A message to medical doctors who are unhappy with their careers [PODCAST]

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“This is a message to any medical doctor who is unhappy with their career. The individual reasons for this dissatisfaction will vary. Whatever the issue, it is important to ask, ‘Is the problem correctable?’ If yes, then you must act and secure your happiness. If no, you must consider other options. One uncomplicated choice is to stay in medicine and practice somewhere else. However, you may also be unhappy in your career because you don’t like medicine. Maybe you are burnt out or no longer feel challenged. Then again, maybe you just don’t want to do it anymore or explain (for the 7,000th time) why a patient doesn’t need antibiotics. This means your options are now down to pursuing a nonclinical medical career or leaving medicine altogether. Regardless, if you don’t like clinical medicine, then why are you still doing it? Perhaps reality is teaching you a lesson: that once you’re in medicine, it’s hard to leave it. This begs the question: Why is medicine so hard to quit?”

Elijah Sadaphal is an emergency physician.

He shares his story and discusses his KevinMD article, “Why quitting medicine is hard.”

This episode is sponsored by the Substance Use Disorder Treatment and Recovery Loan Repayment Program. Would you like to help communities recover from the opioid epidemic? If you said yes, and you are a behavioral health professional or paraprofessional, then I have great news for you. Receive up to $250,000 in student loan repayment in exchange for service in a community disproportionately affected by the opioid crisis. Learn more and apply to join STAR LRP, the Substance Use Disorder Treatment and Recovery Loan Repayment Program. Applications close on July 22.

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Hosted by Kevin Pho, MD, The Podcast by KevinMD shares the stories of the many who intersect with our health care system but are rarely heard from.

Transcript

Kevin Pho: Hi, and welcome to the show, where we share the stories of the many who intersect with our health care system but are rarely heard from. My name is Kevin Pho, founder and editor of KevinMD. Today on the show, we have Elijah Sadaphal. He is an emergency physician, and he wrote the KevinMD article “Why quitting medicine is hard.” Elijah, welcome to the show.

Elijah Sadaphal: Pleasure to be here. Thanks for having me.

Kevin Pho: So we’ll get into your article in a little bit, but first off, can you share your story and journey to where you are today?

Elijah Sadaphal: Yes. So I finished my residency in emergency medicine in Philadelphia 16 years ago. I then moved immediately to the greater New York area and worked in the emergency room for seven years before I transitioned to urgent care full time, and that’s where I’ve been working for the last eight years.

Kevin Pho: All right. So as an urgent care physician, tell me some of the challenges facing urgent care today.

Elijah Sadaphal: Well, it’s an interesting question to answer, because what we’ve noticed in the last year is that, essentially, urgent care in a large part of the five boroughs of New York City has now become the front door to medicine in general. And I say that because there are a lot of barriers to entry for many patients getting in to see their doctor, whether it’s delay or getting a negative COVID test before they’re seen. So in a lot of areas where my group works, we are that first doc. So if you haven’t had a physical in three years or your blood pressure checked, urgent care ends up being the first place where patients come to get to see a doctor.

Kevin Pho: And tell me some typical cases that you’re seeing now. We’re speaking in the middle to end of June, so what are some typical cases that you’re seeing now in urgent care?

Elijah Sadaphal: Roughly 40 percent of the patients that we see is now just straight COVID testing, either to attend a game, a graduation, or to travel. Maybe 20 to 30 percent is going to be URIs and allergies, and the rest is going to be routine physicals, STD testing, sore throats, and colds.

Kevin Pho: What is the proportion of urgent cares that are staffed by emergency physicians? Because around where I am, a lot of urgent cares are being staffed by advanced practice practitioners, physician assistants and nurse practitioners. So in general, what are some of the trends regarding urgent cares being staffed by emergency physicians?

Elijah Sadaphal: In general, based on my own personal experience, the demand to have exclusive emergency physicians has gone way down. In the group for which I work, for example, I would say roughly there’s a 60-40 split between emergency docs and family practitioners, and then you also have, you know, PAs and NPs who also fall under the same banner.

Kevin Pho: All right, so let’s transition into the KevinMD article that you wrote. It’s titled “Why quitting medicine is hard.” Now, for those who didn’t get a chance to read that article, can you just walk my audience through it and share the story of why you decided to write it?

Elijah Sadaphal: The basic gist of the article is that it addresses the psychological difficulty many physicians may have where they are contemplating and considering a career in non-clinical medicine. But because there’s such a great barrier to get into medicine, many feel paralyzed in thinking, “There’s no way I could ever leave.” They may lose their academic position, they may lose their paycheck, et cetera. So the article basically encourages clinicians to say, “Hey, this is not only possible, but it’s actually very doable.” And the barriers that many providers may think are insurmountable actually aren’t that much.

Kevin Pho: What are some of the perceived barriers that you talk about in your article that physicians may face when you’re thinking about leaving clinical medicine?

Elijah Sadaphal: So one barrier may be that there seems to be a stigma that many providers face, that they would be, quote-unquote, “selling out” or abandoning their patients if they moved out of the office into a non-clinical setting, which in reality isn’t true. The world of non-clinical medicine is exceedingly broad.

Here’s a concrete example. We live in a day and age where, you know, anyone could Google any symptom and get 25 different answers, and the amount of disinformation and misinformation is overflowing. So one avenue a clinician could go into is basically being an educator or a teacher and providing, you know, resources online where patients can get reliable, trustworthy medical advice about what it is they’re going through. So you’re still helping patients; it’s just in a different context.

Kevin Pho: And from your experience and from talking to your colleagues, what are some reasons physicians have for potentially leaving clinical medicine?

