I’m very excited to introduce to you our fourth member of The Physician Career Transition Posse, endocrinologist and cat-lover, “Dr. Rachel!”

For those of you new to the Career Transition Posse, the members are physicians who graciously share their career journey as it unfolds in real time. They adopt an alias in the beginning and may reveal their true identity later on.

Please feel free to ask questions and leave comments below. Your support and encouragement are much appreciated!

And now, without further ado, here is Dr. Rachel!

Tell us a little about yourself, Dr. Rachel,

Here’s a little pep talk that I give myself in the morning: You are NOT a bad person. You are not THAT bad of a person. You could be a little better, honestly. It’s possible you are a monster.

Me: Hi, my name is Rachel, and I think about leaving medicine.

People in folding chairs arranged in a circle: Hi, Rachel.

I became a doctor to help people, before I knew that people can really suck. This is the ugly truth, and it’s something that none of the medical school professors will ever mention, not even once during all the hours that you spend in a giant auditorium with them.

All of those hours committing maps of cranial nerves to memory, figuring out which microbes stain what color and why, outlining the steroid synthesis pathway: not once does anyone mention the actual soul-sucking, thankless work that will follow.

Looking back, we should have been suspicious: if seeing patients was so rewarding, what were all these doctors doing teaching us instead? Why weren’t they out there crushing it: clicking endlessly into an EMR system, arguing with difficult patients, pleading with insurance companies through peer-to-peers, finishing notes late into the night at home, answering pages blearily at 3 am?

“Those who can’t do”….probably burned out at some point.

That really should have been my first clue.  

What kind of medical practice setting are you in?

I’m an inpatient endocrinologist. It’s basically like being a hospitalist, except I only see endocrine patients. I follow a two week on, two week off schedule where I work 8am-5pm and take 24hr call every day. I’m also chief of my small inpatient endocrine division.

I work at a community hospital in upstate NY that’s a few hours from where I actually live in NYC and am employed on a locums-like basis, with a stipend for temporary housing and transportation back and forth.

For years I made this impractical commute alone, with two orange cats in the back seat who would yowl mournfully the entire 3 hour drive. Now that I’m married, my husband does all of the driving (we work at the same hospital). He doesn’t yowl much, but he does listen to a LOT of Liverpool soccer podcasts in the car and bemoans the cancellation of something called the Premier League.

People usually look at me askance—how much insulin could one possibly prescribe in the hospital to justify a full-time salary? But you’d be surprised. At least 25-30% of all inpatients have diabetes, and up to 40% of patients with type 1 diabetes have insulin pumps and/or continuous glucose monitors, a growing technology that can be intimidating to those who are unfamiliar.

Inpatient diabetes management has gotten increasingly complicated because drug companies churn out new diabetes meds like bunnies, and confusingly, all of their names start with the letter T (Tresiba, Trulicity, Toujeo, Tradjenta). This becomes a real nuisance for pretty much anyone who’s not an endocrinologist.

In addition, DKA is uncommonly rampant in our ICU, and there’s hardly a person who makes it through the cat scanner without the discovery of an adrenal or pituitary incidentaloma. So business is brisk. Contrary to what one might think, we get a fair amount of calls a lot at night from all corners of the hospital: the ER, labor and delivery, PACU, MICU, the regular floors, cardiovascular ICU, even the detox floor.

How do you feel about patient care?

I’ve been in my current job for 6 years now, which is the longest time I’ve been in any position. Of all the ways to practice medicine, the two weeks on/off model has unquestionably been the best for me. I greatly prefer inpatient medicine and this schedule affords me true protected time off with no call.

At first, the two weeks “off” after an intense 2 week period “on” was restorative. I would do mountains of laundry, watch Frasier re-runs, struggle through a barre class or two. The stress and sadness of the inpatient wards would eventually recede. That widowed 82yr old with progressive dementia and no children. The 49yr old with unexpected hypercalcemia and weight loss. The belligerent patient with recurrent pancreatitis whose repeat admissions had become more frequent. The friendly drunk who always offers you a seat on his bed. The brittle type 1 with ESRD and chronic wound infections.

The words “refractory” or “uncontrolled” and “amputation” in my daily parlance would be replaced with “Rupaul’s Drag Race” and “jeggings” and “Sephora.” But lately my refractory period is taking longer and longer, and I can’t recover from the work binge as quickly as I could 5 years ago. The feelings of frustration, stress and dread won’t go away, no matter how many Frasier episodes I watch in between. It seems that I’ve developed tachyphylaxis to time off, and a new treatment plan is needed.

What made you decide to consider leaving medicine?

I can’t pinpoint the exact moment I realized that doctoring wasn’t all that I’d imagined it to be. Medical school was difficult but also fulfilling and fun: I had great friends, and we learned so much together. Diseases had etiologies and treatments then, rotations had start and end points, and the path ahead was linear and promising in a way that made sense.

Residency was grueling and physically taxing, but I still got by with my friends; the bonds you’d forge over putting in arterial lines or sharing overnight call in the CCU, rounding with that attending who’d always mispronounce the patient name “Bonner” as “boner.” To this day I can’t see that name without smiling. But the climb to the summit ends up a solo one.

