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Former OB/GYN resident and physician coach Chelsea Turgeon discusses her article, “Why does leaving medicine feel like escaping a cult?” In this episode, Chelsea shares her personal journey of resigning from residency and explores the cult-like aspects of the medical profession that make leaving feel so taboo. She highlights the financial burdens, debilitating work routines, and the culture of shame that keep many physicians trapped, even when their well-being is at stake. Listeners will gain insight into the pressures faced by medical professionals and the importance of prioritizing mental health. Chelsea encourages reflection on whether staying in the profession is truly serving one’s happiness and offers a powerful message for anyone feeling stuck in their career.

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Transcript

Kevin Pho: Hi, and welcome to the show. Subscribe at KevinMD.com/podcast. Today we welcome back Chelsea Turgeon. She’s a physician coach. Today’s KevinMD article is “Why does leaving medicine feel like escaping a cult?” Chelsea, welcome back to the show.

Chelsea Turgeon: Thank you so much for having me.

Kevin Pho: All right, so tell us what your latest article is about.

Chelsea Turgeon: Yes. So I obviously use some pretty intense language. “Why does leaving medicine feel like escaping a cult?” And really, the purpose of the article was just to get people to raise some eyebrows, to actually start thinking really critically about what’s going on within the medical profession.

Sometimes when we’re so deep in it, it’s really hard to see what’s happening and to understand because things become so normalized. But for me, as someone who has been out of the profession for about six years now, I have a different, more zoomed-out perspective. And so I have this perspective of, OK, when I wrote my book, “Residency dropout,” why did so many people come to me and say, “I left medicine years ago, but I never felt like I could talk about it,” and they’re kind of hiding in shame? Why is it that one of my clients, when she made the decision to leave medicine, one of her neighbors came to the door in the middle of the day, and she hid because she didn’t want them to know she was home—she didn’t want them to know she left medicine? Why is there such deep shame and guilt? Why are these kinds of feelings around leaving medicine?

Why is it that when I post an article on LinkedIn sharing about my story of choosing myself and leaving the profession, I get comments like, “Shame on you for leaving”? I’m here just kind of observing all of this, and I feel a little bit more third party now—things just don’t feel right. Another part of it: why is it that people feel the need to commit suicide in order to escape the profession? We know that the rate of suicide among physicians is higher than other professions, higher than the general population, and it’s like, why is that our only means of escape? Really, the article came about from me just looking around and asking questions. Then I watched this documentary about the NXIVM cult, and I was like, “Huh, this all feels a little familiar in certain ways.”

Kevin Pho: So for those who aren’t familiar with what you do and your podcast and your book, just tell us a little bit about your journey out of medicine.

Chelsea Turgeon: Yeah, so I’ll go through—really just to go back to the beginning—the reason I went into medicine, now that I look at it, was for all the wrong reasons. And I say “wrong” meaning reasons that would never lead me to a happy, fulfilled life. It was this superficial combo of “I like helping people, I’m good at science, I’m smart enough,” and then the undercurrent of perfectionism, high achievement, unworthiness—that all came together, and I went into medicine.

I did really well: top of my class, great scores on boards, matched into my top-choice residency. It’s that point where you’re at your pinnacle—you achieve everything you think you want, and you think that’s going to make you happy—and I still felt empty. That sent me into a bit of a crisis: what is this? What am I actually doing here? I had a bit of a personal values realignment, more of a spiritual awakening. I got into mindfulness meditation, and I realized—this is all fourth year of med school—this is not a fit anymore.

I didn’t have the courage to leave at that point. I wasn’t ready to give it all up, so I did continue into OB-GYN residency, and it wasn’t until I hit a point of really deep burnout during second year that I finally was at my rock bottom. I thought, “You know what? There’s nowhere else to go but up. Let me make a big change.” And so I resigned from residency during my second year—still had over a hundred thousand dollars of student loan debt—and I booked a one-way ticket to South Korea, because that’s what you do. I sold all my stuff. I got a job teaching.

I spent the next six years—so this was six years ago—traveling around the world. I’ve lived and worked in over 55 countries, learning everything about online business. I’ve built a six-figure business, and I’ve helped hundreds of physician coaches escape burnout and find their purpose. That’s really been the journey that I’m on.

