I’ve thought about how to write this post for a while. It’s been sitting in my draft folder forever. In the end, I came up with downsizing as a key strategy to escaping a miserable career in medicine.
How much you are willing to downsize will influence how easily you can make the transition. I’m writing this with a couple of docs in mind with whom I’m regularly exchanging emails. I feel for you guys and, believe me, I know how hard it is to feel stuck.
Downsizing has a stigma of failure and poverty. I know this from personal experience and we know this from popular culture. Few entertainment stars decide to get rid of their car, live in a tiny studio, or bike to their recording studio.
Downsizing also seems like a huge sacrifice. Until you do it. Drastic measures are sometimes needed to escape medicine but it’s often not as bad as you think.
Once you downsize and no longer compare it to your previous lifestyle, it becomes a freedom rather than a sacrifice.
Escaping a Miserable Career
Obviously this post is geared towards those who struggle to practice medicine. For these individuals the work is a grind and no longer exciting, or pleasurable. They are fantasizing about escaping medicine every day.
I am excited when I meet medical professionals who enjoy the work they do. For these individuals medicine is their calling – it’s what they enjoy doing on a daily basis.
A Miserable Career
I meet far fewer happy physicians and many more who are suffering at their job. Maybe it’s because they work too much, maybe it’s the nature of the profession.
The hardest part is coming to terms that this particular career we chose has become a miserable one. Seems simple, I have been trying to leave it since 2013 and I haven’t been able to fully pull the plug on it.
The next step is paving a way out. Few things will make the income we’re accustomed to in medicine. And, for however complex the field of medicine is, the career path is paved well.
The physicians who are happy with their career seem to have carved out the right niche for themselves. Many gave up the security of being an employee and designed their ideal private medical practice.
I’ve been quite happy doing a little telemedicine on the side. But it’s not stress-free or risk-free. For now it will do.
A Miserable Career
Few adjectives describe a career better in which we’re struggling every day just to do the basics. Any career, particularly in medicine which takes more out of you than you put into it is an exhausting one at the very least and miserable, most likely.
A medical career which seems to constantly change for the worse without giving you a break.
A career in which you no longer feel intellectually challenged.
A profession in which you cannot grow.
One, in which, you have to constantly watch your back for lawyers, the medical board, patients, staff, and managers.
Urgent Care Medicine
Like most physicians, I started out timid and ordered a lot of tests on patients in the Urgent Care. During this time I was learning, improving, and collaborating with colleagues. I was genuinely enjoying the process.
Eventually I started ordering fewer tests. I trusted my instinct and relied on the patient to follow-up with me and engaged in shared decision-making. This led to a few close-calls and eventually a couple of missed cases with poor outcomes.
I learned a lot from these, it’s not like there were wasted mistakes. I studied a little more, read more journals, ran cases by capable colleagues, and I got better. Finally, far fewer mistakes, fewer missed cases.
Freedom to Practice Medicine
By this time practicing Urgent Care medicine was no longer challenging. I wasn’t learning anything new which would change my management. I was reading ridiculous research studies which focused on useless minutia.
I assumed that at this point I knew enough that I could add my own little unique touch. I could master my art of practicing Urgent Care medicine. This was met with stern opposition from both my medical group as well as the medical board.
Yes, you can prescribe medical marijuana to chronic pain and cancer patients, but the medical board looks down on it. Sure, you can do telemedicine but you will remain responsible for anything missed on a physical exam.
If I were to not prescribe tamiflu to a possible influenza patient, it was only okay as long as nothing went wrong.
Planning an Escape
It’s hard escaping medicine if you don’t have any interests outside of medicine, nor any skills. You need something to give you the confidence needed to walk away from medicine or cut back drastically.
Another issue to consider is how imminent the misery is. Are you suffocating under the burden of practice? Are arguments with patients taking you to the edge? Is your health at risk because you’re consumed with staying afloat?
Finances are among the biggest hurdles for many. We get used to the high income from medicine. Not that we need it, we can get by on far less. But it’s easy to be wasteful when you have more of something than you need.
Live with family. Live with friends. Rent out spare rooms. Sell the house. Go live in another country. Housing is a large spending category, so even a small change can save a lot of money.
The rest of the big expenses are student loans which can be placed on hold if you’re not going to be earning money.
You need some spending money. A year’s worth of expenses is ideal. $40k should last a good part of the year if you can downsize. If you’re miserable enough, if the suffering is bad enough then it’s actually easier to make these downsizing decisions.
2. Taking Time Off
Most professional careers are easy to reenter, especially medicine. Quitting is sometimes the best option.
If you have your own medical practice then it’s tougher. Consider subleasing it to another doctor, hire an associate to run it, or sell the practice. You might come across a far better opportunity in the future.
