When Your Job Can’t Be Made Sustainable: Is It Time to Change the Way You Practice?

What happens when you still love medicine - but the way you are practicing it is no longer sustainable?

In this episode of Navigating Possibility, I’m talking about a difficult situation that comes up for many physicians: recognizing that a particular job, schedule, or practice model is taking a toll on your health, while also knowing that changing it may affect your colleagues, your patients, and the organization you work for.

I recently came across a conversation among physicians about an OB/GYN who was struggling with overnight obstetric call and the significant impact of sleep deprivation on her mental health. She wanted to continue practicing medicine, but she was questioning whether she could continue practicing this way.

And that distinction matters.

Because sometimes the question isn't:

"Do I want to practice medicine anymore?"

It's:

"Do I want to practice medicine this way anymore?"

Those are two very different questions - and they can have very different answers.

In this episode, we talk about:

What happens when your current practice model is no longer sustainable
The tension between advocating for yourself and recognizing the impact your needs may have on your colleagues
Why physician burnout can't always be solved at the individual level
The difference between personal responsibility and personal blame
Why health systems need to look at the way work is designed - not just tell physicians to become more resilient
Creative alternatives to the traditional "stay or quit" binary
How to think about schedule changes, different practice models, compensation for additional call, lower-volume environments, and other possibilities
When it's time to stop trying to convince your current organization to change
Why you don't have to wait until you're completely burned out to start making changes
The difference between leaving medicine and leaving a version of medicine that no longer works for you

A surprising finding about women physicians

We also talk about research published in JAMA Internal Medicine examining mortality among more than 3.6 million U.S. workers ages 25–74.

One of the study's most striking findings was that women working in high-income, non-healthcare occupations had a substantial mortality advantage compared with men in those occupations. Among physicians, however, that female survival advantage essentially disappeared.

The study doesn't tell us why - and it doesn't establish that burnout, sleep deprivation, or the healthcare system caused this difference.

But it raises an important question:

What are we asking women physicians to sacrifice in order to succeed in medicine?

And what might happen if we stopped treating those sacrifices as simply the price of being a physician?

The question I want you to consider

If you're struggling in your current career, I don't want you to automatically assume that the only choices are:

Stay miserable.

Leave medicine.

There is a lot of territory in between.

Maybe you need a different schedule.

Maybe you need different boundaries.

Maybe you need to renegotiate your role.

Maybe you need a different practice environment.

Maybe you need to stop taking call.

Maybe you need to move from full-scope practice to a narrower clinical focus.

Maybe you need to leave your organization.

Or maybe, ultimately, you do need to leave medicine.

But before you make that decision, it can be incredibly valuable to ask:

What would medicine have to look like for me to want to stay?

That question opens up possibilities that can be difficult to see when you're exhausted and overwhelmed.

A reminder

Your colleagues' needs matter.

Your patients' needs matter.

And your needs matter, too.

You can take responsibility for your career without taking responsibility for fixing an entire broken system.

And you can recognize that your organization may have legitimate constraints without deciding that you have to sacrifice your health to accommodate them.

Sometimes the answer is to negotiate.

Sometimes it's to adapt.

And sometimes the most important information you can get is discovering that the environment you're in simply isn't capable of giving you what you need.

That doesn't mean you've failed.

It may mean you've learned something important about what comes next.

If you're at a career crossroads

If you're a woman physician wondering whether you should stay, go, or find a completely different way to practice, this is exactly the kind of work I do with clients.

My 1:1 coaching helps women physicians get out of the "I can't do this anymore" spiral and into a more intentional process of figuring out what they actually want - and what is realistically possible.

You don't necessarily need to decide whether you're staying or leaving today.

You may just need some space to explore the possibilities.

Schedule a free introductory consultation

Resources

Study discussed in this episode:

Mortality Among US Physicians and Other Health Care Workers, published in JAMA Internal Medicine.

Read the study →

Key takeaway

You may not need to leave medicine.

You may need to leave the version of medicine that is hurting you.

And sometimes the most important career question isn't:

"Should I stay or should I go?"