Leaving medicine isn’t a loss, it’s a translation problem [PODCAST]

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Leaving medicine can feel like erasing 20 years of work. What if it isn’t a loss at all, but a language problem you can solve? Physician executive Shveta Gupta, a pediatric hematologist-oncologist, joins to unpack why so many doctors quietly fuse their identity with the white coat, and why a change in role can feel like being sent back to zero. This episode is based on her article “Leaving medicine is a translation problem, not a loss,” published on KevinMD. You’ll hear the six words in a job interview that made her feel her whole career had been erased, why she calls this the “false zero,” and how the multidisciplinary rounds and hard family conversations you already lead translate directly into the language of leadership. Along the way she makes the case that you don’t need an MBA to do this, and that the healthcare world needs physician leaders whether it knows it or not. You’ll come away with a new way to name your worth, and concrete first steps to act on it.

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Transcript

Kevin Pho: Hi, and welcome to the show. Subscribe at KevinMD.com/podcast. Today we welcome Shveta Gupta. She’s a physician executive, and today’s KevinMD article is “Leaving medicine is a translation problem, not a loss.” Shveta, welcome to the show.

Shveta Gupta: Thank you, Kevin. I’m so excited to be here, and thank you for having me today.

Kevin Pho: All right, so let’s briefly share your story, and then we’ll jump into why you decided to write this particular article on KevinMD.

Shveta Gupta: Perfect. So Kevin, I’m a pediatric hematologist-oncologist and a physician executive. I’ve spent many years of the last decade in clinical academic medicine, caring for very sick children, building programs, leading physicians, being a physician, training physicians, and improving the systems around patient care. But over time, my work has also expanded to include medical affairs, clinical development, health tech, digital health, and advisory work, a little bit of a portfolio career, and I continue to build on physician leadership.

But what I really wanted to share is the deeper story behind this work, which became clear to me when I returned to the hospital that was very central to my identity. This is Children’s Hospital Los Angeles, and that’s where I did my residency and training. I went there recently with my family and with my now 10-year-old son, and I stood outside the hospital. I wanted to show him inside the hospital where mommy did this and mommy did that, and tell him all the stories.

What happened was something very ordinary, but it had very lasting effects on me. The security guard asked me to get a sticker and stand in a very long line to be able to get into the hospital. Well, appropriate request. I did not have my white coat. I did not have my badge. But what happened inside me really surprised me, along with a comment from my son: “Mommy, I thought you were really special, and you were here for such a long time. I thought they would remember you.”

The chord it struck in me is that the hospital held onto all my work but did not hold onto me. And all of a sudden I realized the fusion of identity with the white coat that had happened without me realizing it, and that I wanted this institution to remember me because of everything I gave to them.

I think that experience helped me see that when we have a change in our professional role, it’s not really only a career change. It’s a sense of belonging, credibility, history, and identity. And when that role changes, the question is not, what will I do next? It’s, who will I be if I’m not this? That question became the foundation of the book I’m writing, called The Second Apprenticeship, and it’s about the work of becoming legible to yourself when you’ve spent your life becoming recognized by medicine. So that’s how it led me to that article as well.

Kevin Pho: So tell me how you worked through that questioning of your identity, because this is a theme that comes up on my podcast a lot. As you know, becoming a doctor is very linear, right? You go through pre-med requirements, and then medical school, internship, residency, fellowship in your case, and there’s only one path, and it’s very difficult to divorce yourself from that path. So after you realize or start to question your identity, should you be more than a physician, or am I more than just a physician, tell us how you worked through those thoughts about your identity.

Shveta Gupta: I think the most important thing first is to recognize those feelings, because what we are really good at as physicians is suppressing anything that is not falling in line.

So like many physicians, I committed to medicine when I was 15. I trained in India. I joined medical school when I was 17. Looking at my child, who’s 10 right now, I don’t think that at 17 he’s going to know much about the world. I don’t think I knew anything about myself or the world when I committed to the next 20 years of my life.

So this is one interesting concept that I have come across: us signing an implicit contract that says be good, be exceptional, don’t go sideways, defer all your wants and needs, and you will have a life that is going to be meaningful and stable. You’re going to be OK financially, and you’re going to enjoy it. None of that is actually true. So that’s why I call it an implicit contract.

So once you start to feel that shift happening inside you, I think it’s very important to name it and not call it burnout or moral injury, because I think it’s something different. I wish I had known that a professional identity can become a home and a constraint at the same time.

When I entered medicine, as you said, our path is demanding, but it’s also clear. There’s a roadmap. There’s the next examination. There is the next credential. There is the next position, and there’s another person deciding whether I was ready. I got very good at being chosen, ranked, evaluated, and approved, and I was always waiting for permission to do something next. So to answer your question again, it’s important first to name it, to realize it, and then it deserves exploration.