Kevin Pho: So now that you’ve had time to reflect, what were some of the—I guess for lack of a better word—cult-like attributes that medicine had that made it so difficult, not only for you, but some of the other physicians you’ve talked to, to leave the profession?

Chelsea Turgeon: Yes. So I went through my own experience, and then I also went and actually read some things about cults to put a list together of the ways medicine kind of resembles a cult. One is expensive involvement, right? There’s significant financial investment that happens at the front end. We take out massive amounts of student loans. I believe medicine is the profession with the longest period of time from when you take out loans and put the investment in to when there’s a payback. You think of other fields—like law and other graduate schools—there’s not as long a period of time where you’re underpaid in order to get it back. So there’s significant financial involvement. Loans are a huge reason a lot of my clients feel like they can’t leave. They do PSLF or military—it just keeps them stuck. There’s a level of financial control that happens when your livelihood and the way you earn your money is tied to this one profession that you have a really specialized set of skills for.

What are some of the other ones? This one is super interesting: mind-altering practices. When you read about that, they talk about chanting and speaking in tongues, and of course we don’t do any of that. But then one of the listed characteristics was debilitating work routines. Debilitating work routines keep you so busy you don’t really have time to think about what’s going on. How many times are we just trying to get through until the next break, until the next vacation, and not actually stopping to think about it? There’s something in that where we don’t have a moment to pause and reflect about what’s going on. When we’re sleep-deprived—even if we do get eight hours of sleep, we’re still working quite a lot—we’re just weaker. We don’t have as much resilience. I look at my clients and think, “You all are incredible. Why do you feel scared to leave? Why do you feel like you can’t do it?” They’re just really burned down from all the work they’ve been doing.

Another part of that, which is another characteristic but very related, is that inordinate amounts of time are expected to be devoted to group activities. How often do we hear, “Medicine is a calling. You should be really happy to go into work on the holidays”? There’s a lot of culture around “spend all your time here.” That’s one of the biggest complaints I get from people who come to me: “My work is all-consuming. It’s not that I hate the work itself; it’s that I also want to do other things, but I’m at home charting.” There was a study done on all the things a primary care doc is expected to do, and it was over 24 hours a day if they actually did everything. So there’s just so much work expected of us that’s supposed to be dedicated to this group.

Then that leads to another characteristic, which is isolation from others. If you’re devoting all of your time to this group, and you have debilitating work routines, then you’re also not really engaging with people outside of the group. A lot of your social circle becomes really small. Now, that doesn’t have to be the case, but it definitely was true for me. I remember feeling early on in medicine, “Oh, my college friends don’t get it. They don’t get how hard this is and what I’m doing,” so you start to feel like you can’t relate to other people, which causes you to self-isolate. But then you’re also so busy that you isolate circumstantially, and you don’t get perspective outside of the group. When I tell anyone outside the medical profession—which is most of my friends now—that doctors work a 24-hour shift, every single person I tell is appalled. No one can actually believe it. And that’s so wild, because look how normal it is in the medical world to do that. You don’t get perspective because you’re so enmeshed in what’s going on.

Kevin Pho: In your own personal journey, when you left residency, you were in the middle of an obstetrics-gynecology residency—arguably one of the most challenging residencies out there. Did you ever get advice that you just had to tough it out and it would get better after you get out, because sometimes residency is the worst point of medical training?

Chelsea Turgeon: Yeah, oh yeah, that’s always the advice you get. That’s another one of the characteristics, too—the illusion of hope, right? There’s this delayed gratification script that we all have, telling us, “Just keep going. It’ll get better.” I actually wanted to quit during my intern year, just a few months in. I met with my chief resident, told her everything I was going through—and it’s not just that I wanted to quit, it’s that I didn’t think medicine was right for me. Because if something’s hard but you really care about it, and you’re invested in it, and it’s aligned with you and your mission and your why, there’s a connection you have to it; you can push through that. You can come back to why you’re doing it. When I kept trying to do that with medicine, like I said, it was so superficial that I didn’t have that deeper thing.

