There is a time to pay off debt, a time to save, a time to learn more and a time to focus on one’s personal life. At the intersection of our careers and our personal lives sometimes we will encounter a great deal of hurt.
Most of us are fortunate in that over our career spans we can gradually work our way from naive students all the way to financially abundant individuals.
We start out studying, passing tests, getting into debt, then choose our medical specialties, earn a little residency income, sign a contract to work as attendings and start getting ourselves out of debt. We then save and invest while lowering our expenses and eventually hit a point when our investments and savings can cover our ongoing household expenses, freeing us of the need of an income from our jobs.
Things don’t always go according to plan
I am incredibly fortunate that I never had a noticeable hiccup on my path towards financial independence. Though I dealt with my share of depression in medical school, overworked myself in residency and had a burnout towards the end of my career as an urgent care physician, I never really skipped a beat.
It’s great to be able to roll with the punches and make lemonade out of lemons. But that can only go so far. When loved ones get sick, when our own health becomes incompatible with gainful employment or when we encounter emotional emergencies, it’s not a time to pay off debt, save, invest or think about financial independence.
I have 2-3 friends and twice that many colleagues who are completely emotionally burnt out. They are getting by on fumes and signs of things crumbling in their lives are becoming obvious.
When you are forced to do something you don’t want to do and suffer because of it, then even the strongest coping forces won’t help you heal. Some physicians are constantly getting an emotional pummeling when they are in the OR, in the ED or working outpatient.
They either are in a terrible place due to other circumstances or they miserably hate their job. They cannot stand what they do, it’s an uphill battle every day and they have run out of excuses of blaming themselves. It’s becoming glaringly obvious that it’s the job.
One of my friends has been feeling this way for nearly 5 years and still is able to blame himself, thinking that he is ungrateful and that he has no reason to feel this way because he is quite a strong surgeon – but denial can be stronger.
Drop & Roll
My therapist in medical school tried to convince me to get out of medicine. She was recognizing that I was suffering unnecessarily and that my options were limited.
I could either continue to suffer, with another 2 years ahead of me, or I could put a stop to it and work on rebuilding my life which by then was so bad that I couldn’t get out of bed in the mornings, I would sneak alcohol into the lectures to prevent panic attacks and I was too depressed to show up to some rotations.
In hindsight, I made it through, I’m a ‘successful’ doctor with halfway decent coping mechanisms. However, if I ever find myself or a loved one in that situation, I would tell them to get the fuck out! Drop, roll and put out that fire.
Forget debt, forget savings
When your heart and mind is on fire then the last thing you should be doing is thinking about your benjamins. Forget the debt and forget trying to save for your retirement – it’s a misplaced priority.
Sure, when you have $400k staring you in the face it’s not easy to dismiss one’s financial obligations. But I think it’s exactly during such times that we should be doing everything possible to completely minimize our dependency on the income from our careers – the same career that’s slowly killing us.
Spending 1-2 years not earning an income will not hurt you much in the long-term. I spent the first 3 years out of residency spending every dollar I earned and then some. I started getting my shit together not until after accumulating another $50k of credit card debt.
Recognizing An Emergency
Whenever you are suffering it’s an emergency. Sometimes the suffering is temporary and something that has an immediate end in sight.
Some suffering is also easily coped with. Some of my fellow medical students were dealing with far more shit than myself and still managed to cope with the stress in a positive manner.
Suffering is when you are hurting emotionally or physically. It’s an additive effect where you can only heal a tiny fracture of the hurt just before more gets piled on top of it.
When I boulder in the gym I suffer. I get cuts, hurt my finger, my meniscus gets torqued to tearful levels, I land on my ass, I land on my shoulders and the next day I’m stiffer than Ron Jeremy.
But I don’t suffer, it’s pain and a hurt that I desire, I welcome. Or it’s the kind of suffering that I can quite easily cope with because the outcome far surpasses any of its negative effects.
And it’s not something that’s far into the future, I don’t have to wait years before I can justify the pain. I am getting an enjoyment while suffering, I anticipate and know how much I can push myself. And when I overdo it, sure, I start having thoughts about skipping the gym – it’s a fine balance, which is completely in my control.
Being in control
I don’t think I have adequate verbal skills to convey this idea across to you guys but when I feel that I am in control then I don’t suffer.
Not control in that overbearing fashion, trying to manipulate the environment, emotions and everything surrounding in order to get a specific response.
Instead, it’s being able take responsibility and guide the input and output of actions. It’s when there are far too many controls on one’s life when we feel the most depleted.
What to do
I think when a doc find herself or himself in such a situation where they must consider leaving the field then they will first blame themselves. Sure, some will blame everyone but themselves, they are still in the denial stage.
The feeling of guilt is perhaps the biggest hurdle. Feeling guilty that we would leave such a massive debt burden behind. Feeling guilty that we are leaving an enviable career. Feeling guilty that we would be giving up a skill which took us years to learn. Feeling guilty about letting others down. Feeling guilty about letting ourselves down.
Guilt is built into us as clinicians, not just perpetuated by society but by our community of fellow physicians.
Fuck everyone’s expectations
Step 1, fuck everyone’s expectations. I want my family and friends to push me to excel but never on a superficial level. Never to just make a lot of money or fulfill their own vision of me.
