I am not a Mormon male. But for fifteen years, I had been doing a remarkably good impression of one. And then, on a Wednesday evening in May 2026, I was outed.
The termination letter was two pages, formal and bloodless. Ninety days’ notice, effective August 31. “With or without cause,” it said, a phrase that is perfectly designed to be both legally protective and humanly devastating. It was signed by two physicians I had trained myself, in a practice I had founded.
I sat with that letter for a long time. I had never been terminated from anything. Not a job, not a committee, not a volunteer position. I was the goody-goody, the rule-follower, the one who stayed late and tried harder and absorbed conditions that would have sent a reasonable person packing years earlier. No medical assistant for nine months? I’ll manage. Office that hasn’t been cleaned in months, un-air-conditioned? I’ll work around it. I was the founder. I had built this from nothing. Surely if I just kept showing up, kept trying, kept being excellent, it would work itself out.
It did not work itself out.
Let me back up. I am a physiatrist and sports medicine physician, fifty-five years old, trained at Mayo, residency at the University of Utah, chief resident, Outstanding Resident of the Year, full-tuition medical school merit scholarship, published researcher. I went to medical school on a humanitarian scholarship that sent me to Nepal to provide rural health care. I did search and rescue at Denali. I am, by any conventional measure, someone who has done the work.
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In 2004, I founded a solo practice in rural Oregon from scratch, grew it, added a second provider, and then did it all again in Idaho in 2008, building what became a multi-physician musculoskeletal and rehabilitation practice, eventually adding a Regenexx regenerative medicine affiliate. I did this in southeastern Idaho, in a community of physicians that is heavily Mormon male. When I arrived in 2008, I was one of three female physicians practicing in town. Despite being different from the local cultural norm, I trained physicians, I mentored mid-levels, I showed up every single day for nearly two decades.
And then, in 2019, I was sued.
I won’t detail the specifics. What I will tell you is that it went all the way to a jury trial, and the jury found in my favor. I want you to understand what that sentence contains: years of depositions, of having my clinical judgment scrutinized by people who were not in the room, of lying awake replaying every decision I had ever made for a patient I had genuinely tried to help. I won. And winning, it turns out, does not erase what the process costs you.
I did eye movement desensitization and reprocessing (EMDR) therapy afterward and it helped. I came back to work without the anxiety, without the anger, and I believed, genuinely believed, that I had processed it and moved on.
What I had not understood was that the lawsuit was not an isolated event. It was the first chapter of a much longer story about what corporate medicine was doing to me, quietly, steadily, over years.
What I have not yet told you is that I had sold the practice to a hospital system years earlier. The two physicians who signed my termination letter did not act alone; they acted within a corporate structure that enabled them, that conflict-avoided when I raised concerns, and that prioritized institutional comfort over the physicians working inside it. This is not a story about two bad actors. It is a story about what corporate medicine does when excellence becomes inconvenient.
When physicians talk about burnout, we tend to picture a specific kind of suffering: the emergency medicine physician seeing her hundredth patient of a 30-hour shift, the primary care doctor buried under 8-minute appointments and an inbox that refills itself like a cursed well. We picture volume, acute trauma, impossible hours.
I was working 20 to 25 hours a week.
By the conventional metrics, I did not qualify as burned out. And so I did not call it that. I called it difficult circumstances. I called it a rough patch. I called it something I could work through if I just kept trying. What I was experiencing had a different name: moral injury.
Moral injury is not burnout from overwork. It is burnout from betrayal, the specific exhaustion that comes from being repeatedly prevented from practicing according to your values, from watching a system you helped build fail to meet the standard you set for it, from staying and trying harder in a place that has quietly communicated, in a thousand small ways, that it does not see you and does not value you.
I had been experiencing moral injury for at least two years before the termination letter arrived. I just didn’t have the language for it. And without the language, I kept doing what goody-goodies do and what I had been trained to do as a physician: I absorbed it, I adapted, and I tried harder.
Here is something I understood only in retrospect, after a friend who is a former Mormon helped me see it clearly: I had spent fifteen years practicing medicine inside a culture built around the authority of Mormon men, a culture of relentless surface pleasantness, of hierarchy presented as harmony, of an unspoken assumption that certain people belonged at the center of things and others were there by invitation. I am a woman. I am not Mormon. I am not male. I founded the practice they were running.
I was never going to fully belong. And the more excellent I became, the more threatening that excellence was, because excellence in someone who doesn’t fit the cultural template doesn’t get celebrated. It gets managed.
The termination, in this light, was not about my performance. It was about their comfort. Understanding that distinction was one of the most liberating realizations of my professional life.