I tried to quit during intern year, and then I was sort of talked out of it for those same reasons. Now, I’m actually glad that that happened, because then I gave it a really good try. I really did my best. I didn’t want to quit just because I wasn’t good at it yet—it’s a hard learning curve. I wanted to actually leave when it was just a clear choice of “This is no longer right for me.”

Kevin Pho: Now, you talked earlier about that culture of silence and the shame for those who want to leave clinical medicine. You mentioned some of your LinkedIn posts, where people would comment, “Shame on you.” What exactly would they say? Why should you be ashamed of that?

Chelsea Turgeon: Such a good question, because I don’t think they ever really make it clear. A couple times, people have given me something specific I should be ashamed about, and one is, “You took someone’s spot.” Because there are limited residency spots, the idea is that I took someone’s spot, and now someone else didn’t get in because of me. While that’s technically true, I don’t take responsibility for that being my problem. That should not be the case. It should not be that you get your medical degree, you go through all that training, and there’s no way for you to practice because there aren’t enough residency spots. That’s a systemic problem; that’s not something I’m going to take responsibility for.

So yeah, that was one reason. I think it all comes from this deep scarcity mindset. Another is “Shame on you for glorifying leaving the profession,” saying that if I talk about it, others will leave too, and it’ll create an exodus. That’s not on me. No one should stay if they don’t want to. People should stay because they want to. If a bunch of qualified people who love practicing medicine still want to leave the system, again, that’s a systemic thing. Those are some of the reasons I’ve been given, but none of those make any sense to me.

Kevin Pho: No, I agree with you. One of the things I’m sure you do in your stories—on your own podcast and what we do here—is really to normalize some of these issues that make medical training and a career in medicine so difficult. There shouldn’t be a culture of silence; there shouldn’t be any shame for people who are undergoing tremendous stress to the point where they’re considering leaving the practice.

Chelsea Turgeon: Yeah, especially for people who are high performers. It’s not that we’re allergic to hard. It’s not that we don’t want challenges. I think we want growth. I think that’s another weird thing that happens: we go through this huge growth process to become an attending, and then there’s not really anywhere else to go. That’s weird. So it’s not that we don’t want challenges or growth, or that we don’t want things that are hard. I love hard. Right now I’m training to summit the highest mountain in Mexico, which is about 18,500 feet. I like challenges, but I want them to be the right kind of challenge—the kind that makes me more of the person who is my best self, not a challenge that makes me shrink and become less of who I want to be.

Kevin Pho: Now, you’re a physician coach, and I’m sure you have many physician clients who come to you in situations like you were in back when you were a resident: burnt out or disillusioned about the practice for various reasons. Take us through one of those coaching sessions. At what point is that fork in the road where they should leave the practice entirely versus stay in with some modifications? I’m sure there are many steps before actually leaving the practice of medicine.

Chelsea Turgeon: Yeah, and I love that we try to make it the last-ditch option, like we have to try everything else before we leave. Sure, that can be the case if you really want to feel certain about it, but I think a lot of us feel so much more certain before we’re ever ready to admit it.

A lot of people come to me in what I call the “tweak to tolerate” phase, where they’re trying to make these small tweaks just to tolerate their day-to-day. They’ll reduce their workload, maybe go part-time, or maybe they’ll get more admin time or reduce the number of patients, or shift to outpatient instead of in the hospital. There are all these small tweaks people make. The best-case scenario is, “I can now tolerate my day.” One of my clients was celebrating, “I’m not crying on the way to work anymore.” But what a low bar! Why are we in this place where we’re trying to tweak to tolerate and salvage something?

When I really connect with clients, what I’m most interested in is helping them connect to their truth and identify their best-case scenario—reclaim their bold dreams and visions, not just “How can you continue in a system that’s really suppressing who you actually are?” What I’m really interested in is not trying to make these little modifications, but getting to the heart of what you actually want. What are you doing here? That way, you can rise up to what you want, instead of trying to tweak things that at best might make your situation mediocre.

Kevin Pho: Give us a spectrum of responses. When you ask people what really motivates them, and whether medicine is part of that world that motivates them, what are some of the answers you hear?

