I was in my car in the parking lot. It was a long day at the clinic. And I did not want to go back in the next morning.
Us doctors aren’t supposed to say that. When we feel it, we always repeat the same things to ourselves. “You’re tired.” “You’re burned out.” “You need sleep, or a vacation, or perspective, because do you have any idea what you have?” Those words rang in my head for nearly five years.
I wasn’t unhappy with medicine. I was unhappy with the terms it bound me to.
Nobody explains the math to you in residency. In an insurance-based practice, you are the product, and your ceiling is your own stamina. That’s the whole equation. Want to earn more? See more people. Want to work less? Earn less. And there’s no third option.
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Meanwhile the notes got longer and the visits got shorter. I wasn’t practicing medicine so much as running a small exhausting factory that happened to be located inside my own body.
Insurance keeps the lights on for most of American health care, and there are excellent doctors who build real careers inside it. I just wasn’t one of them.
Here’s the thing: I’d already learned the lesson once, and forgotten it.
I started my first online business back in 1997, as an intern, making intern money. It was a guide to help med school candidates get into the residency of their choice, something I’d just been through myself. My wife was pregnant, and she paused her job at the library.
My whole business plan was to cover the payment on my Toyota Tacoma. That’s all it did. It never touched the mortgage, it didn’t make us rich, and nobody was going to write about it. But in a year when we were about to have a kid, that little business covered that Tacoma payment every month, and I have thought about that more than I’ve thought about anything I built since. It was the first time I understood that what was in my head could produce money without me physically standing somewhere.
Then I graduated and spent five years forgetting I knew that. Eventually I built a few more things. One of them, an online marketing and software venture, did well enough that I could step away from clinical practice entirely.
But when I stepped away, something surprising happened: I missed it. Not the billing. Not the charting. God, not the charting. I missed the medicine. The patients.
So I came back. This time as an owner instead of an employee, running cash-pay clinics where I get to decide how long a visit takes.
Now, the part everybody leaves out of these essays. The first two years of that practice were awful. I’m not being modest. We furnished the place with used pieces that made IKEA look like a luxury brand. And every two weeks, payroll came at me like a wave I could see coming from a long way off. More than once I sat there deciding whether to pull from our personal savings to cover it. I considered even putting payroll on a credit card.
I have no MBA and I never wanted one. I learned by making expensive mistakes in front of people who were counting on me. Anyone telling you that exiting medicine is simple just wants to sell you a course.
But it worked. And the career I have now is one I actually picked, which turns out to feel nothing like the one I had in that parking lot.
Let’s think back for a second. If I were to talk to that guy in the car, here is what I’d say.
You’re allowed to want different terms. It’s not weakness and it’s not disloyalty to the profession. It took me five years to stop treating a completely reasonable feeling like a symptom.
Start before you’re ready, because ready isn’t coming. Build one thing that earns a dollar outside the exam room, like consulting, teaching, or a focused cash-pay service. Anything close to what you already know. It probably won’t change your life. Mine covered a truck payment. That was it, and that was enough, because its real job was never the money. Its job was to prove to me that I could do it at all, which sounds small and isn’t.
Stay in your lane, at least at first. Every doctor I’ve watched get badly hurt financially reached for something shiny and far from their expertise because a buddy made it look easy, like real estate, restaurants, and crypto. We all know someone like that. You spent a decade building knowledge people will pay for. Don’t set it down to go be an amateur somewhere else.
Lastly, learn the business. We give ten years to pathophysiology and roughly zero hours to how a contract works, how money actually moves, and how to read a partnership agreement before you sign it. Then we act surprised that we have no leverage. Remember, leaving insurance is not the same as leaving medicine.
I won’t pretend cash-pay is right for everyone. Some of you will read this and correctly decide that your patients or your specialty or your community need you exactly where you are. That’s a real answer and I wouldn’t argue with it.
But if you’re the one sitting in the parking lot with the keys in your hand, deciding the dread is a defect in you, consider that it might just be information.
Michael Woo-Ming is a physician entrepreneur.
