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Physician and coach Jessie Mahoney discusses her article “Stepping down in medicine is an evolution.” In this episode, Jessie challenges the cultural belief that stepping down from medical roles is a sign of weakness, reframing it instead as “graduating.” She explains how physicians often hold onto positions out of fear, habit, or identity attachment, even after the role no longer fuels them. Jessie shares how recognizing restlessness, depletion, or loss of joy can serve as invitations to evolve rather than warnings of failure. She introduces tools like Martha Beck’s Body Compass to guide decision-making and advocates for normalizing transitions as a courageous act that benefits both physicians and their colleagues. Listeners will learn how letting go before burnout can open space for new growth, fulfillment, and trust in the medical community.

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Transcript

Kevin Pho: Hi, welcome to the show. Subscribe at KevinMD.com/podcast. Today we welcome back Jessie Mahoney, pediatrician and coach. Today’s KevinMD article is “Stepping down in medicine is an evolution.” Jessie, welcome back to the show.

Jessie Mahoney: Thanks so much for having me again.

Kevin Pho: All right. Tell us what your latest article’s about.

Jessie Mahoney: This article was really written to dismantle this idea that leaving or stepping down from a role is a weakness or a failure. And to shift our thoughts about enduring being the important thing in medicine. We’re taught that you should endure no matter the cost, and I think we often don’t even see the cost.

Kevin Pho: What are examples that you’re talking about when you say stepping down?

Jessie Mahoney: I wrote this because I recently stepped down from something I’ve been doing for over 5 years. I’ve been leading the task force on wellness for my local medical society, and it’s a job I like. I’m passionate about the topic and I am still providing tremendous value.

And my thought was, “I can’t step down because I’m the best person to do this job. Or I’m experienced and who will take the job?” We take on all that when we step down. I also had this inner knowing that my journey was complete there. Once I made the decision, I let them know. I had this tremendous sense of relief and clarity that, “Wow, that was exactly what I was supposed to be doing.”

I realized that I’m creating a space for someone else to step into leadership who is going to learn and grow. I was not learning and growing. At that point, I had been doing it for a long time. I was complete in that journey. It reminded me that so often we have chiefs who have been there for 20 years, 30 years. When you have a job and you’re doing a good job, the expectation is that you’ll stay. How often do people stay until they’re not doing a good job? Until they’re super depleted?

They’ll stay in a job that’s not energizing them, even if it’s an important job and even if you’re good at it. I always like to point that out because we think we can’t step down if it’s important or we’re good at it. Yet our experience in medicine would be so different if we considered graduating.

I love the word graduating because we don’t want to stay in high school forever. We want to go to college. We need to make space for those behind us to step up. But once we finish medical school and residency, we stop graduating. We glorify the chair who’s been doing it for 25 years, and I just wonder how things would feel if we let go of things that were routine and not energizing us and had shifts of energy and change.

Kevin Pho: There’s a little bit of dissonance there. On one hand, you know that you’re the best qualified or best person for that position. But on the other, you felt that your journey was complete in that position. Talk to us about those two competing feelings.

Jessie Mahoney: Well, I think the competing feeling comes from the fact that while you might be the best person in that moment, that’s our scarcity mindset: “Nobody else could do it as well, or they definitely won’t do it the same way you do it.” But there still can be value for someone else to step in and learn.

We have the culture in medicine of training those behind us and letting them be not as qualified until they become as qualified or overqualified. Yet when it comes to these roles or leadership roles, we don’t make room for that. I think we also see this when people are in a practice and they say, “I have to stay. I need to stay because people are dependent on me.” But it comes from a scarcity mindset.

I do believe that while maybe I’m the best person, there are probably other equally good people who are going to bring something different, and that will allow for more evolution and more shift. I think we have a lot of stagnancy in medicine because we just hold on to that. And so I think it’s really an interesting way to shift how we think about things.

It’s scary to step down because your thought is, “What if they can’t find someone? What if stepping down actually is not good for me?” This is the one I hear the most often: “What if nothing comes in to fill that space?” But when you create the space, lots of things come in.

It’s almost like you’re in college, but you’re commuting back to your hometown to go to high school one day a week by keeping this job, and so you’re really getting in the way of your own evolution, which is part of why we’re burnt out.

Kevin Pho: How did you know that your journey in that role was complete?

Jessie Mahoney: I have done a lot of work on connecting with how I feel because in medicine we were trained to not feel. The early signs are this sense of discontent or being unsettled. It’s often irritation and frustration at things that really shouldn’t irritate you or frustrate you.

And I think that we then judge that as, “Something wrong with me,” or we start blaming other people when it can just be that you are complete. There is a tool that I use often for myself and others when thinking about changing, which comes from Martha Beck’s training, and she calls it the body compass. I think for people in medicine, where we have completely disconnected from our body, we’re used to being uncomfortable.

We’re used to having things not feel like a fit. It can get you out of the brain’s thought of fear and into how you feel about it. And so that really looks at this: When you think about this role, what is it from a minus 10 to a plus 10, and any number that you feel there? Being really honest, I find I have to get quiet to ask this question.

