It is the time of the year in which freshly graduated residents and fellows finally enter the health care systems as an attending after years of hard work and training. A time of celebrating and reflection, and a time to stop and think of what you have done and what lies ahead of you. I am sorry, this may not be what you want to hear, but I am tired of seeing burned out and unhappy doctors, and I hope in this you may find some guidance and a way to navigate a period of your career in which I failed myself.

Let me tell you, there is more to it for myself and many others who have been there. In a newly minted attending, there is a natural and unavoidable void. You have spent years striving for something, and it is finally here. There are no more tests, no more lectures, no more didactics, no more supervision, just the wild and open world of freedom. But in the void, there is nothingness, and if you do not fill it with something, it will be filled for you: money, expenses, drugs, alcohol, or the next never-ending career transition, whether it be to a director or the next educational endeavor. Take time to reflect, look back, and feel proud of what you have done. Not many are capable of such feats. Make sure your next decisions are ones of true intent, not born out of the loneliness and emptiness that naturally exist early in your career.

Three months from now, I know I will receive a call from a recently graduated resident, reflecting on how now “that they have gotten here,” they don’t know what to do next. The camaraderie residency is gone, the structure and organization no more. It’s just you and the years of practicing ahead. You are now stuck with your decisions, and there is nothing worse than the slow realization that you have been making mistakes that you were completely unaware of. Nothing is sadder than seeing a young physician burn out. So much potential, but they already hate medicine and haven’t even started with a 20 to 30-year career ahead.

At the peak of my burnout, patients were not people to me anymore. Not men or women or children. They were things. Things to be fixed and that is all, nothing else. Some could be fixed, others not. Whether they died or lived or suffered did not matter, nor did I care anymore. The only thing that mattered was if I was right and not wrong diagnostically. I assure you, the way forward, through burnout, is not to care less and less.

Being endlessly placed in impossible situations for which there are no right answers and by which you will be hunted for the rest of your life, no matter what decision you make. Ultimate responsibility with no control of anything. All this eventually took its toll on me, and before I knew it, I had become something else: a metric-driven and heartless machine.

The words I hear all too often:

“I am already burned out and haven’t even started.”

“I can’t turn back this far out.”

And the worse words of all: “This is not what I thought it would be.”

There are not many careers that are capable of completely destroying you as medicine does. Physicians who burn out and burn out early become used to it, will know nothing else, and will have short and troubled careers. You must understand that practicing medicine is a two-way street. You can use it, and it can use you. A career in medicine can be used for good or bad but is neither. It matters what you do and your relationship with it.

In medicine, you see the river of hell that runs through this human existence. Not many know or acknowledge it. There are few, like us, that must wade in it, and if you become weak and fall, you will drown and be taken down river and become part of it.

Practicing medicine is a gift that will never match how much it can take from you. The more it takes, the less you have of yourself. Until there was nothing left. And when you have nothing left, you are dangerous. Dangerous to all, not just patients. They called it “moral injury” or “burnout,” but what it really was the summation of emotional, mental, and spiritual loss. Everything about you is gone. Lost bit by bit. Day by day. Patient by patient. Never-ending trading of what you knew for how you feel.

The decisions you make early in your attending years are important, and many don’t realize it.

It is a hard lesson, learning to be a new attending. Some learn it right away, some never learn it and will suffer endlessly.

I am sorry to tell you, but your greatest challenge lies ahead.

Your career.

The author is an anonymous physician.

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