RECENTLY, in the wake of R U OK Day and World Suicide Prevention Day, I spent some time thinking of my friends and colleagues facing unprecedented career challenges and seemingly impossible choices. After a conversation with a coworker, I began thinking about my own experience in the early part of this decade, when I found myself working away from home and in a setting that I was not enjoying.

I had recently returned from studying a master’s degree in the United Kingdom and was therefore out of sync with the Australian recruitment cycle. I had applied far and wide for hospital medical officer jobs but found very few vacancies. Eager to return to clinical medicine, I accepted one such short term opening and moved from England to Northern Australia.

I quickly found myself isolated from my family, friends and support network. Unhappy in my job and my environment, I could feel my capacity for empathy failing; I was becoming a worse doctor because of it. Then, a member of my family suddenly became very unwell – it was time to return home. I completed my rotation and moved back to Melbourne.

Upon arriving in Melbourne, I again struggled to find rotations and jobs appropriate for my desired career path. I have written before about the dangers of experience-based discrimination, and so was wary of taking up the wrong opportunity. I felt like I was at a dead end. Although I had embarked on my master’s degree to develop as a doctor, it felt like time “out of the system” had crippled my clinical career. Paradoxically, opportunities abounded in paramedical fields such as biotechnology. I began seriously considering leaving medicine.

On the advice of some friends and colleagues, I met with a doctor to discuss a potential career change. Although the doctor’s intentions were good, their response could not have been less helpful. Rather than counsel me through my various options, they admonished me, lecturing me about the investment that the government had made in my education. According to the doctor, I had an obligation to spend the rest of my life working in the Australian health care system, irrespective of personal enjoyment or fulfillment. I left that meeting with a deep sense of shame that I was considering the move. Shortly afterwards, my PhD funding came through and that discussion passed into memory.

Then, a couple of weeks ago, I asked the following question on Twitter:

For those junior doctors forced out of Australian medicine due to the #trainingcrisis, what would your advice be? Move to a different country to practise medicine or change industries? Where or what?

While some of the responses were constructive, and most seemed well intentioned, I was disappointed with some as they reminded me of the conversation I had 5 or so years ago. Many of the comments advocated changing specialties or moving to the bush. These will be terrific options for some and were undoubtedly put forward by those who love their area of specialisation or locality and want others to share in their experience. But a lack of rural training opportunities and the arduous eligibility criteria for training programs mean that these options, even when individually appealing, are far from simple or universally appropriate.

Furthermore, for those already heavily invested in one field of medicine, the suggestion that they change is confronting. This is particularly true in the absence of any recognition of prior training or guarantee of success the second time around. My medical school classmates will shortly enter their 10th year of practice since graduation. Almost all have dedicated the past decade to work as doctors in training. Most have sat multiple postgraduate exams, and a handful has postgraduate degrees, including PhDs. Some are consultants. Many are still searching for training positions. If I were to suggest to the consultants, who in many cases have done the same number of years of service and the same amount of exams as the aspiring trainees, that they change specialties, I would likely face a very hostile reception. Why would we expect a different response from similarly dedicated, but still aspiring, trainees?

We can wish all we want that the system would not encourage or allow such prolonged commitment without the prospect of career advancement – and I have long advocated for wide-ranging training reform – but the reality is that many doctors in training are facing this predicament. Unfortunately, there is little by way of support or counsel helping them to navigate through this all too common turbulence. Sadly, burnt out trainees are sometimes thrown on the scrapheap, or blamed for their passionate dedication to the “wrong specialty”. It is therefore not surprising that some choose to leave medicine. Disappointingly, many of those I have spoken to report a similar sense of judgement or reproach from their peers that I myself experienced.

I believe that there are initiatives that could be adopted to give far more support to doctors considering a transition – either to a new field or away from clinical medicine altogether. For example, the establishment of a publicly available, exhaustive national training registry would go a long way in helping juniors identify areas of trainee shortages. This could have the added benefit of redistributing doctors to areas of need. Alternatively, enabling those who have made an extended commitment to a specialty to transition with some recognition for the time served, such as a membership qualification, would provide much needed acknowledgement of their contribution and skill.

But we also must be realistic and acknowledge that some doctors will prefer to walk away from medicine or try their luck overseas. As a profession, I feel that we have a responsibility to support these doctors, not admonish them, if and when they make that decision.

As the training crisis leads to a greater and greater number of doctors facing the tough choice to leave medicine, we would all be wise to show our colleagues compassion, understanding and empathy. Shaming these doctors into a career in medicine is a sure-fire recipe for disaster.