Kevin Pho: So in your article you talk about leaving medicine, I guess leaving that identity. For those who didn’t get a chance to read your article, just tell us what happened next in your story.

Shveta Gupta: I want to come back to that. I initially started by thinking of leaving medicine, but all the responses that I got from this article are actually about the shift happening even while you’re in medicine, and I want to come back to that.

So I’ll take you back to a story from the initial transition time. I am sitting and interviewing with a seasoned executive for a medical affairs position, an entry-level position for a hematology rare disease company. On paper, I am an absolute fit for this, because they have expertise in a disease domain that I’m a therapeutic medical expert in, and we spend the first 15 minutes talking about how, in the last 20 years of training and practice, I have taken care of complex patients and built the programs, all the things that I’ve just talked to you about.

In the end, when 20 minutes are over, he says six words that basically became the basis of this article. He said, “But you haven’t done the work.”

And so I want to just sit with this. In one sense, he was right: I haven’t done the medical affairs work, but I have done everything else in the last 20 years. And in that moment, everything came crashing down, because I felt like 20 years’ worth was basically negated to zero in 20 minutes. That was a room where my MD went quiet, because in every room I walk into, my credential speaks for me. Sometimes I don’t have to introduce myself. Just Shveta Gupta, MD. This is who she is. This is what she has done.

After a lot of introspection, I understood that I was collapsing two very different truths. I absolutely had to be a novice and had to learn, but I was not starting from nothing. And the work that I had done was still mine; I just had not learned the language of how to describe it to a room that does not recognize my credential.

With that came two constructs. The one that I name is the false zero, which I introduce in the article as well: We think we’re starting from zero, but we’re not, so it’s a false zero. And the other construct is the untranslated physician, because we are not unqualified, we are just untranslated.

So that one incident and those six words were really what set that in motion, and then I share the story of the physician, which is basically me, sitting and having to fill out that small box for advisory work and write my portfolio and skills. I think that box was very small, because I can’t fit 20 years’ worth of work into it. But I still couldn’t come up with words that would translate into meaningful perception from the other side.

And I think all of that led me to believe that I am not the only one who struggles with this. I think this is a problem that has to be more common. And I think this problem adds to the increasing cost of us transitioning, which doesn’t have to be. We don’t have to own that.

Kevin Pho: I’m so happy you’re sharing this experience, because that false zero is actually the first time I’ve heard this term. It is present for a lot of physicians who want to talk to administrators, and it’s a matter of vocabulary. It’s a matter of not having that language to speak to them. And a lot of times these administrators, people with MBAs, are the ones making a lot of the decisions that affect the lives of physicians. And so the fact that you are telling this story, and the fact that you’re talking about that translation of all you’ve done clinically, but how do you translate that into the language of business, is wonderful to hear.

So what happened next? How did you learn that language? How did you learn to translate what you had clinically, your 20 years of experience, into the physician leadership world?

Shveta Gupta: Well, I took a route where I went and got an MBA. But what I learned through that process, when I sat through 22 months of executive MBA classes, is that you don’t actually need to get those three letters to be able to do this.

When I sat in the organizational behavior class, when I sat in the strategy class, some of the terms that they used, what I intentionally did is I went back into my own physician life. So I’ll give you an example. We do multidisciplinary rounds, something that we do every day. We do difficult family conversations and meetings that we do every day. We make decisions when we have incomplete information. These translate into cross-functional team leadership, stakeholder alignment, and judgment under uncertainty. Now, these are the terms that corporate understands, but what I just said before that are terms which you and I understand and our physician colleagues understand. And I was able to be that translator between the two worlds, and all of a sudden things were clicking.

Then, having explored pharma and biotech, the other side of the corporate world, I learned so many different languages. They talk about gap analysis and literature review. Well, I was born to do that. I do that every day for every single patient. I was asked once, “Can you please present a portfolio for me? What have you done?” And that portfolio should have actual projects. I was like, “But every patient I see in clinic is a project. How big should my portfolio be?”

So, long story short, what I want to say here is that I took that path, but I realized that my colleagues and everybody else may not have the bandwidth, or don’t want to invest time, money, and effort into that, and I wanted to be that voice and translator, saying, “I can tell you about this because you already have it in you.” All you have to do is look at yourself from the outside in instead of the inside out. So that’s how I think about it.

Kevin Pho: So for those physicians who want to ascend into leadership roles and have to learn that language, like you said, they don’t necessarily have to go through a 22-month MBA course. What kind of advice do you have for these physicians? How can they translate what they already know into the language of administration and the language of the corporation? What kind of advice do you have for them?

Shveta Gupta: So I think one of the biggest things that I would give advice on is to really learn what the organizational objectives are. If you understand the organizational objectives, then you can meet them in the middle by actually explaining to them where you are and where you want to be.

