Introduction

When I first arrived in North Carolina several years ago, I thought happiness would come easily. I had completed my medical education in Nepal, was ready to serve as a physician in the U.S. health care system, and carried the excitement of new beginnings. But I learned that happiness is not automatic—especially for physicians navigating American health care while maintaining their sense of purpose.

The transition from practicing medicine in Nepal to establishing myself here was both challenging and transformative. Back home, I could speak my patients’ language of pain and understood their cultural context. Here, I had to rebuild not just my medical practice, but my entire approach to patient care and professional fulfillment.

As physicians, we often focus intensely on our patients’ well-being while neglecting our own. Today, as I run my rheumatology practice, I’ve discovered that sustainable happiness rests on four interconnected pillars I want to share with fellow physicians seeking balance and meaning.

Faith: Finding purpose beyond the prescription pad

Faith—whether spiritual, philosophical, or simply a deep sense of purpose—has been my anchor throughout my medical career. Growing up in Nepal, Eastern teachings shaped my understanding of service. The concept of “dharma” from the Bhagavad Gita became particularly relevant: performing righteous action without attachment to results.

This philosophy transformed how I approach patient care. Instead of being driven primarily by financial outcomes or professional recognition, I focus on serving each patient with complete dedication. When I see a young mother who can no longer hold her baby due to rheumatoid arthritis, I’m not just treating inflammation—I’m participating in something larger than myself.

The practice of mindfulness has become essential to my daily routine. Before seeing patients, I center myself, remembering that each person deserves my full attention and compassion. This transforms clinical work from routine medical care to meaningful service.

In those early, often daunting days of building my practice—navigating insurance complexities, staff shortages, and financial uncertainty—I continually returned to that deeper sense of purpose. Ancient teachings about maintaining composure through both triumph and setback guided my approach to entrepreneurship, helping me face each challenge with resilience. The administrative work—strategic planning, compliance, and financial oversight—became an extension of my service, a necessary stewardship to ensure my practice remained a sustainable force for healing.

Family: Redefining work-life integration

As physicians, we often struggle with work-life balance. The reality is that medicine is demanding, and traditional balance may be unrealistic. Instead, I’ve learned to focus on work-life integration—aligning my professional calling with family values.

As a father of two and husband to a woman pursuing her own health care mission, I’ve discovered that family support is crucial for sustainable medical practice. My wife dreams of serving the Indo-Nepalese community by supporting new mothers. Watching her passion taught me that successful families in medicine often involve both partners pursuing meaningful work while supporting each other’s missions.

Running a medical practice while raising young children has taught me that “family” extends beyond blood relatives. My patients have become extended family—especially elderly patients who remind me why I chose medicine. My clinic staff has become family too, as we work together with shared values and purpose. Family means any circle of belonging that reminds you that your work has meaning beyond yourself and that you’re not alone in medical practice challenges.

Meaningful work: From employment to entrepreneurship

The transition from employed physician to running my own practice—Empowered Arthritis and Rheumatology Center PLLC—forced me to reconnect with medicine’s deeper purpose beyond productivity metrics and RVU targets. This reminded me why I chose rheumatology: the opportunity to dramatically improve patients’ quality of life through comprehensive, compassionate care.

Starting my own practice allowed me to implement a patient-centered philosophy more fully. I could take adequate time with patients, listen to their complete stories, and address not just physical symptoms but their fears and hopes. The business aspects became acts of stewardship, ensuring this vehicle for healing remains sustainable.

I’ve found deep meaning in mentoring young physicians, particularly those from immigrant backgrounds, sharing strategies for maintaining cultural identity while excelling in American health care. Teaching them to honor their values while providing excellent patient care has become another form of service. Meaningful work in medicine isn’t just about clinical excellence—it’s about creating systems and relationships that allow you to practice medicine as you envisioned when you first chose this profession.

Friends: The colleagues who sustain us

Building meaningful connections with colleagues—both within and outside our specialty—is crucial for personal well-being and professional growth. The early days of establishing my practice were isolating. Long clinic hours, family time, and business management demands left little energy for professional networking. I realized I was becoming clinically successful but professionally lonely.

Now, I’m intentionally building a community of physician colleagues who understand our unique challenges. Through medical societies and local physician groups, I’ve found practitioners who share similar values about patient care and professional integrity. Professional friendship requires the same intentionality as building a medical practice. You must show up consistently, offer support without expecting immediate returns, and create space for vulnerability. These relationships have become my informal board of advisors and accountability partners.

Integration: The synergy of all four pillars

These four pillars—faith, family, meaningful work, and friends—are interconnected foundations that strengthen each other. When grounded in purpose, I show up more patiently for family and patients. When fulfilled in work, I have more energy for colleagues and community. When professional relationships support me, I better serve others and guide my family.

I’m not perfect at balancing all four pillars. There have been seasons when practice demands dominated everything, when family felt neglected, when I drifted from purpose, or when professional relationships grew quiet. But I’ve learned to recognize these imbalances and gently work to restore equilibrium.

A call to reflection

As physicians, we dedicate our lives to healing others but often neglect our own well-being. High rates of physician burnout remind us that clinical excellence alone isn’t enough for a fulfilling career.

My journey from Nepal to running a successful rheumatology practice has taught me that true professional satisfaction comes from nurturing the foundations that sustain us as whole human beings:

• Faith that grounds us and gives meaning to our service
• Family that supports us and shares our mission
• Meaningful work that fulfills us and serves our community
• Friends that walk beside us and help us grow

Which pillar needs more of your attention today?

Whether you’re a resident starting your career, a mid-career physician feeling burned out, or a senior doctor considering retirement, these pillars can guide you toward more fulfilling and sustainable medical practice. Our patients need us to be not just clinically excellent, but personally fulfilled and professionally sustained.

Ananta Subedi is a rheumatologist.