In early 2019, I made a job change — from my first job at a small, private nephrology practice, into working in the pulmonary department at a large hospital system. Though it was hard to leave that first job, I was going to be working with people that I knew and respected from my time working as a staff nurse years ago, and was going to have a more stable schedule. I was eager for the opportunity to learn about something completely different. I didn’t think much about my happiness because I thought that would come in time. And happiness did eventually come, but it took a lot of despair and another job change before I found it.
I knew pulmonary would be a challenging field, but I did not anticipate all of the knowledge from other areas of medicine that I would need to pull from. In all honesty, I plowed right into it. It would be a lot of asthma and COPD — things that I saw a lot in primary care and thought I would be able to handle. I was not prepared for all of the gray areas outside of these differentials. I did not have much experience with interstitial lung disease and had at that point in my career never read a path report to a patient. It did not occur to me that I would be diagnosing patients with lung cancer.
It was quickly clear to me that what I was in for was quite different than what I had anticipated. I had a lot more autonomy than I had expected, which in itself is not a bad thing. Yet as a new nurse practitioner, much less someone new to a specialty, I felt unmoored. I felt helpless as the list of patients I wanted to review with my staff grew longer, and as COVID-19 evolved and spread throughout the rest of 2020, I had less and less contact with my staff doctors.
The helplessness I felt was likely compounded by the stress of discovering that pulmonary was not where I belonged. It wasn’t that I didn’t like pulmonary as a specialty. I did. I just never felt like it was a right fit. Whether it was my own frustration at the limited treatment modalities available or the palpable despair that filled most of the exam rooms, I’m not sure. I became very angry at myself because I could not ascend the steep learning curve of pulmonology without support from my staff physicians, who had no time to spare not because they were unfriendly, but because of COVID-19.
Thoughts of quitting health care entirely filled my head. I was devastated. I spent most of my days feeling like Sisyphus, just trying to push my rock to the end of the day. Sometimes, I was able to spend a couple of seconds feeling mildly accomplished, having felt like I had been able to apply my knowledge and help a patient. But those feelings were fleeting, and fueled by the void that COVID-19 created, I knew something had to change for me.
If it were not for the pandemic, I might still be in pulmonary, and maybe I would have been able to carve a niche for myself. While I do not think that the pandemic alone is responsible for my unhappiness, it sure showed me how frail happiness at work can be. And as someone who will be working for several more decades (hopefully), I knew I owed it to myself to find my place. I found my way into cardiology and although the learning curve is still steep, I have no regrets. I think I have finally found a place where I am challenged, but not to the point of nervous collapse.
It is really hard to know what your job will be like until you get into the thick of it. Sometimes things work well for years and then the change starts to occur. In my case, I knew I was pushing harder than normal to make it work, and after everything that had happened over the last two years, I realized that being happy at work was a requisite worth considering. Schedules, pay structure, RVUs, and bonuses are all crucial to picking a job — yet dare I say that it is worthwhile to put your happiness near the top of the list? I wish I had realized it sooner. My unhappiness stymied my growth and it wasn’t until I was working another job in another specialty that I found I could look back on my time in pulmonary and see that I actually did learn a lot. I took a ton of knowledge with me into my new role, and although this has admittedly not been the most efficient way to grow as a provider, I think the experience did make me better at what I do.
So what is the nugget of advice that you will take away from this piece? Health care on its best day can be a total mess, and you deserve to find a place where you are acknowledged and valued. It is not a luxury — I think it is as important to patient care as our training is. It is not always possible to know how a field will feel with just a clinical rotation. Sometimes you have to get all the way into the thick of it to really know. And although my opinion may not be popular with recruiters, it is OK to admit when a specialty is not working, and it is more than OK to keep looking for a better fit. We all deserve to be happy with our work.
Share your expectations versus reality of a specialty in the comments.
Blythe is a cardiology NP in the greater New Orleans area. Her special interests include improving social determinants of health in underserved communities and prevention of lateral violence in health care. She is a devoted mother, enjoying sewing and gardening in her spare time. She is a 2021–2022 Doximity Op-Med Fellow.
Illustration by April Brust
