Is staying worth it? How one physician broke free from the “sunk cost fallacy” [PODCAST]

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We sit down with anesthesiologist Kolleen Dougherty as she reflects on her experience of career burnout after two decades at a Level 1 hospital. Kolleen shares the internal struggles that kept her in a job that no longer brought her joy and how fear, loyalty, and the “sunk cost fallacy” contributed to her staying longer than she should have. She opens up about her journey to making the difficult decision to leave and the relief that followed.

Kolleen Dougherty is an anesthesiologist.

She discusses the KevinMD article, “Why this doctor stayed stuck in a job for years and how she finally broke free.”

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Transcript

Kevin Pho: Hi, and welcome to the show. Subscribe at KevinMD.com/podcast. Today we welcome Kolleen Dougherty. She’s an anesthesia and critical care physician. Today’s KevinMD article is “Why this doctor stayed stuck in a job for years and how she finally broke free.” Kolleen, welcome to the show.

Kolleen Dougherty: Thank you so much, Kevin, for having me. I’m really excited to be here.

Kevin Pho: So let’s start by briefly sharing your story.

Kolleen Dougherty: Sure. So I was born and raised in New Jersey, and ever since I was a little girl, I knew I wanted to be a physician. I then journeyed down to Atlanta, Georgia, to Emory University, where I went to college. I came back up north to Columbia College of Physicians and Surgeons in New York City, where I received my medical degree and stayed for my internship. And then I did my anesthesia and ICU training in Boston, both at Massachusetts General Hospital for my fellowship and the Brigham and Women’s for my anesthesia residency. And then, thanks to my husband, who always vacationed in Maine, we decided to move up to Maine, and I’ve been in Maine ever since.

Kevin Pho: All right, wonderful. Let’s talk about your KevinMD article, “Why this doctor stayed stuck in a job for years and how she finally broke free.” So before talking about the article, what led you to write it in the first place?

Kolleen Dougherty: Well, I left my clinical job, which I was at for over twenty-four years, a little over a year ago now. And in that intervening time, the past year, I’ve had a lot of time to catch up on my sleep, which has been magnificent. I can’t oversell that. But also, I’ve had a lot of time to think about why I stayed in my job a lot longer than I really knew I should have.

It was one of the best decisions I ever made, to leave my job. I consider it right up there with the decision of where to do my training, marrying my wonderful husband, and having my kids. It is one of the best decisions, but I realized I should have made that decision probably about two to three years earlier than I did. And so I really started wondering, why did I stay? Why didn’t I leave when I really felt like I should have?

And it really boiled down to what I consider three major reasons why I stayed longer than I should have. One was the psychological trap that was really popularized by Richard Thaler, the sunk cost fallacy, which affects all of us in different ways. For me, I think the biggest example is staying in a job that I knew I should have left. But it could be why you continue reading a book longer than you want to. You don’t really like the book, but you want to finish it; for some reason, you’re just sticking it out. Or you go to a movie, and you pay your ticket price, and you hate the movie, but you stay till the end even though you don’t like it. And why do we do those things?

So that was one of the big reasons. I felt like I had dedicated twenty-four years of my life to this one practice, and during that time, I’d created great relationships and built my professional reputation. And I felt like, “Wow, it’s going to take me twenty-four years to get to the same place in another location.” Or, “I’m finally higher on the seniority list, and I can finally pick better vacation, so why would I leave?” And it was all those sunk cost fallacies that kept me there. That was one reason.

Another major reason was fear: fear of the unknown, fear of change, going back to that expression of “the devil you know is better than the devil you don’t.” I just felt like, “Well, maybe this is the best there is, and I’ll just stay,” because I was afraid.

And the third one was loyalty. I did spend twenty-four years with these partners and colleagues, and in some ways, they do become your second family. I spent holidays with them, and we saw each other go through pregnancies, have children, and celebrate all those major milestones. And so I felt a little guilty about leaving and leaving them behind in the situation that we were in. And so for those reasons, I really stayed a lot longer than I should have. I wrote the article really to shed some light on it, to hopefully give people who might be pondering the same decision some things to really think about.

Kevin Pho: You mentioned earlier, as part of your story, that you have always dreamed of being a physician ever since you were a little girl. So tell us what your job was like. Tell us, what were some of the pressures that actually led you away from clinical medicine?

Kolleen Dougherty: Well, when I started my job at my group, I was physician number 24, and over the past two decades, our group kept growing and growing and growing, and we soon blossomed to eighty physicians. And I felt like that collegial camaraderie that we did share initially was really hard to maintain in a group of eighty people. I felt like I was just a number in a system. And then there were the pressures that we’re all facing in medicine right now: the productivity, the treadmill, feeling like I didn’t really get enough time to spend with patients. I just felt like, for me, it was really time to take a step back and reevaluate where I wanted to see the next stage of my career.