Elijah Sadaphal: Some people are frustrated, and definitely in urgent care in New York, since many people in our position bore the brunt of the first wave of the pandemic over the past year, a lot of people are just spent and psychologically frustrated, and they’re now going on fumes. So it may just be a therapeutic change of scenery, or people wanting a new intellectual challenge to take the next step in their career.

Kevin Pho: And you mentioned being an educator as one avenue outside of clinical medicine. What are some other examples of avenues outside of clinical medicine that some physicians may pursue?

Elijah Sadaphal: You could write content on social media, or you could also write content for urgent care. So if patients were coming to your urgent care site and were seeking general information articles on a sore throat or a cough, you could be the individual that writes information. You could also be a regulatory writer, someone who writes proposals to the federal authorities to get approval for a new drug, or even do needs assessments, where you’re basically looking for people to sponsor CME activities.

Kevin Pho: And where can physicians find some of these opportunities?

Elijah Sadaphal: A great place to start, and this is the company that I use, is called SEAK, S-E-A-K. So if you were to Google “SEAK non-clinical careers,” they basically have a host of courses and programs you can take, where there are other providers who have made that transition from clinical to non-clinical medicine, and they have a lot of valuable resources.

Kevin Pho: Now, before a physician considers leaving clinical medicine, what are some steps in between? Should they be seeking help to find reasons why they could stay in clinical medicine, or should they be seeking other support services before they leave clinical medicine entirely?

Elijah Sadaphal: Oh, of course. I mean, it’s far, considering the amount of education and training, you know, any provider has to go through. The path of least resistance is to stay. So the first question someone should ask, if there’s a barrier between where they are and them being happy, the first question to ask is, is the problem correctable? And if the problem is, there is no dilemma; they basically remain where they are.

But the two biggest things that I think someone needs to do are to get in touch with a mentor, someone who’s actually made the transition, and always make sure they’re transitioning to something and not merely escaping from something. Because if you’re merely escaping from something, then you’re not actually going to make any actionable forward progress.

Kevin Pho: Now, from your experience, are you seeing a lot of physicians leave clinical medicine 100 percent, or are they doing perhaps a 50-50 split, where they do some shifts in whatever clinical setting they’re in and the other 50 percent are doing non-clinical endeavors?

Elijah Sadaphal: Usually, from what I’ve seen, the transition is always gradual, only because, with rare exceptions, the income a provider would make in a non-clinical career would be less than a clinical one. So they would begin at maybe 95/5 clinical/non-clinical, and then over a period of six to 18 months, wean down one while they increase the other.

Kevin Pho: So I talked to a lot of physicians on this podcast, and a lot of physicians write on my blog about physician burnout and about moral injury, and it’s not just in urgent care but in primary care and in pretty much every specialty as well. Now, take me through the thought process of that physician who is considering a career outside of clinical medicine. Tell me the questions they should be asking themselves. And you did mention SEAK as one place, but walk me through the workflow that they should be undergoing.

Elijah Sadaphal: So there’s a great book. The author’s name escapes me, but the title of the book is “Did I Waste All That Training?” And essentially, there’s a five-step process: It’s introspection, exploration, networking, preparation, and acquisition. In that five-step process, the number one thing any provider has to spend time on is introspection, where they have to ask themselves why. Start with why: Why am I unhappy where I am? Why do I want to change? What do I expect, and where do I want to go?

And essentially, it’s making a concrete list of the things that you like and dislike about where you are now, and then writing down as well what would be your ideal job. What is it you want the most? And then you evaluate: Is where you are now matching your ideal? And then consider how your ideal would more closely align with your goals. So you begin with earnest introspection and consider not only where you are but why you want to go where you want to go.

Kevin Pho: And from your experience and from the people that you talk to, has anyone regretted leaving clinical medicine?

Elijah Sadaphal: It’s funny you ask, because one of the individuals that mentored me, when she made her initial switch, she began going into being a lecturer and, you know, being a speaker all across the country, and she actually found out she hated it. And it’s from that dislike of doing that that she then tried something new and then discovered medical writing. So on the one hand, there are a handful of people who originally disliked what they went into, but that’s the beauty of keeping your options open and not having tunnel vision about the thing I’m going to do with XYZ, because you won’t know till you try it.

Kevin Pho: We’re talking to Elijah Sadaphal. He’s an emergency physician, and he wrote the KevinMD article “Why quitting medicine is hard.” Elijah, you mentioned the stigma about some physicians leaving clinical medicine, and there’s a perception that doctors who don’t see patients are not considered, in quotations, “real doctors.” I was wondering if you could comment on that. What’s your response to people who think doctors who don’t see patients, who seek careers outside of clinical medicine, who proverbially sell out, aren’t considered real physicians?

Elijah Sadaphal: Yeah, I think when we all took the oath to do no harm, that oath didn’t only apply to, you know, having a white coat and a stethoscope on and seeing people in the hospital or the office. In the interest of patients, how we help them as doctors is very, very broad. One person can be in the research lab, one person in the operating room, one person in urgent care, and one person could be, you know, behind their desk writing a book. So the goal isn’t really us. The goal is to help people, to educate them, to empower them, and to essentially expand not only their lives but also their health. And when you think about it that way, you know, we’re all members of a body, and each, you know, organ does a different thing.

Kevin Pho: And my final question: What’s your take-home message that you want to leave with the KevinMD audience?

Elijah Sadaphal: That for any provider, any physician who’s contemplating a non-clinical career, it is very doable. It is very accessible, and there are already thousands and thousands of people doing it. So if you so choose, the first thing to do is to introspect and then begin exploring.

Kevin Pho: Elijah, thank you so much for sharing your time and insight, and thanks again for being on the show.

Elijah Sadaphal: Thank you, Kevin. My pleasure.

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