I walked away from seeing patients in the clinic completely. It was terrible at first and I missed it. Now, the thought of seeing patients in the clinic feels much more like a chore and I don’t care to return to it. I’ve found far better options to earn a good income.
I have 2 friends who are my best brainstormer friends, H. and N.. Both are great listeners, they ask me a shit-ton of questions, and then giving me good feedback.
The more people you brainstorm with the better. Sometimes they will reveal an option that was stupidly obvious but you just couldn’t see it in the fog of work-stress.
4. Trying New Things
Should you decide to take some time off, it’s helpful to try different things. Getting out of your comfort zone and exploring every viable option can make you feel less dependent on medicine.
My friend N. is great at this. She has looked into sleep apnea clinics, aesthetics, frenectomies, and all sorts of other options. She’ll take courses on it and research the shit out of it until she knows for sure whether it’s a viable option or something to pass up on.
If you haven’t been exposed to a lot in life outside of your profession, go to the library for inspiration. Pick up random books, look at pictures, read some chapters. Just seeing all the different topics out there can inspire you to try something new.
5. Taking Risks
Eventually you’ll have to take a leap. It might be a small one, or it may need to be a drastic one. If you look long enough, something eventually pops up as a viable option.
Even better, you might meet someone during your searches whom you can partner up with.
Falling back on medicine should be a last resort in your escape phase. Move in with your parents. Work on the book you’ve always wanted to write. Open the store or restaurant you’ve plotted. Don’t limit yourself because others are telling you that you’ll fail.
6. Retirement & Savings
When you’re trying to escape a miserable career, it’s best to not worry about savings and retirement accounts. These will take care of themselves once you find something you enjoy doing. Missing a few years of saving money or contributing to retirement accounts won’t risk your future.
If you design a career from which you’ll never want to retire, you’ll have solved 95% of your retirement and savings dilemmas. In fact, my #1 retirement plan involves earning an income until I drop dead.
It’s possible to live in the US on <$2,000/month. You may not want to do it but I know people living comfortably on that kind of income.
For $3,000/month you should be able to live a more luxurious lifestyle. You can afford your own health insurance, a nice apartment, a car, some entertainment money, and have a little extra to set aside.
Downsize to a cheaper state. Downsize to a cheaper country such as Spain, Thailand, Philippines, Poland, Mexico, or New Zealand.
Everything can be downsized.
You can share an apartment instead of living alone.
You can cook your own food for $150/month.
You can get subsidized health insurance.
You can have a cell phone for free or $10/month.
You can commute by public transport or on a bicycle.
If you have been miserable for a while, it’s likely that you will have surrounded yourself by equally miserable people. It’s time to scratch off these individuals.
You will have to cut them out eventually when you find what you’re passionate about – when you stop being miserable. Many of them wanted you around so that they could commiserate with you.
These individuals might be close friends, a parent, a sibling, or even a partner. It’s good to be firm and let them know what you are trying to achieve. Some will accept this and cheer you on. Most will constantly remind you how good you have it in your current career, how spoilt you are for wanting to leave medicine, and that there is nothing better out there.
Life is too short to be around miserable people. Dump them, move on, and if they love you enough, they will come back to you, cheering you on.
As medical professionals we spend decades learning health science. There is a lot of ways of earning money with health science but no if you don’t have other complementary skills. One of the most important skills to master, for example, is sales.
Selling your services, selling your knowledge, selling yourself, selling tools, selling devices, or selling apps. Whatever it might be, sales is a great place to start your learning.
But I mention learning because the more you know, the more options present themselves. You don’t need to master Instagram but learning how to grow your social following can help you with your future projects. This includes networking with others.
Learning about investing, whether in real estate or stocks, might provide you with a new income stream. Maybe even a new career.
Learning to paint, draw, sculpt, or write are all skills worth learning. But learning to market yourself is more important. Real artists don’t starve (book link). But nobody will know about your art unless you can get it out there.
I’m a little پررو when I need to be. It translates to brazen. Even though I’m a little shy, as well, because I’m an introvert, I have no problem finding the right people to ask them the questions I need to get what I want.
When I was interested in real estate, I pinged every friend or acquaintance – successful or not – and picked their brains on their real estate investing strategies.
I did the same when applying to medical school and later choosing my specialty in medicine. I’ve been able to shortcut some unpleasant processes by asking a lot of questions.
Proximity is Key
You don’t need to look in another state or another country for a way to escape a miserable career.
It’s often someone or something quite close to us that can help solve our problems. It might be a friend who is looking to hire someone. It might be a company next-door which is looking for help. How can you help them out?
Maybe there is a storefront that is perfect for your ideal business. There might be a school near you offering exactly what you are hoping to learn.
Ask family, ask friends, ask neighbors, and ask local businesses. I would guess that the best jobs are filled when the right person happens before the right employer.
If you want to get into clinical consulting then your best resources might be the companies you’ve worked at in the past.