And I’m not going to lie, the schedule was really tough. Once you get to a certain size in a group, it was really hard to switch a call, for instance. If my children had an event that came up, it was hard to find someone to take that call. You would think with eighty people it would be easier, but we had so much subspecialization, and we covered. Some people were credentialed at one location and not the other. So it really became problematic to fit the other priorities in my life into my schedule. So for those reasons, I really felt like I needed to move on.

Kevin Pho: And these difficulties weren’t exclusive to just your practice? There weren’t any other clinical options, other jobs, going part-time? Those weren’t options before you decided to leave clinical medicine entirely?

Kolleen Dougherty: To be honest, there were some opportunities to maybe scale back a little bit. But for me, again, I felt like the whole environment of the hospital system that I was at, and the group I was at, had changed so much from what I was used to that I really wanted just to start over.

Kevin Pho: So you mentioned those three factors that kept you at this job probably longer than you should have. So how did you navigate those feelings? Was there a final event that made you say, “That’s it”? How did you eventually address those three causes that made you stay there longer than you should have?

Kolleen Dougherty: I did a lot of self-reflection. I also joined a few coaching programs. I don’t know if you’re familiar with Empowering Women Physicians; that is a professional group that Sunny Smith, who is a family medicine physician out of San Diego, runs. And so it was a lot of internal thought work, I’d say, about what direction I wanted my life in and what other goals I might have as I was getting ready to transition to a whole new stage.

I have four children, and three were in college. My oldest just recently graduated, which is exciting, and I have one left in high school, who will hopefully be going to college next year. I mean, she’s a great student, but we’re in the throes of her application process right now. But I kind of felt like, “Wow, now’s a good time for me to really think about that next chapter in my life and what I want it to look like.” And I really wanted to explore some other opportunities, both within clinical medicine and outside of medicine.

Kevin Pho: And now that you made a decision, any regrets? How do you feel about it?

Kolleen Dougherty: No, no regrets whatsoever. I’m not going to lie, the first few months were a little challenging, as far as waking up and being like, “What do I do today?” For so long in my life, I think I’ve always had that schedule. As an anesthesiologist, I would get to work by 6:30 in the morning, and there’s a certain feeling of excitement and accomplishment when, by 10:00 a.m., I’ve already taken care of three patients and launched their anesthetics, and the rest of the world is just getting their first cup of coffee on. So it was a little challenging to navigate the next steps per se, but I think that was also a needed time for me to really sit back and start to enjoy time and understand what I wanted to accomplish next.

Kevin Pho: So if you were to replay all of this and reflect and think about what you could have done differently, maybe leaving earlier, is there anything that you would have done differently?

Kolleen Dougherty: I think just really trying to figure out the reasons I was staying. Were they really things that I needed to work through, or was it really just my limiting beliefs that were holding me back? Because I think so often our primitive brain tries to keep us safe. Our primitive brain wants us to not take risky steps; it’s there to keep us alive, from the very beginning. And so I think a lot of my staying was really based on a fear and a limiting belief.

Whereas now that I’ve moved forward, I feel like there are so many opportunities that I didn’t even know were out there that are becoming more and more apparent as I venture forward and continue to reach out to other people. I’ve reconnected with so many past friends from both medical school and my residency and training and my fellowship. I’ve reached out to residents that I helped train. One of the nice things about my job was that we trained anesthesia residents, and I also interacted in the ICU setting with surgical residents and ED residents. And so, quite honestly, there are probably hundreds of residents that I’ve helped train over the last twenty-four years, and it’s been really nice to reconnect with them and find out what they are up to and what their system of medicine is like. They’re scattered throughout the entire United States. So I spent some time really touching base with a lot of past friends and colleagues, and that’s been a really fun, exciting, eye-opening experience, quite frankly.

Kevin Pho: So tell me some of the reaction that you received, both from your colleagues and from these people that you’re reaching out to. Do they ever say, “I wish I could have done what you did”?

Kolleen Dougherty: Yes. I mean, I do realize that I’m somewhat in a privileged position, as far as being able to kind of walk away from my job from a financial standpoint. I mean, some people don’t really have that opportunity. I think because I’ve spent twenty-four years at my job, and I worked full-time for the full twenty-four years, and I’m very blessed and lucky to have my husband, who also works, we were able to financially do that and give me this time to really step away from working at all and just really contemplate my next steps. And I do appreciate that some people don’t have that opportunity to do that for whatever reason, financial stability being one of the bigger challenges that keep people stuck.

