The Guilt of Quitting as a Doctor and Overcoming Burnout

One doctor’s perspective on the importance of knowing when to make a change

I sent a tweet to my surgeon brother today. It pointed out the stress being faced every day by pediatric ER physicians during this unprecedented RSV, Flu and COVID season. Knowing I recently made a career change from the adult ER/urgent care environment, he asked me “do you feel guilty your friends are working hard and you are living the good life?” This got me to thinking about guilt and burnout in medicine. But first I think it is important to understand my journey to this career path.

I knew in high school that I wanted to become a physician. My brother was going through training at the time, and while I knew that surgery was not for me, I wanted to try to help people. My pursuit to become a physician had begun.

First I had to do well in college, which I did. I remember skipping parties and much of the “college experience” at a major state university in order to get into medical school. I worked my butt off studying as a double major in history and microbiology, worked in a lab to try to get published (almost a necessity to get into med school), tutored, and worked as an EMT for 3 years.

Despite also doing well on the MCATs, I did not get into medical school the first time I applied. I only applied to US MD programs because I thought “I got this.” But the truth is that the environment has always been extremely competitive and many highly qualified, smart applicants have to go to foreign schools. After college I decided to get an MPH instead of going to a post baccalaureate programs where you take med school classes so you then can show you have a good GPA when you reapply. I wanted to gain knowledge, not just learn the same thing twice.

While getting my degree, I was actually happy to be learning! Crazy notion right? I loved my history courses in college (I was a double major in microbiology and history) because I got to read and learn new things, but my science classes almost felt like a “must do” to get into med school (this is not entirely true as you only need pre-requisites but most pre-med students choose a science major). I got bored quickly in many of them. But during my program in public health, I was able to work with urban gardens in Philadelphia, creating an evaluation system for kids and adults on how urban gardens affected health and social capital if food deserts. I loved it. After getting into medical school at the Philadelphia College of Osteopathic Medicine, I decided to pursue family medicine based on the experiences I had working with communities in those gardens. I wanted to have relationships with my patients to help them not only treat disease, but to prevent disease.

I trained in Baltimore for residency and, while it was extremely stressful, I was well supported by amazing teachers and mentors. When my dad became ill and eventually passed away during my training, everyone helped me and gave me the time off I needed. I am forever grateful for my education and experience there.

After training, I decided I wanted more action so I decided to work in an urgent care/acute care setting (essentially way more advanced than urgent care with imaging modalities like MRI/CT with all specialists like an ER but just one step down as we were not attached to a hospital). From 2018 until 2020, the job was as expected. It was stressful at times, but with plenty of days off in a shift work lifestyle. I had no work to take home. I was good at the job and enjoyed fixing issues for patients or ruling out emergencies.

Things changed with COVID. Like many medical systems, in the beginning of the pandemic, everything shut down except for our department. As a “healthy” physician with no major medical concerns when we knew so little about COVID, I was one of the doctors tasked with working in a screening trailer. Donned in a hazard suit, with a P100 face-mask in a negative pressure trailer, I had to triage patients into our facility. Wait times stacked up, many sick COVID patients filled our rooms. All other disease processes seemed to vanish as patients were too frightened to seek care for fear of exposure. My fiancée (now wife) has an autoimmune condition so I was careful to wear layers, strip at our apartment door, drop clothes into the washer and shower immediately. I hated those 3 am showers but they were necessary. And so it went on until the vaccine became available.

I felt safer at work. I felt better about visiting my mom. Work became better for a few months as there was a transition where people stayed home but were vaccinated and felt safe. Sick patients with disease processes we hadn’t been seeing since the peak of the pandemic, started to come back in.

Then came the COVID surges. I remember July of 2021 vividly. The volumes were crazy. We had about 19 rooms and about 50–60 patients at a time in our facility. Now we were seeing sick patients and “worried well” patients which were ones that were worried they had COVID or some other issue that was not urgent or emergent. This seemed to get worse over time especially since specialties like family medicine and pediatrics would not see patients with fevers or COVID symptoms. The mix of dealing with ill and well patients was very hard not only due to volume but also due to the emotional factors involved in caring for so many people in so many different medical situations. The facility where I worked did not have PAs who often see less acute patients in the ER setting. It seemed, again, everything fell on my department. Burnout was peaking its head.