The weeks after the letter arrived were not my finest hours. I did not sleep well. I would fall toward sleep and then jolt awake, replaying conversations, composing the perfect response I would never send, cycling through shame and fury and grief in no particular order. I questioned whether I deserved to feel this bad. I had not been working crushing hours. I had financial security. I had options. Did I really qualify for this level of distress?
I want to speak directly to any physician reading this who has asked themselves the same question: yes. You qualify. The number of hours you worked is not the measure of whether you are allowed to be devastated. What matters is what those hours cost you, and what the system took from you that cannot be measured in time.
I eventually called the Physician Support Line: 1-888-409-0141, free, confidential, run entirely by volunteer psychiatrists, open to any physician who needs to talk to someone who understands from the inside. I had almost not called because I was afraid of taking up space meant for someone in more acute distress. The volunteer on the other end of the line would have found that reasoning both familiar and completely wrong.
I returned to EMDR therapy. I went backpacking in the White Clouds with my husband and two friends. I climbed the South Teton. I watched my son guide whitewater in Stanley, Idaho, and let the river do what rivers do. I learned, slowly, to distinguish between the exhaustion of genuine burnout and the temporary disorientation of a nervous system that had been running a threat response for too long and needed time to unclench.
The mountains helped more than I can adequately explain. I do my best thinking on trails, at altitude, with my body working and my mind finally quiet enough to hear itself. Somewhere on a run in Stanley, I reached a number (I got up to $100 million) and realized there was no amount of money that would send me back to what I had left. I value myself too much. That felt like real freedom.
I am throwing myself a graduation party on September 11, 2026. The invitations say “Graduation from Corporate Medicine, Class of 2026.” My attorney made me include a disclaimer that I am not actively practicing in a competing location. My attorney also, apparently, has no idea who she is dealing with.
I am on sabbatical. I do not know yet what comes next. I have a micro-practice idea: menopausal women and musculoskeletal consults, built slowly on word of mouth with overhead so low it barely qualifies as overhead. I have mountains I have not yet climbed. I have a husband who is healthy and present and here, and I have been thinking carefully about what I want the next ten years to look like while he is still in the best health of his life. I have a nervous system that is, for the first time in years, beginning to feel like my own again.
What I know is this: I am not the burned-out physician I thought I didn’t qualify to be. I am a physician who loved her work and her patients so completely that she stayed in a situation that was slowly eroding her, because leaving felt like abandonment. What finally liberated me was not a brave decision to walk away. It was two small people making a small, frightened decision that accidentally handed me my life back.
I am grateful to them. Not because what they did was right. It wasn’t. But because sometimes the wrong people do the right thing entirely by accident, and sometimes the door that gets closed behind you turns out to be the one that was keeping you in.
If you are reading this at 2 a.m., replaying a conversation you can’t stop hearing, wondering if what you’re feeling is real or valid or serious enough to deserve attention, I want you to know something. It is real. It is valid. And the fact that you are asking whether it is serious enough is itself the answer.
You do not have to have seen nine million COVID patients to be allowed to be broken by what medicine has asked of you. You do not have to have worked impossible hours to have given more than was sustainable. Moral injury is quiet and cumulative and it does not announce itself. It just slowly makes you someone you don’t recognize, until one day you get a letter that says “with or without cause” and your whole nervous system finally says: this. This is what I have been trying to tell you.
Call the Physician Support Line. Find an EMDR therapist. Go outside and move your body in a place that reminds you that you are more than your credentials and your billing codes and your inbox. Let the mountain (or the ocean, or the trail, or whatever landscape tells the truth for you) remind you who you actually are.
You built something. You showed up. You loved your patients and your work with everything you had.
That is not a small thing. That is everything.
And if the institution you built it inside of couldn’t see that, well. That is a verdict about them, not about you.
Everything is always working out for me. I believe it will always work out for you, too.
Sarah A. Vlach is a physiatrist and sports medicine physician based in Victor, Idaho, at the base of the Teton Range. She trained at Mayo Medical School and completed her residency at the University of Utah, where she served as chief resident and received the Outstanding Resident of the Year Award.
She has founded two independent medical practices, most recently serving as the exclusive Idaho affiliate of Regenexx, a national regenerative medicine network. Her clinical interests include precision musculoskeletal care, regenerative orthobiologics, acupuncture, and women’s health. Her earlier research on pain perception in electrodiagnostic testing and on cardiac outcomes in children has appeared in Archives of Physical Medicine and Rehabilitation, the Journal of the American College of Cardiology, and Pediatric Research.
After nearly two decades in corporate medicine, she is on sabbatical: resting, recovering, and figuring out what comes next. She lives in the mountains, moves in them daily, and does her best thinking on trails at altitude. She can be found on LinkedIn.
