Seven Reasons Why I Quit Clinical Practice to Become a Physician Executive

Two years ago, I decided to make a major change in my life, one that drew gasps of horror from many. I resigned from a faculty position at a prestigious internationally renowned university and accepted a telecommute position at a notorious health insurance company. The disappointment that this move generated among my friends and family was amusing to me. I felt a bit irritated at the same time – it was my life after all and I could do whatever I wanted. Yet, a red devil lurked somewhere in the vicinity of the grey cells in my brain mocking me for my decision. You sold your soul. You went to the dark side. You are the medical Darth Vader. You will die a painful death.

Well, maybe not the last one! I must say though, that I have never regretted it since then. After three decades spent in trying to understand the physiological nuances of the human body, the pathological processes that give rise to disease, and the remedies that cure or mitigate these disorders, I simply gave up. When people ask me why, I never know how to succinctly answer that question – because it is impossible to express the rationale in a few words and sentences. So here I am documenting the 7 reasons why it felt right to pivot so radically in my career.

(1) I was physically tired. The constant demands of taking care of sick people day after day after day is bound to take a toll on the human body. More than two decades spent working 80-100 hours a week without proper sleep, regular meals, delaying ordinary physical needs like trips to the bathroom, lack of time or motivation to exercise, and existing in chronic exhaustion has long term consequences. I didn’t want to drop dead one day.

(2) I was losing my mind. Multi-tasking on all cylinders without any reasonable breaks and trying to juggle exams, work, family and social life put me in a constant catch-up mode. Never a day passed when I could safely say that I had completed all my commitments. The brain was forever churning out a to-do list that needed to be done. There was never enough time to take a deep breath and let the mind relax. The chemicals were undeniably deleted. I didn’t want to end up in a psychiatry ward.

(3) Regulations from administrators suffocated me. When did medicine become all about electronic health records, documentation, meaningful use, checking boxes, cut and paste, templates, approvals, denials, pre-authorizations, claims, billing, insurance coverage, codes, and endless medical policies? I wanted to take care of patients, not fulfill meaningless requirements that would allow me to do that. Existing in perpetual anxiety about processes and protocols was unbearable. I found myself trying to write the best possible progress note because it would be a surrogate for my expertise as a physician – a comprehensive note must mean that the author was an outstanding physician too, right? Wrong.

(4) I lost the joy of taking care of patients. The fundamental essence of medicine is the relationship between the two components that hold up the world of healthcare – the patient and the doctor. It is indeed the most rewarding piece of being a doctor. I remember the enthusiasm of curing patients at the start of my career. It was incredibly empowering to be able to heal a sick person and watch them go home without the disorder they sought care with me for. This relationship has been cruelly attacked by the sundry demands of the business that healthcare has become. Who cares about how we get along anymore? A patient has become just a case or an appointment or an admission or a discharge or a bed or a body. A doctor has become just a provider. A provider? Of what? Professionalism is taught in training programs as always being upright, distant, formal and polite. No one teaches the value of a profound bond with the patient that is often critical in the healing process. I didn’t want to become like the ubiquitous computers that we were forced to spend more time with than the patients – impassive, emotionless, cold, detached and indifferent. But I did, in a way.

(5) I never had time to do other things in my life like travel, read, be creative, take care of my parents, and do philanthropic work. My job took up so much of my time and energy that there was no inclination or motivation to indulge in activities outside of the home and work. In short, I was just existing, not living. I didn’t want to not be able to do these things forever.

(6) Caring for sick people constantly drained me of all emotion. I was so busy trying to resolve other people’s problems that I almost resented any time I had to give to my family or friends. It was just not as rewarding. The whoop of joy when a patient got better was a high bar – the whoop from a child’s grade or victory in sports or graduation or an adult’s career success or silver wedding anniversary or 40^th birthday was never the same. I started feeling mild contempt for regular folks trying to lead normal lives and seeking joy in ordinary things. They seemed to be celebrating mediocrity all the time. They would never know the real happiness that came from healing people. I now understand that it was a ridiculous feeling. I was letting my work spill uncontrollably into my personal life. I had become judgmental.

(7) I felt despondent about my future as a physician. I do not anticipate that things will get better overall in healthcare. We are never going back to the old style of patient care where doctors were sanctified, hallowed, and revered for their commitment, dignity, noble intent, and pristine goodness. Physicians all over the world have lost respect and instead struggle for daily existence. Much is the result of their own actions, at times unscrupulous, uncaring, callous, and dishonest. It is going to get worse before it gets better and I will be long gone by then. Now, I can somewhat sneakily say that I am not a part of this cohort and therefore I doesn’t matter to me. I have moved on.

At times it does feel like I have sold my soul by working in an industry that is traditionally considered a foe by clinicians. Like Darth Vader, I could become immune to the needs to anyone else but myself. But looking back at the last few years I do not regret it at all. I am happy and healthy and I look forward to a productive decade ahead of me. I am able to do all the things on my long bucket list. I travel and take care of my elderly parents.

I watch TV.

I exercise daily.

I play with the dog.

I sit on my bed for hours on weekends doing nothing.

I stare into space for long periods of time without causing any harm.

I meditate.

I take deep breaths.

I use the bathroom exactly when I need to.

I write for my blog.

I organize get togethers.

I do social work.

I sleep in peace.

I wake up in peace.

I rarely drive.

I take care of my skin and hair diligently.

I read books.

I go to the library.

I invite guests during the weekdays.

I stay up late.

I wake up late.

I never work on the weekends.

These may seem small things. Until you cannot do them. Then you realize small things are big things. I do big things now. Thank God I took the decision to take control. It was not easy but totally worthwhile.