Dr Tim Lindsay is an Australian doctor and PhD student in the MRC Epidemiology Unit, at the University of Cambridge, UK, supported by the Cambridge Commonwealth Trust.

 

The statements or opinions expressed in this article reflect the views of the authors and do not represent the official policy of the AMA, the MJA or InSight+ unless so stated.


Poll

I have considered leaving the clinical practice of medicine






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26 thoughts on “We must destigmatise leaving medicine

  1. Jenny Reath says:

    Dear Tim
    Thank you for your honest reflections. I was taken back to my return from the UK almost 40 years ago after a period of part time hospital posts and with a young baby. I also struggled to find a clinical training pathway as do many parents (mostly women) who step out of full time work. My chosen career in Aboriginal health was hugely assisted by re-training opportunities and a part time flexible training pathway offered by RACGP at that time. These options are now greatly limited. I fear we are at risk of losing good and committed doctors who with the right support could continue in medicine.

  2. Andrew C says:

    Sorry to hear about the negative and discouraging responses you have received. After 13 years of clinical practice, mainly as a GP, I decided to become a freelance photographer. That was 16 years ago. I’m now the editor of a mission magazine, earning a fraction of what I used to in med – but happy and content. When I decided to move on, the comments I got from colleagues were on the line if “Good on you, brave move, wish I could”. For me, med was never my passion, so if I had got negative feedback about changing professions that would probably have only made it easier to kick away. I imagine it would be more difficult if you wanted to stay in med but aren’t getting the advice and options you need. Hope you find your answers and fulfill your dreams.

  3. Anonymous says:

    I considered leaving medicine first during my undergraduate training, but ultimately decided to press on and find a comfortable specialty in the longer term. After 10 years in my specialty I did leave to enter into buiness and property development. I stuck that out for 5 months, then returned to Medicine. About 10 years later I took another few months off to just relax, and then another 10 years on I retired and travelled overseas each year. I stayed out of Medicine for 3 years before putting my hand up for occasional locum work. I now work fulltime about 10 weeks or so per year in rural locations, and enjoy the rest of the year off. I’d have taken up that option sooner had it occurred to me, though I might have worked more weeks per year if I’d started it earlier.

  4. Stewart Lloyd says:

    Your concerns are far from “new”, Tim. Around 35 years ago, while training to be a surgeon in the UK NHS, I actively investigated leaving medicine, much to the bemusement of those around me – one of my consultants said “to do what…?”

    At the time I left the NHS, that organisation was seen as almost the only route of training in UK medicine and those who left it, for whatever reason and for however long, were seen as committing professional suicide. That was certainly the attitude of my peers and superiors, and it is now even more the case. In the end, I didn’t actually leave medicine but found, by an exceptionally diverse and “interesting” route (I won’t bore you with my cv) a niche in occupational medicine, from which I have recently retired following a professionally and financially rewarding career in UK and Australia. Many of my career moves have been abrupt left turns and leaps into the dark, but somehow I always seemed to land on my feet. You might say that that is pure luck, but I believe that one makes one’s own luck and to meet these challenges (including the disapproval of one’s colleagues) head on is all part of the fun.

    It can be done, but one must have ambition, drive and a very thick skin. All the very best for the future.

  5. Anonymous says:

    When I was a trainee, junior doctors who did altruistic medical work (such as in the Third World) were paradoxically penalised being accepted into training programs as they had a ‘hole’ in their employment records in the Australian public health system and didn’t have the networks or continuous employment record they would have had if they remained in Australia (charity didn’t begin at home).

  6. Anonymous says:

    AHPRA doesn’t recognise Adolescent and Young Adult Medicine (AYAM) as a specialty or subspecialty which is sorely needed (we have Neonatology even though most paediatricians see babies). Also following on from AYAM recognition/accreditation should be access to relevant MBS Item numbers to adequately be able to devote time and resources to AYAM consultations and the unique nature of transition of care, self-management and HEADSS models.

  7. Anonymous says:

    Thank you for sharing your experience.
    I went through my crisis nearly 20 years ago when I first contemplated leaving medicine as a junior trainee. I recall the advice I received from a peer support service here in Victoria: I had 3 options: medicine, pharma or journalism. None particularly appealing. I then entered a training programme because it was the area of medicine I hated the least. Burnt out and depressed, I failed my Fellowship exams–my first “failure” in life. This was an extremely painful time and as a profession, we are well aware of mental health issues in the profession, but back then…

    Seeking advice for an alternative career was non-existent. Once a doctor got off the treadmill, they simply disappeared. Those within the profession cannot offer advice and are blinkered by their own experience and bias.
    Those outside can’t understand why a doctor would choose to leave.

