The First Route of Medical Departure

Leaving a life in medicine can sound a little like smoking cessation. Whether at the beginning, or the end, of a career, there are really just three approaches: you can quit “cold turkey” (completely pull the plug); “wean down” (ease out by working part-time); or use “replacement therapy” (by finding non-clinical work to partly or completely replace your medical career). They all work. So which one is best for you? Well, it depends.

Leaving medicine cold turkey.

So let’s start with the easy-to-understand clean break from your medical habit–leaving “cold turkey”–the one-step transition from your regular clinical routine, to resigning from your hospital affiliation, giving up your office and patients, and giving up your medical license. Most physicians do not choose this path by choice (it is too scary!), perhaps intimidated at least in part because of its finality (it is usually an irreversible step), and the uncertainty of the expected void that follows it. For many, it seems easier to “ease my way out of it.” More on this later.

However, for those that take this absolute and definitive plunge, their decision has to start with a pretty clear and sustained feeling that the party is finally over, and is based on a thorough and frank review of the risks and benefits taking this step. The minuses outweigh the pluses of staying, most uncertainties have been laid to rest, and that to ease your way out at this point would somehow be more painful. Breaking up is hard to do, especially for such a long term and meaningful relationship; but it can be done, and it can be the right thing to do, especially if “just hanging in there” indefinitely no longer feels like a goal.

The mechanics of leaving–easy.

The mechanics of such a step are pretty straight forward: set a date of your departure, let your hospital, colleagues, and staff know with appropriate notice, and hand in (or not renew) your medical license with an explanatory note. You may need to redirect your patients somewhere and/or find a buyer for your practice; you will need to arrange and secure longterm protection for your medical records, and create a process to deal with incoming medical mail that will continue to appear months, and even years after you leave. There may be some College and registration issues that include eliminating all references to the word “doctor” in your professional company name once you are unlicensed. And you will likely find yourself explaining your rationale to surprised colleagues and co-workers many times, even brushing off rumors that you might have some kind of terminal disease. Otherwise though, this is the easy part.

The internal dialogue to walk away–difficult.

What perceptions compel a doctor to break off a career they have so deeply invested in? Here are a few personal narratives that physician retirement-contemplators have that commonly surface after a couple of decades of clinical work (they have also been embraced at any stage of a career). The more of these that resonate, the more clear will be the decision to quit medicine–the doctor’s exit (“Drexit“?!) arguments:

Why it is time to go

I feel like I have nothing left to give, my empathy is all but gone, and “I cannot go one more day”;

I am chronically tired and sleep-deprived, I have done my bit, I have given my all to my community and to my patients, and it is time for someone younger to take over;

There is now no joy left in Mudville–the time pressures and burdens of my work now routinely outweigh the satisfaction–it has become noticeably more stressful, more litigious, more bureaucratic, more chaotic, and more technically demanding;

I am practicing defensively with every patient I see, more worried about making a mistake, and I can no longer keep up to my ongoing obligation to maintain continuing medical education, the technology of medical information systems, and the constant changes in the pharmacopiea. 

I am exposed to too much suffering and death that I cannot help–it is a wearing, psychological burden that continues to grow, some of which I am being unfairly blamed for;

I am not having fun, I am no longer learning or growing, and I am losing tolerance to patient’s continuing unrealistic expectations of both me and the profession;

I am no longer under any illusions that I am irreplaceable;

I am worried about impending personal health or family issues looming larger than before, and I now need to clearly prioritize me and my family’s needs over the demands of medicine.

I have already outlived some of my colleagues, many of whom never spent any quality time for themselve–the writing is on the wall for me;

Many of my medical friends and colleagues have retired or moved on, and I am feeling less connected to the newer hospital staff;

The altruistic desires that drove me to become a doctor have eroded, leaving only a drive to make money–the missionary in me has become a mercenary;

My financial managers have reassured me that I have enough to retire on, and therefore do not need the office cashflow.

Now that I am getting older, I still want some quality time for other life goals, including travel and reconnecting with my growing family while I still have the health and vitality to enjoy them.

The dialogue to remain–also difficult.

However, you may have some conflicting messages also echoing through your head, to remain in your career, to stay the course; these are headwinds that can impair you with ambivalence in your decision-making as you contemplate retirement.

Parenthetically, the process of intentional behaviour change–first introduced in 1983 as “The Stages of Change”— identifies this ambivalence as the “Contemplative Stage”; it is when an individual weighs strong arguments on both sides of a decision (such as quitting smoking or, in this case, retiring), prompting the ambivalence. And as long as these countering arguments have purchase, definitive decision-making is impaired, at least, until they can be somehow discredited or devalued. Ambivalence equals inertia–the status quo is preserved–and you will do nothing.

Not ready to go.

The (“Remain”) arguments–to continue with your career–can be equally pursuasive. Perhaps you will also recognize some of these thoughts in your process of contemplating retirement:

I get a strong feeling of importance and usefulness in my medical career that I may struggle with finding elsewhere, and I foresee this will be important to me going forward. So I may regret leaving.

I have spent my whole adult life training and the refining my skills as a physician–but am I ready drop it all, to walk away from all my training and hard-won experience, what is so valuable to the community, and for which I am so deeply invested, even defined by?

I may get lonely or bored with long hours at home, without much need for medical discussions, and without contact with my colleagues and long time associates.

I don’t really have any hobbies or interests to fill my time if I completely leave medicine. What would I do with myself? Is there anything out there that is as enjoyable, stimulating and meaningful as my medical career? I am never going to be a golfer!

I worry that I may find myself in accelerated physical or intellectual decline if I leave medicine.

I still like certain aspects of what I do, and am not ready to give that up, since it took me many years to get to these medical niches and access to these kinds of patients.

I enjoy and even thrive on the respect I get for the role(s) I play in the medical community I am in. Will my sense of identity be undermined by leaving medicine?

Will my family or friends think less of me or be disappointed in me if I leave medicine? Will such a decision initiate family worry over finances, the need to sell our house, or move?

I worry that being home all the time might even become a stress to our marriage, since we have not usually been in the house together for extended periods up to now.

I think it would be better if my spouse and I retire at the same time, so that we could continue to be on the same page for our immediate and future plans. This is a conversation we have not had yet, since I am still not sure I am ready to retire.

I am still not that old, I still have gas in the tank, and I can still contribute my unique skills to the community’s cause.

Despite assurances from my financial advisors, I am still hesitant to pull the plug on my medical income, since there are so many uncertainties that could come up that require more money than expected.

Since quitting medicine, and not renewing a medical license is almost an irreversible step (given the hoops you would have to jump through if you wanted to return), I would have to be more than just “pretty sure” about quitting cold turkey.

Am I really that unhappy in medicine–am I just whining and overstating my unhappiness? Most of my colleagues are hanging in. And there are few jobs that offer as much challenge and diversity, much less as good a pay scale.  I  might regret leaving.

There are almost certainly many more variations of these. When you ask yourself these, are some holding you back? How ambivalent are you about quitting? What do you still have to resolve to make it happen? This is the first battleground on the path to a successful retirement.

Should you get past this, as you lose your ambivalence and become determined to retire, what happens next? Will it be easy street and singing in the rain? In the next post, I will review some of the unexpected “withdrawal symptoms” that physicians may have to suffer through when they leave their profession completely.