Someone who loves you should want the best for you. They should want you to minimize your own suffering, to want you to be at peace, to be content with your situation, and they should want you to achieve your own definition of success while adding to the success of those around you.
Do you have people who you’re trying to satisfy or impress? Is your partner cutting you down because of your decisions? You know what I’d say to that!
When I decided to walk away from Kaiser and ‘retired’, I got a lotta hate. Not evil hate, just insecurity hate, the kind that people throw at you because they don’t know how to deal with their own insecurities.
I knew those individuals were still good people and they are still friends/family of mine. But I told them to fuck off (figuratively). Even after that, it is still a process, but they are coming along and realizing that I no longer identify with being a doctor – I am retired for all intents and purposes.
Are you unhappy? Are you miserable? Are you depressed? Are you suffering silently? Don’t lie to yourself and don’t deceive yourself. It’s not that you’re doing so intentionally, but it’s a natural reaction to deny such negative emotions or downplay them.
What matters most to you? Is it how you are perceived in society? Is there something that brings you real joy which you aren’t doing? If you can’t find joy in anything then you are likely clinically depressed and that’s a whole another situation to deal with.
Perspective means that you can look at your own situation independently, within the context of your life. If you just keep floating along thinking that it’s normal or okay to suffer because everyone else is suffering then you are deluding yourself.
Save to escape
A buddy of mine is married with kids. Hates medicine and is ready to pull the plug on that career. He has also completely fallen out of love with his wife. He wants to see his kids but he’s okay seeing them just a couple of times per month.
His household overhead is $15k/month. Cars, student loan debt, a home, after school programs, daycare and expensive social outings with their friends.
He was telling me his story and I could tell the dude was overwhelmed. I told him that he can put his loans into forbearance, cancel his auto lease, put the house up for sale (or have his wife take it over) and live on his own for <$1,500/month.
I’m telling you, when I said this he lit up, he was so happy. Not happy to leave his family or quit medicine, that thought makes him miserable. But knowing that there is a way out made him feel less stressed – that’s perspective.
He has money in his 401k which he can cash out, pay taxes on it, and he will have enough money to live off of for 2 years. Not that I think he will pursue any of these options, but knowing that there are other options is freeing.
Prepare to escape
Preparing to escape refer to escaping into something instead of out of something. If I just ran away from medical school back in the day then I would have been miserable and would have had a lot of regrets. Every one of my future failures would have been blamed on running away from that professional degree.
I was a bit too overwhelmed at that time to develop a backup plan. I am not even sure if I was ready to pursue any other kind of education without suffering equally. That’s not the case now, a few years after becoming an attending I prepared for a potential exit strategy.
It’s important to start brainstorming now. Either come up with some good backup plans or find something positive to do. Once you’re ready to pull the plug don’t think of the next career, just focus on doing positive things. Spend more time with loved ones. Move in with your brother/sister, move in with your folks or spend more time at home with kids if you have a family of your own.
Then start doing some volunteering. Do something positive that will keep the negative feelings from resurfacing.
Get the fuck out
I know, I curse too much. But listen, sometimes you just go to get out! Don’t worry, you don’t have to renounce your citizenship, you don’t have to give up your medical license, you won’t suddenly lose your medical school diploma. You can always come back!
The point is to stop any further damage. Not only are you harming yourself more but no doubt, you are spreading that negativity out into the world.
By getting out you will gain even better perspective. You can think clearly while not having to report to the OR, not having to deal with those angry staff members, not having to battle that commute or get constant exposure to your equally unhappy colleagues.
Take a few months and don’t do shit. Wake up when you want, stroll to a cafe, do a few yoga sessions at the gym and meet up with friends. Connect with all those individuals you’ve been meaning to get back in touch with.
How to deal with your employer
There are so many options for anyone who truly needs to get out of their job. Thankfully, the job environment in the US is fairly protective of the employed individual.
You can request administrative leave. You can cash in a sabbatical. You can use FMLA or use your long-term disability.
Ideally, it’s best to use one of these avenues before walking into your boss’s office and throwing down a resignation letter. But sometimes, you’re so fucked that the only thing you can do is to walk away.
I would still recommend writing some sort of letter to a supervisor and state that you are in severe emotional or physical distress and that you cannot return to work at this time. There is some protection offered by announcing this while you are still under your employment contract. It will leave you solid options to pick up some of the pieces once you are in a better situation.
If you’re a shitty employee and everyone at work hates you then it’s gonna be that much harder. Maybe you’ve gotten to this point because you have been so miserable at work, or maybe you’re just an abrasive person.
If your employer is toxic then you may hit even more roadblocks and create even more stress when trying to negotiate an escape. Instead, it might be best to just drop the mic and walk out (right after writing that email about emotional burnout).
There is always something better waiting around the corner when you consciously leave a negative situation. Even without any secondary plans, wonderful things will present themselves to you.
Don’t be so blind to not recognize such opportunities, don’t be so negative to dismiss them and don’t be so judgemental that they will pass you up.
Find a positive person, someone who thinks differently than you, and run your situation by them. Set aside your expectations, your judgements and try to put less emphasis on the hurt.
Surround yourself with positive individuals or those who can recognize the positive in you and your situation.
I also strongly recommend getting involved in your community. Fuck, it’s such a cliché thing to say but get out there and meet people. Go to libraries, cafe’s, community events, socials and meet your friends’ friends.