The problem that I have faced personally, and that I see with my colleagues around us, is that we are so focused on our patient and on ourselves that we’re not able to look beyond to the overall health care strategy, the health care ecosystem. Where is the organization, where does it want to go, and what are the long-term and short-term objectives? If you open yourself up to that, then you can actually align yourself, not forgetting the patient that you’re focused on, but also able to talk across the aisle and get this message across and make sense.

I also feel that we need people who are translators, and I would say that I aspire to be one of those, where when the organizational executives make decisions, they understand the clinical implications, because I can speak that language. But also, when the physicians are frustrated and not understanding that, then they can understand what the strategy is.

Because at the end of the day, I hate to say this, but the truth is that medicine is a business. On my first day of my EMBA, executive MBA, there was a question about all for-profit organizations. I was the only physician in the class, and I raised my hand and I said, “Well, I work for a not-for-profit.” And the economics professor, we were learning macroeconomics and microeconomics, said, “Everything is for profit. There’s nothing that is not-for-profit.”

And I don’t mean to say this to sound controversial. But that is the truth. And I think as physicians we need to accept the truth that if there is no money coming in, there’s nothing that’s funding anything. So there are organizational objectives for a reason. You do not need to be a finance expert to learn that. I think it’s just how you have to shift your thinking; you just have to put another lens on and shift the way you think.

Kevin Pho: And I’m sure you’re familiar with the phrase, right? “No margin, no mission.”

Shveta Gupta: Yes. No margin, no mission.

Kevin Pho: That is something that physicians need to get used to. That’s the reality, whether they like it or not, right?

Shveta Gupta: Yes.

Kevin Pho: So one of the themes that I also like to explore is sharing stories of what physicians are doing beyond their degree, as you are. So tell us what you’re doing now and where you see your career trajectory in the near future.

Shveta Gupta: So I currently practice passionately, to keep myself clinically grounded, at the intersection of hematology and women’s health. So that’s my clinical part.

With the MBA, one of my goals is to be able to really focus on, again, being the physician leader, and it doesn’t necessarily mean it needs to be a hospital system. I have looked beyond the hospital system, and this whole health care ecosystem is so broad, and they all need physician leaders. They may know it or not, or they may like it or not, but they all need physician leaders to be able to run it.

The other thing that I have discovered as one of my selves, which I wanted to talk a little bit about, is that I want to be an author. I’m very, very excited, and I’m working on my first book, which, as I shared, is going to be titled The Second Apprenticeship.

So some things that I’m really curious and passionate about right now are identity formation for physicians, because we commit so early, and there’s not enough literature around there, because we talk about all the other people, but not physicians in general. I’m also really excited to learn more about that foreclosure and how that one self gets fused with the white coat, and I think it happens to all of us, but we just don’t realize it, and there are different points in time when our lives diverge, even if it might come as a calling to us.

Other things that I have been very excited about are the concepts of recognition and translation. We talked a little bit about translation, but really recognizing this and understanding who you are. I have also become deeply curious about when someone wants to change, whether it is staying in the same job, leaving it, a partial change, a portfolio, going and being a swimmer, going and being a piano player, going and doing whatever: How do you really calculate that loss? And I publish on Substack, and I talk about those different kinds of losses, and I really want to talk to more people and experts and reach out to them and talk and see how they reflect when they have made a change. So these are some of the things that I’m very excited about and working on.

And I am very active in the digital health and health tech community, where I play an advisor role, but also helping physicians advocate for themselves, so that when someone reaches out to you and says, “Can I pick your brain about this?” you know your worth and make sure you are appropriately compensated for your expertise, which is not for free.

Kevin Pho: Fantastic. Wonderful, wonderful words. We’re talking to Shveta Gupta. She’s a physician executive. Today’s KevinMD article is “Leaving medicine is a translation problem, not a loss.” Shveta, let’s end with some of your take-home messages that you want to leave with the KevinMD audience.

Shveta Gupta: So one of the things that I love, a quote that I love, is that you are a doctor, you’re not just a doctor, and I think that’s very profound.

The other thing I want to leave my audience with is that you’re the one wearing the white coat. You’re not the white coat. So just really start to think about separating your identity from the role, separating your recognition from your worth, because they’re not the same thing.

And then I would just say build your identity through action. I quote Herminia Ibarra on this: Go send that email, go make that phone call, go get on that podcast, go do it and take that action. You don’t need a five- or 10-year plan like you were taught before. You can take these little actions and really get to the next steps of your identity formation that you just didn’t know existed beyond your white coat.

Kevin Pho: Shveta, thank you so much for sharing your story, time, and insight, and thanks again for coming on the show.

Shveta Gupta: Perfect. Thank you so much, Kevin. Thank you for having me.

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