The slogan of my high school was a verse from Proverbs: “Educate a child according to his way, and even when he is old, he will not depart from it.”

I thought about that line a lot in PA school. And again in law school. And again last year, finishing my MBA at the USC Marshall School of Business in my late thirties.

My mother wanted me to be a doctor. Not a health care professional, broadly. A doctor. MD or nothing. She wanted to see me in a white lab coat, and as her only child, I understood early that the lab coat wasn’t really about me. It was about her. What she’d worked for, what she’d hoped, what she wanted for me.

My father was different. He never tried to steer me toward anything in particular. He supported me doing whatever I wanted to do. That sounds simple, but in practice it was the harder kind of parenting. He gave me the freedom to choose, which meant the choice was actually mine, which meant I had to live with it.

I also heard, from various directions, that I’d be broke if I went to law school. Too many lawyers. Saturated market. I believed enough of it to factor it in. At eighteen, the safer story was health care.

So I compromised. USC for undergrad, then the PA program at City University of New York. I delivered the lab coat. For seven years I wore it.

I’m glad it went the way it did. I learned a tremendous amount in clinical practice that I use every single day in my legal work. The journey wasn’t linear, but each chapter taught me something I couldn’t have learned any other way.

I’m writing this because clinicians reach out to me regularly asking about leaving medicine for law. There’s no shortage of pieces about burnout. There are fewer pieces about why people went into medicine in the first place, and what that means for whether they should leave.

The threshold question

It’s almost never what should I do? The real question, when you sit with it, is whose voice is in my head telling me to stay?

For some people it’s a parent. For some it’s a spouse. For some it’s the cautionary stories they absorbed in their twenties. For some it’s the version of themselves they were at twenty-two, who made a decision their thirty-five-year-old self is now obligated to honor.

The voice has to be identified before any of the rest of the conversation matters. Most of the burned-out clinicians I talk to are not actually burned out on medicine. They’re burned out on living a life someone else chose for them. Those are different problems with different solutions.

The daily friction of practice

Most of clinical practice is not the satisfying part. It’s the calls to insurance companies arguing about prior authorizations. It’s the imaging study you ordered three weeks ago that’s still pending review. It’s the patient who needs physical therapy now, who’s been waiting six weeks for the referral to be approved, who is meanwhile getting worse because the window for early rehab is closing. It’s the medication that worked for them last year that’s now off the formulary.

The clinical decision making, the actual reason you went to school for this, ends up being maybe a quarter of the job. The rest is administrative friction with the systems that are supposed to be helping your patients get better. It’s not dramatic. It’s not the kind of thing that makes you quit on any given day. But it accumulates.

Practicing in pain medicine

I worked in pain medicine. By the end, the job looked like this: Urine drug screens, every visit. CURES report reviews, every visit. Morphine equivalent calculations. Opioid taper plans for patients who’d been on stable regimens for many years before the guidelines changed. Patients in the chair across from me, in real distress, while I tried to figure out, in fifteen minutes, whether they had a legitimate injury, were drug seeking, were diverting, or some combination of the three.

I was trained to take care of people. The job, by the end, felt closer to working for the DEA. I was a verifier, a gatekeeper, an enforcer. The therapeutic relationship I’d gone into health care to have was almost entirely subordinated to the regulatory architecture built around it.

The regulatory architecture, in turn, kept changing. The 2016 CDC guideline pushed clinicians toward a 50 MME ceiling, and what was framed as a recommendation became, in practice, a hard line that clinicians, pharmacies, and payers enforced as policy. Hydrocodone combinations like Norco moved from Schedule III to Schedule II, which meant no refills, no phone-in prescriptions, and a paper trail for every encounter. Every visit became a risk-mitigation exercise. The clinical question was no longer just what would help this patient. It was also: What does this look like if my chart is audited, if my license is reviewed, if I am the next clinician named in a malpractice suit over an opioid death I had nothing to do with? Patients felt the shift before clinicians admitted to it. They knew they were being managed defensively, and the trust that had taken years to build started to thin.

There’s a particular kind of moral fatigue that builds up when your clinical role and your patients’ interests are in structural tension. The clinicians I worked with were doing their best. The patients were doing their best. The system itself had become something nobody had quite signed up for.

I left because I could see the next ten years if I stayed, and I didn’t want them.

What clinical work gave me

I miss some of my patients, specifically. The chronic pain patients who came in every month for years, who told me about their lives and the small wars they were fighting with their bodies. I cared about those people. I think about a few of them often.

What I miss is harder to name. Even in a pain clinic, where the relationships were complicated and sometimes adversarial in their own way, the work was still oriented around a clinical goal. Someone was trying to get better, or trying to function, or trying to manage something that wasn’t going to fully resolve. That orientation, even when the relationships around it were strained, gave the work a center.

Litigation has a different center. The work is oriented around proving something, recovering something, or denying something. Both are legitimate. They feel different to live inside. There is no version of a personal injury case where the plaintiff, the defendant, and the carrier all agree on what matters next, and I didn’t realize how much of my baseline contentment in clinical work came from being in an environment that, however strained, was still organized around a clinical goal.

I don’t miss the urine cups. I don’t miss the prior authorization calls. But I miss the people, and I miss being part of work that, whatever else it was, still had a clinical center.

Advice for clinicians considering the transition

• Identify the voice: If you’re staying because of someone else’s dream, or someone else’s warning, no career move solves that.
• Be specific about what’s broken: I didn’t leave medicine. I left a particular kind of medicine, in a particular regulatory moment. If I’d been doing dermatology in private practice, I might still be a PA. The honest question isn’t is medicine for me, it’s is this version of medicine, in this setting, sustainable for me.
• Your clinical training is not a sunk cost: It is one of the most transferable credentials in the working world. Pharma, medical devices, health tech, health care consulting, hospital administration, public health, biotech investing, regulatory affairs, medical writing, health care law. Every one of these fields needs people who actually understand medicine, and almost none of them have enough.
• Bring the clinician with you: I still pattern match when I read medical records. I still notice when reported symptoms don’t track with the documented physical exam. Those instincts make me a better attorney, not a worse one. Don’t try to leave the clinician behind. The whole point is that you bring it with you.
• Some people shouldn’t do this: Some clinicians who reach out are not unhappy with medicine; they’re unhappy with their administrator, their schedule, their setting. The right move is to identify what’s actually broken before changing careers. A career change is an expensive answer to the wrong question.

Closing reflection

I read the opening verse correctly at eighteen. I just couldn’t act on it. I knew the way I was supposed to go and I was afraid of what would happen if I tried. Afraid of the debt. Afraid of being wrong. Afraid the path I actually wanted wouldn’t work out. But more than any of that, I was afraid of letting my mom down. So I chose the fear I could live with.

What I understand now is that I wasn’t departing from the way. I was taking the long route through it. The way you’re meant to go pulls at you. You can suppress it for years. You can compromise honorably and serve people you love in the process. But you don’t actually depart from it, even when you think you have.

I was educated to take care of people and to think hard about how systems treat them. PA school taught me to take care of people. Pain medicine taught me, painfully, what happens when systems fail the people they’re built to serve. Law school and the MBA taught me how to think about those systems and how to push back on them.

If you’re a clinician reading this and something in it sounds familiar, find the slowest, quietest version of the question and ask it of yourself. Not should I leave medicine, but whose life am I currently living, and is it mine?

The answer doesn’t have to be a career change. The question is the same either way, and you owe yourself the time to sit with it before you answer.

Michael Geller is an attorney.