    For my own well-being, I need to get as far away from medicine as possible: I went overseas to study a business degree. The difficulty I found on returning to Australia was that I was an undifferentiated doctor and people could not look passed the medical degree, despite an additional qualification from a leading university. Having done medicine for 12 years, my identity was intertwined with the profession. To not practice as a “real doctor” and not having any additional qualification, I was restricted in practice, unappealing to all industries bar pharma, with no one to ask for advice or career path to be seen. Other doctors could not understand it, and I felt ostracised and a phoney.

    I have returned to medicine and I have no interest in it. Thankfully, I have built a business where I only practice 20% of the time. I have had to forge my own path and after 20 yrs, I have been able to get it where I wanted it.

  8. Dr John Hollingsworth says:

    Reading some of the comments I believe that the doctors should not have started medicine in the first place .I have worked all over the world and in NSW country and never had a problem thinking I should be somewhere else. Jobs are all over the world in medicine. You only have to want to do them.

  9. Douglas Gow, retired anaesthetist. says:

    What a silly statement Dr Hollingsworth! Who amongst us could have imagined the drudgery of medical school, the horrors of the workload of a trainee, when you’re 18 and just left school. You are very lucky to have found your perfect practice, but it shows an unsympathetic view on life for those who have been less fortunate.

  10. Anonymous says:

    I have every sympathy for the recent graduates who will struggle to get into training programmes whether in a specialty or general practice. The massive increase in the number of graduates (more than a doubling) over the past 5-10 years has resulted in the number of applicants far exceeding the number of places available in all training programmes. While there have been some increases, most programmes are hospital based and there is no space or funding for large increases in numbers of training spots.
    Many graduates will either never get into a programme or fail to complete it and feel forced to leave the profession which they love.
    Our polies who went from too few med school places to, now, a huge surplus have done us all a massive disservice.
    The universities are entrusted with getting all students through the course and bear no responsibilty for what happens to them after graduation.
    The health services have responsibility for providing health care on limited budgets and training junior doctors but do not have responsibility for ensuring all are trained beyond internship.
    The Colleges are responsible for post-graduate training but generally limit the number of training spots based on workforce considerations.
    This situation is VERY different to when I graduated.

  11. Anonymous says:

    Dr Hollingsworth you have no right to judge people you don’t know. All the evidence suggests that it is precisely the most compassionate and dedicated doctors who are at risk of burn-out. For most, the problem is not medicine per se, but the System, in which doctors in the western world increasingly find themselves working as powerless functionaries in health organizations characterized by gross dysfunction and separation between authority and responsibility. Don’t take my word for it, read “Terminal Decline” by Mohamed Khadra, “Doctored” by Sandeep Jauhar, “Mass Listeria” by Theodore Dalrymple and especially “Hippocratic Oaths” by Raymond Tallis… one can hardly say these people should not have started medicine, on the contrary their disillusionment springs from their sense that they belong to a dying profession.
    I am still a doctor by the way and even enjoy it from time to time: but then I am older, have two post-grad qualifications, and don’t lack for work. I pity new grads, though.

  12. Eric Asher says:

    Dear Tim,
    Each of the above writers makes a valid point but ultimately how we integrate such ideas defines who we are and becoming.

    I found my Sydney University MBBS very useful as a young hospital doctor over 40 years ago, but of little real therapeutic benefit in my heart’s desire: to be a family doctor, to greet my patients entering the world with joy, to encourage them on their life’s path and to ease their passing with dignity and without needless pain.
    So: three choices were before me: to stay as a GP I was but to be of little use to my patients, to forget my dreams and go into the hospital system or, as Sun Tzu says in The Art of War: “On intersecting ground, form alliances”.
    I met good men and women on the same path as mine, but a little ahead on their journey.
    Appropriate Orthodox Medicine, Acupuncture, Homeopathy and a little Hypnotherapy went a long way to make me feel of value to my patients again.

    To mix a metaphor, if we do not follow our hearts we risk becoming prunes: plums with experience.

