You are considering retiring from medicine; maybe after 35 years or 20, or even after only five since completing training. I obviously can't tell you if that is a good move or what to do with your pending retirement, but I retired two years ago and I want to share some reflections of my journey, as well as some of the emotions and quasi-disordered thinking that I have experienced.
I was a neurologist and a neuro-oncologist, teaching medical students and residents and participating in research for over two decades. My patients often had malignant brain tumors, neurologically disabling conditions, and requirements for complex and interdisciplinary care. Eventually it was time for me to move on, to leave the stress and the toll it was taking on my personal life and my ability to enjoy my job. Fortunately, I had other interests that had been whispering in my ear for years. I finally decided I needed to pursue those interests full-time.
Since leaving medicine, I have gone through a range of emotions: relief, happiness, relaxation, but also a sense of betrayal, anger, and grief. The strangest emotion has been a persistent feeling of guilt.
The guilt has been multi-faceted, interestingly distressing, and slow to fade. I felt tremendously guilty about everything surrounding my decision to leave medicine; from leaving the patients with whom I had a long working relationship and those who I knew were waiting in the wings for the type of care I had provided, saddling my colleagues with more call and higher patient volume, to ending the mentorship and support role I had played with students and young faculty. While I clearly needed to move on for myself and have not regretted that decision for one minute, the physician identity development ingrained during my education and training had burrowed deeply into my psyche and is the little voice on my shoulder that even now continues to say, “You are selfish to prioritize yourself.” As a Gen Xer, the sandwich generation, I had watched the generational tension develop between considering medicine a calling like my surgeon father’s generation and a job like my pulmonologist child’s. The Hippocratic Oath, society, my peers, and years of physician identity formation brainwashing makes it extremely difficult to claim priority for my own mental and physical health.
I can testify that if you leave medicine “prematurely,” some colleagues will be privately — but probably not publicly — supportive, and may even express envy for your ability to leave the profession. Many more will judge you for failure to uphold your tacit contract with society, for your lack of loyalty, for your personal failings and lack of resilience. Interestingly, the former patients I have encountered since I left have uniformly been supportive and understanding of my right to disengage from medicine. The problem with the lack of external support for a decision to leave medicine is tremendously compounded by the internal beating we have been conditioned to deliver to ourselves for putting our own lives first. The irony, of course, is that I dedicated my career to giving my patients their best possible life despite their “diagnosis” and here I was feeling terrible for trying to give myself my best possible life.
Sometimes, years later, I still find myself feeling guilty that I left vulnerable patients to the vagaries of our dysfunctional American health care system. I remember the difficulty they have paying for chemotherapy and getting rehabilitation services, and in having to travel ridiculous distances to come see me due to a lack of local clinicians. I remember the pain and suffering that their diseases have caused them. In those moments I remind myself that I am only one person, that I did the best of what I could do, and that I am not irreplaceable. Case in point, my position was not filled for quite a long time, presumably due to difficulty in recruiting someone to fill it. Various parties contacted me about taking the job and in a fit of guilt, I reached out and offered to fill in despite not really desiring to re-engage. Almost immediately I realized that the egotistical belief that I was duty-bound to serve those patients speaks to several major logical fallacies.
1) The False Dichotomy Fallacy: The modern conception that physicians are either all in or failing to meet their commitment to the oath fails to acknowledge the destructive effects of the health care system. Physicians working part-time, moving to concierge care, taking low paying jobs — these all honor the oath. Administrative pressures that fail to recognize that some people will function optimally in less profitable and less hierarchical structures will continue to burn out their talent.
2) The Ad Hominem Fallacy: There is a notion that physicians who leave the organization or the field are failures, weak, dangerous, difficult, or whatever pejorative explanation is provided. This serves to villainize the very people patients need to turn to for their health care. When physicians have left my former institution they are “disappeared” to patients and colleagues. If physicians worry about being cast as the enemy, they cannot make a choice for themselves that allows them to do their best work.
3) Sunk Cost Fallacy: The argument that a physician has invested years and accumulated debt to become a physician does not equate to a societal or institutional contract to provide a service at the expense of their own health.
4) Appeal to Authority Fallacy: Just because one's mentors, chair/s, and parents felt that a physician should be a physician at all costs does not make it so. Young physicians taking a stand to preserve their work-life balance may well be the catalysts to a more humane profession. I have worked at institutions that accepted physician suicide as a cost of doing business, rather than a wake-up call that the culture was seriously disordered. The hierarchy can and should be challenged.
Most people I know went into medicine to help others. We are trained to take responsibility for delivering care to others, often at the expense of ourselves, and leaving the profession at a time of turmoil and dysfunction can feel like quitting. When it is time to leave, my suggestion is to tell yourself that you are doing or did your best, you are only human, and that there are more ways for you to help others in this world than the one role in medicine. Consider volunteering for roles in your community that benefit others, but that offer alternative remuneration or leadership opportunities. You will be surprised at how fulfilling it is to do good without thinking about compensation and prestige. Although it isn't the highly specialized medicine I did before, I am able to scratch the itch of wanting to help patients by serving on a volunteer ski patrol and working at the local food shelf. And one of these days, I will stop beating myself up for choosing to look after myself first.
Dr. Kunschner is a recently retired former academic neurologist and neurooncologist who practiced at Allegheny General Hospital in Pittsburgh, PA and at Dartmouth Hitchcock Medical Center in Lebanon, NH. Dr. Kunschner directed the Neurology residency at Dartmouth Hitchcock for 10 years, and served as Assistant Dean for Student Affairs, Diversity, Equity and Inclusion at Drexel University School of Medicine. She is not currently employed as a physician and can be found on LinkedIn and Instagram @Lara_Ronan_fineart.
Illustration by April Brust
