to get better, rather than slowly deteriorate and quit all of a sudden.
Step 2 – Be Organized, Be Honest
In my experience, asking The Question opened up a floodgate of additional questions and it became really difficult to keep track of what was going on. So I sketched out a flowchart to stay organized and track my progress. I’ve included it in the Visual Tools section.
Some of the questions can take months to answer. That’s okay. What’s important is that your answers are accurate, so you need to be brutally honest with yourself. For example, when I initially asked myself the most important question, “do I want to practice clinical medicine?” an obnoxious voice in my head would immediately answer “OF COURSE YOU DO! WHY ELSE WOULD YOU HAVE CHOSEN TO PURSUE MEDICINE??” I was clearly too scared to even entertain the possibility that I didn’t like clinical work. But after reading the books in the Resources page and using the tools below, I was eventually able to move past this weird illusion of cognitive dissonance and discovered that I actually didn’t want to practice.
You can see how this would be painful to admit after 8 years of training. But I’m so glad I figured it out now, rather than 20 years into my career. So do what you need to do in order to overcome any barriers to answering honestly. That is, answer these questions in the bubble of an idealistic world. Let go of your ego, expectations from family/friends, salary expectations, etc. Once you find the answers to these introspective questions, you can ground your solutions in the real world.
Step 3 – Explore
I hope I’ve given you the proper perspective to start this process. It can be unsettling at first because you are forced to consider options that branch from the “safe” path of clinical medicine that you have been traveling down for so long. But once you let that feeling go, it becomes easier, and even fun, to take a journey into your mind. I found it so refreshing, as I was finally able to explore thoughts that I never had time to before. In my case, medical training sort of forced me into a mental box, so it was nice to break out.
I’m sure everyone has their own methods of letting go of the world and getting all introspective and deep. Do what works for you. I’ll share what worked for me:
This is something I had been doing on and off for years and always found helpful, existential crisis or not. But this time I did my best to practice daily and it helped immensely. Especially when it came to that frustrating question “do I like clinical medicine?” It was so hard for me to admit that after all these years, the answer was no. But meditating allowed me to find answers even when I didn’t (initially) like them.
It also allowed me to zoom out and see the timeline of my entire life. My perspective widened. I could look to the past and understand what brought me to this point, and then look forward to see the long-term affects of either decision (quitting or staying) and how I felt about them. It’s difficult to explain the gravity of this super power, but I’m telling you, it was awesome.
Learn from the experience of others
The hardest part of the process was getting the perspective and advice of others who have left clinical medicine. This step is what motivated me to create this site! Almost everything in the Resources page will help here, especially the books! Both were written by doctors who left medicine. I hope the rest of my site can help as well.
I had so many thoughts running through my head that I couldn’t keep track of them, so I ended up journaling in Google Docs. I probably wrote 50 pages over the several months that this took place. It helped me keep everything organized and ultimately helped me understand myself and the world I was living in.
Journaling led me to create the images in the Visual Tools section. I would highly recommend checking them out and adapting them to your situation. I found The Scale image especially helpful throughout my process.
Talking to others
This can include friends, family, colleagues, whomever. In my case, I was very slow and deliberate at telling new people. I couldn’t handle sharing with too many people at once. I elaborate a bit on this subject in the FAQ.
I did this pretty frequently. Sometimes by myself, sometimes with my fiance, sometimes on the phone, whatever worked at the time. Nature helped.
This is a tough one, but it’s an important part of the equation. So important that I added it to the fancy flowchart above! Getting board certified before you leave medicine will without a doubt open more non-clinical doors for you (and increase the chances of getting a physician-level salary). Many companies are looking for MDs who are experts in a given field. For that reason, practicing for a few years AFTER board certification can be very beneficial as well.
I say this to support my last point: if you think you can survive through residency, get board certified, and maybe even practice for a few years, do it. Not only will it open more non-clinical doors, but you’ll be able to experience true attending-ship first-had (and determine whether its doable) AND you’ll be able to fall back on a clinical career in the future if you choose to.
Having said that, if you are at the end of your rope during residency and feel you have done everything you can to make it work, then the cost of continuing may not be worth the board certification. Basically, your threshold to leave medicine should be very high before board certification, but can decrease as you progress through your career after board certification.
- There are alternatives to quitting, such as transferring to a different residency. Check out the FAQ for details. If you know of any other good resources on the subject, please let me know!
- I framed this situation as answering the question “do I want to practice medicine?” Technically, if we’re talking about completing residency, the question is “do I have career goals that require board certification?”
This is the longest and most important part of the process. Take your time! Ask yourself hard questions (“do I like medicine?”). Check out the rest of this site. Do some Googling of your own. This phase took me a few months. If you’re wondering when I’ll talk about money, check out Part Three.