  13. Anonymous says:

    Your article resonated with me, as I also left Medicine, some 10+ years ago now. I was also estranged from my support systems when I was making the decision, having moved here from the country I graduated in. I remember that period as the loneliest, most depressing period of my life and I reached my lowest ebb. So much of that was due to the shame that seemed to flow from a decision to leave, guilt at wasting taxpayers’ money, family sacrifices. However, with the help of a few close friends I eventually made the decision to leave.
    I won’t say I have never looked back. I wonder if with a bit more professional career help, I could have found a niche within medicine – but this wouldn’t have been easy as an OTD. I have since worked in a couple of different health and disability related fields and am now very professionally satisfied. I don’t earn what my colleagues who stayed in Medicine do now, but I own my own house and have a decent standard of living, a job that makes a difference and truly helps people (which is why I went into medicine) and time to spend with my family and friends.

  14. Raymond Yeow, BA MBBS; https://www.linkedin.com/in/raymondyeow says:

    “…..publicly available, exhaustive national training registry would go a long way in helping juniors identify areas of trainee shortages…”

    Try this
    https://www.health.nsw.gov.au/careers/Pages/career-planning.aspx
    These medical speciality fact sheets are designed to help doctors and other health professionals make informed choices to ensure their career plans not only fulfil their personal aspirations but also align with service needs.
    Based on extensive workforce modelling, information covered includes:
    •workforce characteristics (number of practitioners, average age and gender representation)
    •demand (demand for training positions, retirement intentions and additional fellows needed)
    •geographical distribution across NSW.

    #trainingcrisis
    — try GP training ?
    https://nacchocommunique.files.wordpress.com/2019/07/ama-president-press-club-address.pdf
    “….GP training has been undersubscribed for two consecutive years….”

    https://creativecareersinmedicine.com/
    extremely useful resource …I attended CCIM 2018 in Sydney…..amazing conference
    they have FB page as well

  15. Anne Malatt says:

    Thank you Tim for a very thoughtful article about a problem which affects all of us. I struggled in the early years of my specialty training and briefly thought of leaving medicine, but decided to stay on and now love my chosen profession. My best friend who was training with me was not so fortunate and when she became disenchanted with medicine and the stresses of surgical training, could see no way out but to kill herself.
    This is the great and ever-increasing concern as there are more and more young doctors vying for too few training positions. On top of all the considerable stresses we had to face 30 years ago, they now have to worry about whether they will get a job at all, let alone one in their chosen specialty.
    It is disheartening to hear the lack of support that people receive when they express their doubts and concerns about practising medicine. We must care for people as people first and foremost, irrespective of which specialty they want to do or even whether they want to do medicine at all, and offer them support and other choices in life, so that they do not feel they are trapped in something they no longer enjoy.
    Not everyone is cut out for this rather demanding profession, nor does everyone find it rewarding, but that does not make them any less worthy as a person, and having to make a decision to leave a profession that they have worked so hard to be in requires an enormous level of support from those of us in it.

  16. Anonymous says:

    Commenting here as I, like others, have in the past searched to find out what people do when they leave medicine- and the voices are few and far between. I wondered since my 4th year of med school, what else one could do with a medical degree, apart from be a doctor. I had a doctor friend who became an actor, and another who pursued a successful business degree. On graduation I took the shortest path to part time work (GP). Although I was a good GP, I found the responsibility stressful. I was lucky enough to have a decade long ‘parenting break’, which I realised later was another sign I wasn’t keen to return. Finally, I retrained as an allied health professional and I’m enjoying my first team-based job, where the responsibility is shared. Generally, the process has gone well, although comments from both sides have been challenging at times. I’ve also had friends suggest I’m wasting the government’s money … and my new colleagues wonder why a doctor would ever want to do anything else (and give up the $$).

  17. Deprescriber prescriber says:

    It makes me reflect on what makes the system accepting a surmountable amount of UK trained junior drs flockung into my home country. I train and worked with these junior drs in the NHS and found 70%have left the NHS UK to work my home country in search of better life, sun and money. So if we are accepting drs from overseas there ought to be a shortages of the profession? If there isn’t then why are we accepting them into the country? I came to the UK as there’s a shortages of my profession over 12 years ago but my younger peers won’t be able to today as it’s no longer on the shortage list. Shouldn’t immigration system be responsive towards our home grown graduates? I realised that my university has provided the highest level of training and am shocked at the graduates in the UK have a lower calibre of training, which was why they were desperate for Aussies to go across in those days.

  18. Anonymous says:

    Changing careers is one very stressful event & recognising the need to do this sooner and managing the process well is vital for the individual as well as system. It didn’t work out for loads of reasons.

    Increase positions available for those training & cap entry into medicine. Remove the undue stress for trying to get into limited positions. Make positions healthier but not expecting so much overtime. Lower the rate of pay for working as a doctor so more positions can be funded.
    Accept that medicine is a helping profession. Help the community first & care for each other. It’s not business, it’s health.