Chelsea Turgeon: A lot of my clients are interested in advocating for people who are underrepresented. They want to actually make change. They really did get into medicine because they wanted to help people, but usually at a bigger level than just one-to-one. Those are the people I attract. So, “I want to actually change systems; I want to have an impact beyond the day-to-day, moment-to-moment.” A lot of my clients have that bigger vision. At one point they thought medicine was part of it, but it’s this “expectations hangover” of the day-to-day realities of the system not matching what they envisioned when they first went in.

Another group of my clients wants to do deep, holistic healing. They want to help people be well, not just bandaging sickness. They want to help people learn how to heal themselves and take more natural approaches. The theme is real, lasting change for people.

Kevin Pho: You mentioned “tweak to tolerate,” and that’s the traditional advice. We have a lot of physician coaches who come on this show who say exactly what you said: cut down to half-time, maybe 0.75 FTE, more admin time. From your experience, does that actually work? Can that work for people who can rediscover their passion for medicine again?

Chelsea Turgeon: It depends. I do think there’s an important part of the “tweak to tolerate” process, because, like I said, those mind-altering practices and inordinate work hours sometimes mean just doing that is enough to give you space to really connect back to yourself and see what you truly want. I have had clients who make some changes. I think the change I’ve seen most frequently is moving into some sort of direct primary care role, where there’s just longer time with patients. If we had to look at the one factor that makes the biggest difference, it’s that 15-minute patient visits are just not OK. Any physician who truly does love the practice of medicine—if they have 30 minutes to an hour with patients and see fewer patients each day, focusing on quality over quantity—that’s a much better recipe for fulfillment.

Kevin Pho: Let’s give you a hypothetical physician, a very common scenario. They feel trapped, mostly for the financial reasons you said—hundreds of thousands of dollars of student debt. They’re in a job they don’t like, and they’re losing their passion for medicine. Tell us the questions they need to ask themselves to try to escape that trap, and maybe figure out whether medicine is even right for them. What are some of those questions?

Chelsea Turgeon: Yes, so the person you just described seems very burned out, more like “in a hole,” below baseline. The question to ask at that point is not “What is my passion? What do I love doing?” None of that. You don’t need to ask what lights you up or anything that’s in the positive, because that’s far too inaccessible from where you currently are. If you’re in that place where you’re below your baseline, the question to ask is “What feels like relief?” When you ask that question, you might realize that cutting back hours is relief. Or maybe a sabbatical is relief. What you need is to move toward what feels like relief to get yourself back to baseline. Once you’re at baseline, then you can start asking some deeper questions about what you actually want to do and what’s going to fulfill you. But when you’re in that darker place, please don’t try to ask yourself what your passion is or what you love doing—just get back to your baseline first.

Kevin Pho: And from a more systemic viewpoint, what needs to change in medicine and medical education to make it less cult-like, to fix some of those systemic issues you described?

Chelsea Turgeon: Honestly, I don’t know if it can be fixed. I think the only thing I can think of is the entire thing crumbles—which is probably not the answer you wanted to hear, but I don’t see a way. Any change within the system is just a tweak to tolerate. I think the whole thing needs a makeover and to be completely readjusted. I don’t think there’s anything we can change to make it what we really need it to be.

Kevin Pho: Is that because of the inertia we traditionally associate with medicine, that resistance to change and adherence to the status quo?

Chelsea Turgeon: Yes, I think any change is going to be too slow and too small, and it’ll be too little, too late. People are burning out. People are having really dire health consequences. The people who come to me often have their autoimmune disease flaring up, headaches, all these chronic issues. Right now, I don’t see any clear path toward a solution, so I think it’s a grassroots vibe: people get themselves out, take care of themselves, and we’ll see what happens with the system.

Kevin Pho: We’re talking to Chelsea Turgeon. She’s a physician coach. Today’s KevinMD article is “Why does leaving medicine feel like escaping a cult?” Chelsea, let’s end with some take-home messages that you want to leave with the KevinMD audience.

Chelsea Turgeon: Yes. I want you to know that your lived experience matters, and it’s the most important data point you can have when you’re making any career decision. When I say “lived experience,” what I mean is how you feel matters. It’s OK to honor your feelings and to know that whatever you’re experiencing is real and true, and you get to honor that.

Kevin Pho: Chelsea, thank you so much for sharing your perspective and insight, and thanks again for coming back on the show.

Chelsea Turgeon: Thank you for having me.