Because we’re trained in medicine to scan the world with our eyes, I have to close my eyes; otherwise, I have no idea. I do the hand-to-heart and ask that question. Even if it’s a zero, that information can guide you. “Oh, this is a neutral spot.” It’s still information.

It doesn’t have to be, “Oh, it’s a negative 10.” You can leave a role before it’s a negative 10 and it’s information for the future. Because you might say, “Well, it’s a zero, so I’m going to do one more meeting, see how I feel. I’m going to do one more round.” Many things have term limits, for example.

But you also don’t have to wait for a term limit. I think we’re so used to not making change in medicine, but reconnecting to how your body feels. It’s often super subtle because we don’t allow ourselves to be super annoyed and frustrated. “That’s not OK.” It’s this vaguely unsettled feeling of, “Wow. I don’t know if this is right for me.” Or maybe you don’t want to go to the meeting even though it’s something you care about.

I think that can be a clue that it’s not energizing you; it doesn’t feel exciting anymore. We’re so used to doing things that don’t energize us and don’t excite us, and doing them when we’re exhausted and depleted, but we’re afraid of space. Creating this space. When you create this space, something cool, inevitably inspiring, exciting, a different role can step in. When we let go of something, we create space for someone else and space for you.

Kevin Pho: Now when you coach physicians or talk to your colleagues and sometimes you see it would be a better option for them to step down, but as you said, the culture of medicine prevents them from doing so. How do you get them to potentially make that leap?

Jessie Mahoney: It takes courage. I think I often point out that you have discomfort. There’s discomfort in changing, but there’s discomfort in where you are. We just discount that. If you’re going to sit in discomfort, do you want to sit in discomfort and continue to get the outcome that you have, or sit in discomfort so you can get to somewhere else?

The other thing that helps physicians do this is the idea that they’re helping someone else by giving them a chance to step in. We often won’t do these things for ourselves, but we will do them for other people. The other thought that I will sometimes use that was very effective for me in making choices is: What will the world miss out on if I don’t step down? What will I miss out on? What will others miss out on? What potential could come from shifting into something different?

I think we would never want our children to stay doing something that was no longer serving them where they were not growing. We wouldn’t say, “You have to stay in elementary school.” So this idea that we’re all here to grow and develop.

We have this idea as a pediatrician. We are in developmental phases, but somehow in medicine, when you finish residency or fellowship, you’re complete. “There’s no more growing. There’s no more changing.” It’s part of why medicine feels so heavy. What if we all had permission or seasons or chapters?

Maybe this is your chapter of working for a big organization. Maybe your next chapter is private practice, or your next chapter is advocacy, and that they can have overlapping spheres. But recognizing that this idea of being a physician for 30 years in one spot, being this one role, maybe doesn’t fit the world as it is today.

Kevin Pho: You mentioned that sometimes stepping down and having someone else go into that role can inject that organization with new ideas. What’s an example of that? Just give us a story of that in action. What would that look like? And have you encountered or talked to one of your colleagues or coached someone where that actually happened?

Jessie Mahoney: Well, it happens all the time. I’ll just give a personal example. At one point, I had been the site chief of my own department, and I will say I was hopefully doing a really good job. I didn’t step down because it wasn’t working anymore, but I needed more space for other things.

So when I stepped down, someone else had the opportunity to step in and he approached it very differently. That brings an energy of change and an encouragement for other people to change, and that really changed how the department felt for lots of people.

Again, I think we are so used to, we notice it when someone leaves after 20 years, 30 years, then it’s OK for them to leave because they’re about to retire. But if we have this infusion of energy and shifted focus, maybe their focus is on something different. They have a different way of seeing the same problem.

I think part of our challenge we’ve talked about is judgment. “There’s a right way to see it and this is the way to see the problem.” But what if there are many ways to see the problem? Medicine is so complex, and departmental management, organization, structure, and strategy really do need a fresh perspective.

When we’ve been seeing something in one way, which as a human being is just what we do, having someone else come in might shuffle the way that lots of things get done. That is actually what we need in medicine. Medicine changes so fast that it can bring an infusion of completely different new ideas.

Kevin Pho: We’re talking to Jessie Mahoney, pediatrician and coach. Today’s KevinMD article is “Stepping down in medicine is an evolution.” Jessie, as always, we’ll end with some take-home messages that you want to leave with the KevinMD audience.

Jessie Mahoney: My message would be to leave before there’s collapse or a crisis, or, “I just can’t do it anymore.” Remembering that we’re trained to endure and that those subtle signs of discomfort or being unsettled can be clues that it’s time for you to do something else. That’s not a failing; it’s an opportunity for you to evolve, for others to evolve, and for medicine to evolve.

Kevin Pho: Jessie, as always, thank you so much for sharing your perspective and insight. Thanks again for coming back on the show.

Jessie Mahoney: Thanks for having me.