Then doctors started to leave because the stress was weighing on their health and interfering with the lives of their families. We became shorter and shorter staffed, as was the case across the country with COVID. Hospitals lost money due to decreased profits, could not pay bonuses, and in many cases had to decrease salaries for all physicians. I was lucky I worked for an organization that did not cut my pay, but the weight of the increased workload became more noticeable. My sleep worsened. I was anxious before every shift. I started to become angry when I had to go to work.

Compassion fatigue is a form of burnout where “a deep physical, emotional and spiritual exhaustion is accompanied by acute emotional pain. Whereas physicians with burnout adapt to their exhaustion by becoming less empathetic and more withdrawn, compassion-fatigued physicians continue to give themselves fully to their patients, finding it difficult to maintain a healthy balance of empathy and objectivity. Those who have experienced compassion fatigue describe it as being sucked into a vortex that pulls them slowly downward. They have no idea how to stop the downward spiral, so they do what they've done since medical school: They work harder and continue to give to others until they're completely tapped out (AAFP)”

I truly cared for each patient I took responsibility over like they were my family, because I would want the same if my loved ones were in a similar, vulnerable situation. However, burnout started hanging around me more frequently.

After another year of similar feelings, I decided to make a change. And when I say “I decided” I mean my wife finally talked sense into me after seeing my misery and stress for too long. I was lucky to have found a less stressful job. I changed to a better schedule and while I plan to go back part time, I needed some time away. But why did this decision take so long? I recently posed the same question to a friend who left intensive care for similar reasons. It also took him a long time even after identifying the mental and physical strain on him and his loved ones. He responded:

“Fear of the unknown, worry about what others will think, survivor guilt on getting out and leaving colleagues behind to pick up the slack. Also, not recognizing the power of self-worth or the doors that are opened to us because of our degrees. Lastly, the lack of awareness that self-sacrifice is not the norm for most people in society.”

On the question from my brother, I started thinking about self sacrifice and guilt. It stinks that they go hand in hand for doctors who just want to help people. I am infinitely happier and less stressed now that I made a change in career, but guilt still sets in at times.

I answered the question. “I used to. I feel bad for my colleagues working hard to serve their communities while they are understaffed and I know I can sacrifice a weekend day (now that I have weekends to myself for the first time in my life since college) to help. At the same time, I feel bad for patients just seeking care in a system that was never prepared for COVID and its consequences. However, being miserable and living a shorter unhealthier life as a result of quelling guilt, is not worth it. If you love what you do, keep doing it because we all search for that. The stress is worth it when it is overshadowed by happiness and a sense of purpose. Anyone stuck in a job, whether it be medicine or any other profession, that makes them miserable day by day, needs to change their situation.”

It took me a long time to figure that out because of how hard I worked to get to where I am. Was the sacrifice worth it? Should I have chosen a different path? Ultimately, I have no regrets. Being a physician and accomplishing all that I did to get to where I am has taught me many lessons. I still love teaching patients and helping anyone I can with complicated medical questions or issues (I still receive many texts from family and friends for such advice).

We are always taught in medicine to first take care of ourselves, before the patient, however medical training and the profession itself is far from that reality. Often we as physicians must sacrifice our own health in order to function in the medical system and keep up with demand. This is especially true for emergency medicine and primary care specialties. And although I have not quit medicine, putting a focus on myself, my health, and the time I have with loved ones, has become the most important thing. The definition of guilt implies wrongdoing, and nothing can be further from the truth when we all have one life to live. We must enjoy every day because it is a gift to be healthy and alive. Do good things. Help others. Live and enjoy life. Forget the guilt.

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Reference: “Overcoming Compassion Fatigue” https://www.aafp.org/pubs/fpm/issues/2000/0400/p39.html