With each stage of training, my colleagues became fewer, the camaraderie weaker, the patients sicker and more demanding. Once done with training, I found myself working mostly alone, just me and the patient, in an exhausting silo of suffering, anxiety, fear and disease.

The crush of hospital bureaucracy and politics was also tiring. I wondered constantly if this was the right field for me. My parents are both physicians and when I confessed these misgivings to them, they were shocked to learn that I’d expected happiness. Medicine was not a means to happiness, they told me, bewildered. It was a stable paycheck. It was job security. It was respectable work. I felt ashamed by my naivete. It felt self-indulgent to hope for more. We drove back up to the hospital for another two week stretch.

Then the pandemic struck. In the past few weeks, a deadly virus was suddenly circulating in my workplace, and the odds of dying from my work crept up to a somewhat uncomfortably non-zero number. I continued to see patients in the hospital (PPE shortage aside—save that one for another day), and on one hand, I did feel a heightened awareness of the purpose of my job—that is, to help keep people alive.

I especially saw this awareness in my ICU and ER physician colleagues, many of whom stepped up with a fearless and compassionate alacrity that I both admired and envied. Comparatively, my role was minor, but I was still struck by the rapidity with which many diabetic COVID patients decompensated. I watched patients speak on the phone in one minute and be intubated just moments later.

Two weeks into the pandemic, my ER physician husband came home from a night shift and after switching off the bedroom light, he informed me neutrally that while he was full code, he didn’t want to be trach’ed or PEG’ed, ever. Just in case, he said. If it was clear he wouldn’t be getting off the ventilator, he didn’t want either. I understood that, right? I nodded in the dark, lying next to him. We’d both been doing this long enough not to harbor any delusions about the limits of modern medicine.

My sweet, peaceful husband is not the worrying type. Mere moments after his sobering statements he was fast asleep, no doubt dreaming of winning the Premier League, I was left staring unseeingly at the ceiling. Was this really how it could end for us? How many more morning cortisol levels would I order before it all ended? Would this be the only type of life I’d ever known? I imagined my headstone: “She loved cats, and always ruled out adrenal insufficiency. Final RVU count: 23 million. RIP.”

There had to be another way.

What do you want to be different in your career?

I’d like to have a better balance of creativity and art in my life, as adjunct to medicine. I fear that doing nothing but either thinking about patients or trying to forget about patients has caused a part of my brain and heart to atrophy. It’s left me profoundly empty and unhappy.

Is clinical practice still an option? Why or why not?

I think so, in some capacity. I don’t want to lose my skills.  

What are some clinical or nonclinical career options you’re exploring?

Teaching, writing, public speaking…some combination of the three. Telemedicine is a consideration, because I’ve heard you don’t have to wear pants.

On a scale of 0 – 10, with 10 feeling very confident, how confident are you that your career transition with work out?

6. If that were the score you gave a blind date, that would be disappointing. But if that were the likelihood of you winning 50 million next week, you’d be pretty excited! So it’s all about perspective.

What is your biggest hope about this change process?

That I will somehow find some form of compassion, joy and meaning in my work.

And world peace. Go big or go home, right?

What is your biggest fear about this change process?

That I’ll end up homeless, penniless and unemployed. That the cats will have to eat Temptations (the feline equivalent of Cheetos) instead of their expensive grain-free treats, due to budget constraints. That I’ll forget that I’m not wearing pants and stand up on camera.

Anything else you would like to share?

I’ve never considered myself a dreamer. If you haven’t guessed by now, I’m not really an optimist, either, which I’d always thought was a necessary-but-not-sufficient ingredient for dreaming. It’s funny, though, what happens when the threat of death moves from this vague figure on the horizon to a presence that’s slid clear across the chessboard, pinning you in unexpected checkmate—how suddenly and urgently dreams struggle back to life.

I’ve been dreaming a lot lately. They’re silly dreams. I dream about riding the subway again with throngs of early morning commuters, AirPods shoved deep into my ears, Lana Del Rey turned up loud.

I dream of weaving my way through clothing racks at the store, idly fingering fabrics without fear, murmuring ‘excuse me’ as I squeeze past strangers, so closely that I almost brush against them.

I dream of pushing elevator buttons with my bare hands while chatting with my colleagues, a crowd of us piling into the car (“there’s room for one more, get in!”).

I dream of sipping my cocktail, eyes widening and then demanding that my friend try it, before we peruse our shared menu.

I dream of applauding for a musical performance in a room packed with strangers, some of us whistling for emphasis, aerosolized particles be damned.

I dream of clapping my hand over my mouth when you tell me the news. I laugh out loud at what you say. We don’t wear masks anymore.

I dream of leaving medicine, sometimes. I dream of writing more, creating more, crafting more, dancing more. Once upon a time, I was embarrassed by these dreams. But I make bargains with them now. I beg them not to fade.

If we can all survive this season of relentless disease and dying, I tell them, I won’t neglect them anymore. I’ve seen the ghosts of COVID past. I’ve learned the lessons of my sins. Let me wake up from this nightmare. I’m ready for change to begin.

A big thank you to Dr. Rachel for bringing us in such a compelling way into this part of her journey. If you want to listen to a song that captures this point in time for her, check out Who Knows, by Beginners.

Stay tuned to her updates and new stories from The Physician Career Transition Posse!

PS. Dr. Rachel selected her Cat Photo Avatar.