  19. Anonymous says:

    I have never been sure if medicine is for me. I’ve spent all four of my working years to date considering what my alternatives might be. It’s so hard to find examples of people who have left medicine and made successful alternative career choices. Where do these people go?
    Who can I speak to to try and decide whether or not to stay in medicine?
    Who can help me to identify alternative career pathways?

  20. Anonymous says:

    I made a choice to leave my chosen speciality of general practice nearly four years ago. Unfortunately, stresses I was experiencing from my work, meant that I felt I could no longer work in a manner which I felt represented my profession in a positive way and benefited patients as a principle aim. I obviously also had declining mental well being. I miss my work on a regular basis as I had really enjoyed the privileges involved in long term relationships with patients . Despite getting relevant psychiatric support, I had to make the choice I made. Having worked in medicine for about 30 years – mostly full time – I am happy I have “reasonably paid back my training”. I wasn’t given much in the way of support from my peers when I left, and feel like I am now kicked out of the loop despite still being involved in running a practice. Given when I trained, I was lucky in that I never had to struggle to find work and training and felt rewarded in my career. I had always intended working till much closer to retirement age and I Just want it noted that support could benefit us at any stage along the journey

  21. Dr Jemma Hogan says:

    Great article Tim and one that I’m sure resonates with many! I’m currently conducting a research project looking into the factors contributing to attrition in medicine and would encourage anyone who has quit or is seriously thinking about quitting (quite a few based on the poll!) to complete this survey so we can get a better insight into this issue within the profession. Link: https://curtin.au1.qualtrics.com/jfe/form/SV_0dmC1NcNAul7G5v

  22. MKD says:

    Today there are many more services evolving to assist those with a medical degree consider a wide range of career options. The medical degree is becoming more like a law degree and many other tertiary degrees in that it no longer guarantees a career in medicine. However the broader skills learnt can be applied in many roles. Organisations such as Creative Careers in Medicine https://creativecareersinmedicine.com/ and the many career advisory services now available to doctors now assist doctors to look for alternatives. These services work with new graduates and doctors at all stages of their career who need to leave medicine for a wide range of reasons.
    The reasons why other doctors may not be supportive when a doctor leaves clinical medicine may vary from lack of understanding (because medicine is their passion) to those who feel unsettled because they are wondering if they should be leaving too. Seeing a colleague change paths can be disturbing.
    However as the saying goes You Only Live Once (YOLO) and it is important that you spend that life doing things you enjoy and are passionate about. Many other people have five or more changes in their career direction and never regret previous pathways. When you study medicine at University there is no obligation to practice clinical medicine.

  23. Anonymous says:

    I’m PGY3 and a lost soul too. Sometimes I felt like a failure, constantly worried about not getting into training program and getting older each year. On the other hand I’m also unsure of what to do if I leave medicine.

  24. Anonymous says:

    I think it’s great there are more services to help find alternative careers for people with a medical degree (though there’s still a long way to go). It’s ridiculous to think everyone who graduates would be happy with the realities of the actual job. People change careers all the time. Why should medicine be any different? But somehow it is. Practicing medicine clinically sucked the life out of me…it took so much more than I wanted to give. The decision to leave was made easy for me in the end – it was that or my relationship and mental health. I was lucky in that I had a previous career to fall back on. But even though I am so much happier now, I still feel the pull…something about the hard work I put in to become a doctor, and my dream vs. the realities of the system. It’s so tough! I don’t have a good answer but I do feel lucky to have ‘escaped’ when I did.

  25. Sassy says:

    Hey moving countries is not so bad! NZ is lovely, so why not consider there as well if not happy with Aus options? Is no further away than some parts of Aus, whoever you are, and you can still use qualifications in Aus

  26. Dr Jo Hely says:

    Tim, your excellent article raises many important issues. As a medical career advisor, I regularly work with doctors, young and not-so-young, who are looking for advice about career paths other than clinical medicine. Most express some sense of shame or guilt about “wasting their training” and many are isolated because they feel they can’t tell colleagues and even family what they are considering. There have always been those for whom clinical medicine wasn’t a good fit but the situation is exacerbated by the hugely competitive training environment.
    Medical training gives doctors a range of highly valuable and transferable skills in addition to clinical acumen and there are many non-clinical career paths, both within and outside of medicine. As a profession, we need to be providing more information to students and junior doctors about ALL their career options and better supporting those for whom medicine isn’t the best fit.

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