Not long ago, my husband and I had a sobering realization: If we did not make major changes, we would regret spending our best years using every ounce of our energy on work. We accepted that exhaustion from our jobs was normal. Burnout became our status quo, and even a sabbatical didn’t create lasting well-being.

Unwilling to live with the regret of overworking, we ultimately made major changes and created careers that were fulfilling and healing. I started my own practice, and he took a job with less travel and more autonomy.

Now, after coaching hundreds of physicians through career change, I know that there are very predictable stages of change that doctors go through when transitioning from overworked and exhausted to a place of autonomy, purpose, and sustainability. I want to walk you through the stages of change that many doctors go through when transitioning from employed, overworked, and exhausted to a place of autonomy, purpose, and sustainability in their careers. Whether you’re building a practice or leading within an organization, this transformation follows a predictable pattern.

Stage 1: Stuck – This is just how it is

At this stage, burnout feels like your default state. You’re exhausted, drowning in admin tasks, and may feel like there’s no way out. First step? Edit what no longer serves you. If you’re severely burnt out, consider taking FMLA leave.

My number one recommendation for anyone in your position is to connect with someone outside of your circle. This can be a therapist, coach, or friend who can objectively offer help. It’s really hard to make good choices that aren’t reactionary when we’re depleted.

Decide what an ideal day would be like for you. Write it down. How does it feel? What are you doing and not doing? Compare what you’ve written to where you are. How big is the gap between what you want and where you are?

Then, something shifts. You start to notice.

Stage 2: Noticing – Something has to change

Here’s where you start realizing: I deserve a better life.

You recognize you’re suffering, but you may not know what to do about it yet. Noticing our suffering in medicine is like spotting a crack in a dam. At first, it’s barely visible—just a hairline fracture, easy to ignore. But once you see it, you can’t unsee it. You realize the pressure has been building for years. If you ignore it, the dam will eventually break. Something has to give. You don’t have to have the solution yet, but you know change is coming.

The act of noticing is like the first crack in the ice. It defrosts you. It starts to thaw the numbness, making space for self-compassion. You recognize that you don’t want to live like this.

Start by identifying your core values—what makes you you—and ask yourself if those values show up in your daily life. Who are you? This can be tough, but I promise you that you exist outside of what you do for a living.

• What do you love doing?
• What lights you up?
• What is your zone of genius?

Pay attention to resentment—it often points to misalignment with your values. If you feel it, lean in. It can be a huge clue to what really matters to you. When I was at this stage, a group of women in my neighborhood invited me to play tennis with them at 10 a.m. It was impossible for me to do it. I had zero white space in my day. I was resentful that I couldn’t just do it. This resentment was a compass pointing me to what I wanted and desperately needed.

Not all suffering is the same. The struggle of med school had a clear purpose, but your current grind? Maybe not. I’m grinding day after day, but I’m never, ever getting ahead.

Stage 3: Discovery – There has to be a better way

Now, you’re actively questioning whether the way you’ve been working is the only option. You’re realizing that your identity is bigger than your job. You recognize that you’re exhausted at the end of the day and have no energy for anyone or anything. You’re not living the life you want or expected. You regret where you are but refuse to accept that this is your only option.

Self-compassion is key. It’s’ OK to admit that your current situation is not OK and that you deserve better.

Fear of change will creep in. It’s normal! But this doesn’t have to be an all-or-nothing decision. The suffering we recognize can feel less terrifying than making a change.

Start researching alternatives, talking to people who’ve made career changes, and exploring what’s possible. Who is living the life you want? Who is doing this well? Get curious even if it feels wobbly.

Now it’s time to make some plans.

Stage 4: Data collection – I have options

This is where you move from idea to action:

• Can you adjust your current job to make it more tolerable?
• What organizations might align better with your values?
• Could you start your own practice in small, manageable steps?
• Begin financial planning and gathering the people and tools you’ll need.

“But the pension!” my husband would say whenever I came home from work and said, “I don’t think I can take this anymore.” My previous job had a great pension plan (or so I thought). I kept telling myself that I just needed to stick it out a little longer, and one day, I’d have financial security.

I dug into the numbers. After 15 years, I had vested for $1,200 per month. Is that enough for me to sacrifice my mental health to stay in an organization that no longer aligned with me?

It’s time.

Stage 5: Action – I’m really doing this!

Now, you’re making real moves—launching a business, switching jobs, or reclaiming control over your career. The key here is momentum:

• Set a launch date and work backward to map out your steps.
• Track your progress with key performance indicators (KPIs).
• If starting a practice, implement a marketing strategy and start building your patient base.
• Surround yourself with people who are making changes. The people who are stuck want you to stay stuck with them. Seeing you launch means they have to reconcile their own stuff. Miserable people are challenged when they see someone make changes that make them happy.

Where are you?

Do you recognize yourself in any of these stages? What do you need to do? What’s your next step?

You know how to manage complex illnesses. Starting a business or making a career change is not really that hard, and it’s certainly not as hard as anything else you’ve done.

Take one step today. Block time on your calendar. Make a call. Write down your vision. You’ve handled far tougher challenges. This is just the next one.

If you’re feeling stuck, know this: You are not powerless. Change doesn’t happen overnight, but taking even one small step today can start shifting you toward a career that cares for you and your patients.

Kara Pepper is an internal medicine physician.