Jennifer, an intern who I hung out with at our recent physician retreat, wanted my advice about quitting her residency. I told her to send me her pros & cons. Here’s her list—14 reasons to quit (& 17 to stay) plus my thoughts below.
14 reasons to quit residency
1. Usually have these feelings when I am extremely overwhelmed
2. To take care of me, physical, emotional, spiritually
3. Expand soul
4. To live in the highest love
5. To share my gifts with the world
6. Have become more angry, spiteful, sad, uninspired at times (but am ok when get good rest)
7. To travel with my family (can do this after 2 years)
8. No more abuse (but am closer to family/friends as I reach out and get help, breaks very useful)
9. Freedom
10. Much time spent not learning what I want to learn in intern year (but next year much better)
11. To deeply read material on my own and ask mentors questions when need help
12. Entrepreneurial spirit
13. Feel like I am pushing people away and becoming more distant when I am very overworked
14. Will be spending much less time with clinic patients and will learn bad habits, how much can I actually learn in this environment?
17 Reasons To Stay
1. Thoughts of leaving are out of fear, not a well-thought out decision
2. When I have a good break, I want to stay
3. To finish what I started
4. To not throw other residents under the bus
5. For experience, to learn
6. To have confidence in myself and my decisions
7. Difficult to get license in New York, may come across lots of obstacles
8. For board certification – opens up many doors, including being able to do locums work, various part-time jobs while trying to make ends meet while opening up clinic, taking some insurance
9. Can open up clinic without board certification, but future plans may change where I would like to do jobs that require it
10. Can mentor interns, I love to teach
11. My residency faculty/other residents treat me very well even though the workload is inhumane
12. Still have big vacation plans during residency
13. Don’t feel ready yet to start own practice – lots to learn
14. Second year residency much better
15. Various people that didn’t gain board certification said to do it if able to; it can be a large obstacle if don’t have this certification
16. Mental health is stable with good support and after breaks
17. Will be able to live in the highest love when done in 2 years if keep reaching out for help and taking care of myself as much as possible.
Quick video summary of issues to consider before quitting:
My Thoughts
1. Medical training IS exhausting and may be downright abusive. Though there are work-hour restrictions (ACGME cap of 28-hour shifts and 80-hour work weeks—still ridiculous & illegal in any other industry) residents share that these “caps” are not enforced and doctors-in-training may be forced to lie on their timecards (computer screen locks up and flags them if they log more than 80 hours and some are sent to psychiatrists and given psych meds for “ADHD” because they won’t process patients fast enough and lie on their time cards). By the way, I LOVED my residency program. There are good programs out there.
2. It IS very hard to care for yourself physically, emotionally, spiritually plus care for your patients with compassion and skill when you can’t poop, pee, sleep, eat, have sex, go on dates, see friends and family during 80+ hour work weeks immersed in human suffering and death. Consequently you may become angry, spiteful, sad, uninspired. That is a normal response to chronic physiologic distress.
3. Medical training may teach you bad habits you don’t want to learn such as it’s okay to treat sick people in 5-minute increments and to dole out pills for every ill and to lie on the hospital computer about your work hours and more. You may also be exposed to lots of stressed out and unhappy doctors and find it hard to find true mentors because toxic working conditions are harmful for everyone. Have compassion. Your attendings are suffering too.
4. Residency training is not an ideal time for your entrepreneurial spirit to blossom. Though some docs have been able to launch podcasts and blogs, many are just barely hanging on in fight-of-flight survival mode for 3+ years.
5. Fear-driven decisions WILL undermine your dreams. Make responsive not reactive decisions. Don’t let your emotions hijack your clear thinking. Create a pros and cons list when you are well rested—a great exercise in objectively outlining your concerns and making your best decision based on facts, not feelings.
6. You CAN practice medicine legally after one year of residency. If you want to be a neurosurgeon you’ll obviously need to complete residency. If you want to launch an outpatient primary care practice, you can be licensed in many states after your intern year. You may have less opportunities as an employee, but your opportunities as a business owner or entrepreneur are limitless. You can mentor med students and residents whether you complete residency or not.
7. You don’t need board certification. I gave up mine because I did not find that it was helpful. You can be in-network as a preferred provider with insurance companies without board certification (only one in my region requires board cert). You CAN take insurance without board certification. (FYI: NPs have less training and are practicing independently in many states without residency or board certification. You can do it too.)
8. You must live YOUR dream in medicine. You didn’t enter medicine on whim. Jennifer, remember YOUR dream that you shared at the retreat. The dream that brought you to med school in the first place. Be true to yourself. Though you want to finish what you started and don’t want to “throw other residents under the bus,” your primary goal should be to pursue your dream. Save yourself. Then save others. For more help contact our free physician helpline.
Her Decision
Though I struggle with abuse sometimes, I am able to recover because I am actively seeking help. I have a very good support system. So my strategic and well-thought out decision is to stay. I will seek help constantly and the next 2 years will be better. Completing residency will open doors for me so I can live my dream to my highest potential.
Breakthrough your fear. You can live your dream in medicine!
Are YOU ready to live your dream?
Don’t forget that in Missouri if did not match or if you have not completed a residency you may be able to practice as an Assistant Physician, which is a midlevel position in which you practice under a Collaborative Practice Arrangement with a licensed doctor much like a Nurse Practitioner. If you need some time away from your residency you could take a year or two off and still keep your skills up and make an income. Then you could possibly go back to your residency or if you like your practice as an Assistant Physician you could decide to stay in that arrangement.
YES!! The great state of Missouri is ahead of the curve thanks to YOU Keith!! Endless gratitude.
You all dont mention med school loans? Most residents have a significant amount and uncle Sam wont forgive these loans.
I take issue with #7 on your list of “My Thoughts.” Nurse Practitioners DO require board certification to practice. Not only do nurses take a certification examination, nurse practitioners are required to take boards also. NPs may not have to take boards as frequently as MD/DO colleagues, but they are required. NPs have attended 4 years of undergraduate education, plus 3 years of Nurse Practitioner training, plus gained a good deal of experience working as Registered Nurses prior to becoming NPs. Some NPs also elect to complete residencies, although you are correct the residencies are not required for NPs (although this is increasingly the trend).
I work at a college/university and many nursing students are going straight from their BSN into an online NP program with only zero to one year experience. I have seen many go on to practice independently immediately after completing their NP program online. While understand that a lot of nurses used to have a lot of bedside experience before becoming NPs, that just isn’t the case any more and certainly not the trend. I’m not saying that you have done it here but many folks want the title of “doctor” but aren’t interested in the depth of knowledge that should be necessary to become one. Doctors of nursing are needed and important. However, attempts by a lot of recent graduates to conflate the education received by nurses and physicians is inaccurate and dangerous.
There is a family practitioner by the name of Dr. Gabor Mate who says that resiliency is a result of connection and communal support which is the antithesis of residency training. Whoever thought up this system of training was downright insane. The thing is, most of the torture of residency training is gratuitous. Most of what I learned about being a good doctor occurred after training anyway. All the hours and stress during residency didn’t involve a lot of teaching or leading on my mentor’s parts. It was obvious to me that what they really wanted to do was to see how much shit you could take without breaking or to see how they could trip you up. It didn’t have anything to do with the art of medicine.