But absolutely, I think there are a lot of people who want to find something different, but they’re just not sure how to go about doing that or what’s the first step to take besides quitting. I mean, obviously, if you’re financially dependent on an income stream, it’s always probably best to find that next job before leaving your current job. But I do think that sometimes time to just be with your own thoughts and really reflect is really, or at least was, very crucial to my journey.

Kevin Pho: So what kind of things do you advise these people who wish they could have done what you did? You mentioned reflection, so tell us more about what exactly that entails, or how long did you have to reflect before you made that final decision?

Kolleen Dougherty: Great question. I think, for me, reflection was a lot of thinking about values and what kind of legacy you want to leave. I think it’s easy to get caught up in a day-to-day existence, where you go to work, you have your schedule of patients in front of you, and you do a great job getting through that one day. And it’s easy for those days to pile up, and that’s what I did for twenty-four years. I mean, I’m very proud of the work that I did, and I don’t regret taking care of any of those patients. But it’s easy to just kind of stay stagnant and stay in that, “Oh, maybe next summer I’ll do something,” or, “Next year I’ll do something,” and you just get by day to day, versus all of a sudden you’re ten years into it and you haven’t really accomplished any of those other things you want to.

So I think really trying to think about what else you might want in your life or want to accomplish, because, not to be negative, but we all don’t know how long we have on this planet. And I think waiting for tomorrow to always live your dreams or get to do all the things you want to do isn’t always the best plan. And waiting for things to change, which is something I did for a long time too: “Oh, it’s going to get better next year, when we hire more people,” or, “Oh, it’ll get better when we get the new electronic medical record up and running,” or when we get more scribes, or when we get whatever it is that people are thinking will crack the nut that will get things better for you. It may not come, or it may not come in a time frame that works for you. And so I think really trying to understand what’s important to you, your values, your legacy, what else you want in your life, and taking a little bit more ownership of that and realizing that you have more authority over what you’re doing than you realize.

Kevin Pho: Now, is this it for you? Do you think that you may have any inkling to go back to clinical medicine?

Kolleen Dougherty: Yeah. As much as I love the last year off, Kevin, I really, really do miss taking care of patients. I miss that feeling of helping someone at the most vulnerable time in their life. Often people think doctors go into anesthesia because they don’t want to talk to patients, or they don’t want to interact with the patient, and I wholeheartedly disagree. I mean, I think we see patients at the most vulnerable time of their life. They’re coming in for surgery, they’re facing one of the most stressful events of their life, they’re scared, and they have no idea who we are. And within a matter of minutes, we have to establish rapport with them and really try to understand not only their medical comorbidities and their needs but also alleviate as much anxiety as we can and build that relationship. And I really do miss the patients that I was very, very blessed to help take care of, and I do miss interacting with my physician colleagues, and talking the talk, and the banter of medicine.

And so I do think I will go back. What I often tell people who ask is that I don’t think I’m going to go back to full-time, pick your vacation a year and a half ahead of time, take call every third or fourth night, or whatever. That’s not something I’m really interested in doing. So right now, I’m starting to explore per diem and locum opportunities, where I can pick and choose, if you will, the weeks that really work for my schedule and my children and my family schedule, and get those touch points of patient care that I really am missing. But I also don’t have to get mired in the politics of the hospital organizations or the business of medicine. I just don’t want to have to go in and go to meetings about how to earn more revenue streams from delivering anesthesia. That’s not something that is really high on my priority list.

Kevin Pho: We’re talking to Kolleen Dougherty. She’s an anesthesia and critical care physician. Today’s KevinMD article is “Why this doctor stayed stuck in a job for years and how she finally broke free.” Kolleen, we’ll end with some of your take-home messages to the KevinMD audience.

Kolleen Dougherty: Sure. I’d say one of the biggest take-homes is change is hard. I think, again, our brain wants us to stay safe, and so it will put up a lot of barriers in your thoughts about why you shouldn’t leave. And I’d say really try to look deeply into those reasons and see if they really are true reasons to stay, or things that you can alter to make it so that it is a better environment for you.

If you’re looking to leave, I think the biggest one I’d say is indecision is a decision. For so long, I told myself, I knew there was a question of, “Should I leave?” and I just wouldn’t answer it. And I thought somehow putting it off was easier, but that in itself is a decision to stay, even though I didn’t recognize it as it was. So I think realizing that, if you want to leave, really try to figure out why and how best to move forward, so that you can live the best life that you want to for yourself.

Kevin Pho: Kolleen, thank you so much for sharing your story, time, and insight. Thanks again for coming on the show.

Kolleen Dougherty: Thanks for having me, Kevin. Really appreciate it.

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