I loved morning report during my internal medicine residency at the University of Pennsylvania. Sure, the free bagels and coffee were nice, but what I really loved was starting my day sitting around a table with my fellow residents and a few tenured gray-haired professors discussing challenging cases. Like a good mystery novel, the patient’s history was unveiled in pieces. With each new clue, the communal differential diagnosis would morph, discussion and debate would ensue, and by the end of the hour the diagnosis (usually some esoteric infectious disease or rheumatologic condition) would be revealed. One lucky resident with the correct diagnosis would go home with two free movie tickets.

Now some 20 years later, I log on to our hospital’s remotely held medical grand rounds every Tuesday at 8 a.m., video off and microphone muted, screen minimized, so I can simultaneously clean out my EMR’s inbox in preparation for the day’s inevitable deluge of messages. At the end of the hour, I make sure to log into our hospital’s CME app to accrue my 1.0 AMA credit, unsure if I learned anything.

We are confronted with so many hurdles early in our careers, so many boxes to check in our 20s and early 30s before we finally get to (what we believe to be) the finish line. When we have successfully jumped through the hoops set forth by our medical schools and training institutions, we create our own boxes to check (i.e., being promoted, making partner, earning a higher salary). The pursuit of these goals drives us, becomes our ikigai, the reason we get up and go to work each morning.

Along the way, our focus on the next thing, and the next thing, suffocates our innate curiosity and wonder, deemphasizing learning in lieu of efficiency — see more patients, generate more revenue, crank out more publications. And what about camaraderie? For those of us in practice, long gone are team rounds and case conferences. I cherish the ad hoc hallway conversations with my colleagues, squeezed in during rare gaps in my overstuffed endoscopy schedule.

But what happens after we have checked all the boxes? We manufacture new ones, of course. Only these contrived goals often lack real meaning, rendering our pursuit passionless and leaving many of us, you guessed it, burned out. Burnout is not just administrative headaches and EMR chores, it is the (inevitable?) final resting place for physicians who have been indoctrinated with a box-checking mindset since medical school.

The physicians I know who have rediscovered their love for medicine have given me hope. Some have decreased time spent doing compensated clinical work (oh, the dreaded RVU) and established a research career in academia or pharma; some take time to instruct students. Others have volunteered time to care for vulnerable niche populations (i.e., immigrants, women). Whatever the endeavor, the hallmark feature of all such pursuits is its decoupling from traditional mileposts such as monetary compensation and administrative titles.

“To coast, or to pivot?” is the existential question facing many mid-career physicians. Do we remain on autopilot in our now mature, self-running practices, or do we shift gears to rekindle our waning passion for medicine?

So many platforms are dominated by physicians hyping their side-gigs — real estate investing, pharma consulting, medical malpractice work, etc. There is certainly a place for these diversions. But it is time to hear from physicians who have found lifelong meaning in medicine, especially those who have pivoted mid-career to reclaim the joy and sense of purpose we are all looking for.

Colleagues, please help me find that morning report feeling again: the curiosity, the challenge, the camaraderie. (I do not need the movie tickets.)

How have you found meaning in medicine again? Share in the comments.

Anish A Sheth MD is Chief of Gastroenterology at Penn Medicine Princeton Health and is the author of several books on gut health including the best-seller, What's Your Poo Telling You? He is a mid-career physician who loves practicing medicine and is looking for ways to keep the fire burning!

Illustration by Jennifer Bogartz