Four rigorous years, filled with countless long days and nights of education, is often just the beginning for most medical trainees. The Match and subsequent residency await on the horizon. It is the norm in health care, and very few stray from that path. But medicine is a long and arduous path, one that can take its toll on trainees and physicians alike.
As I entered my final year of medical school, something felt off. As much as I was invested in this path forward, I felt drained and unsure. As someone with chronic illnesses, I was particularly burnt out from being constantly surrounded by illness and suffering. I found myself struggling to show up to the hospital at my best, despite wanting to give my all in caring for patients. Surely residency and a life in clinical practice were not the only option after medical school. I decided to probe this question further and see what else was possible aside from a white coat career. As a result, I have made the decision to forgo residency applications and pursue a career outside of clinical medicine. It is probably the best decision that I could have made, for my career and for my health.
My story is not unique; an increasing number of physicians and trainees are stepping away from medicine each year. A November 2023 article from the American Medical Association reported that 40 percent of doctors were contemplating or set on exits from their current organization within the next two years, highlighting a significant exodus from the field. The reasons for this departure are multifactorial, including rising burnout rates, dissatisfaction with working conditions, bureaucratic red tape, and newfound work-life balance expectations, especially among younger trainees. Even among medical students, rising debt and stress levels have an impact and take their toll.
Burnout—one of the main drivers—has been examined heavily within medicine. In the early 2000s, rates of burnout among physicians were 25 percent. However, pre-pandemic rates jumped to as high as 40 percent, one physician writes. During the COVID-19 pandemic, when burnout rates were as high as 60 percent within medicine, the broader societal re-evaluation of work-life balance expectations found its way into the field. Burnout is a serious problem in health care; a recent Washington Post report found that doctors struggle with burnout and depression at higher rates than the public. They are additionally twice as likely to die by suicide, a grim statistic that is further exacerbated by fears of mental health disclosure affecting one’s medical licensure. Significant stigma and an expectation that doctors are to be “perfect” are creating an atmosphere where treatment-seeking is discouraged and potentially punished, at the expense of the well-being of the physician.
Within the American health care system, administrative responsibilities, navigating insurance, and other job-related stressors have become a regular part of a practicing physician’s day, eating into the actual time spent caring for patients. A study published in the Annals of Internal Medicine found that for every hour spent seeing a patient, a provider spent nearly two additional hours on documentation and other desk work each day. What was once a noble pursuit to impact the health of others has become complicated by a myriad of extraneous factors that are affecting the very ability to deliver meaningful care, driving some out the door.
Going through medical training and becoming a physician is not the end all. The skills acquired during training, namely critical thinking, complex problem solving, and working within a fast-paced environment, are essential in a lot of roles, making trainees and physicians top candidates when exploring careers outside of clinical medicine. With an MD there are a variety of career options that exist that allow you to leverage your medical experience in a non-clinical way. Health tech, consulting, and other finance roles actively recruit MDs for their expertise, often offering a career with better hours, flexibility, and at times higher pay. Other roles, such as medical writing and medical science liaison work, offer similar benefits outside of clinical medicine, providing better work-life balance for those contemplating a switch in careers.
This current exodus comes at a cost, however: With the Association of American Medical Colleges predicting there to be a shortage of 124,000 physicians by 2034, something must be done about the conditions that are compelling doctors to leave the field. First and foremost, the workplace must improve. The causes of burnout—long working hours, piling administrative responsibilities, inadequate mental health coverage—need to be addressed. The pathway to becoming a physician is grueling and often without measures to support an individual through the process. There needs to be a decrease in the stigma around mental health treatment to improve the management of stress during while training or practicing, especially at a time when physician anxiety, depression, and suicide are on the rise. The administrative and bureaucratic burdens that have crept into practice need to lessen, either through the help of AI technologies or new policies aimed at reducing this load. Overall, there needs to be an adoption of flexibility within medicine; it is not a one-size-fits-all career, and allowing physicians to better tailor their careers to their overall life may help with retaining those who are contemplating leaving.
While I am by no means encouraging doctors to leave medicine, I am advocating for the field to have a moment of reflection. We can only be the best practitioners for our patients when we are at our best personally. The field of medicine is one that demands this standard, for the sake of our patients. But if burnout or some other factor is taking that passion away and interfering with life, it is predictable that some will re-evaluate their career choices. Sometimes sticking with the norm can cause more harm than good when more sustainable options exist.
Christopher Nmai is a medical student.
