I took this photo from the window seat on a flight I was on last year.  I don’t remember where I was going or why (I fly a lot these days).  I just remember looking out my window and seeing this spectacular cloud line that looked so solid, it was almost like you could step out onto it and not fall through.  Kind of like a leap of faith, if you will.  ( I settled for grabbing my iPhone and snapping a picture.)

I’ve had a number of blog followers at this point ask me to write about my experience in making the jump and leaving clinical medicine.  Which of course prompted me to think about exactly how it happened.  That’s the one thing about blogging – you really have to go back and mentally trudge through the muck again if you want to be able to write about it in any convincing detail.

I think it’s important to say before I start any of this that my story is definitely not some sort of equation for escaping a career that makes you miserable.  I had a very specific set of circumstances (some fortunate, some created very deliberately) that allowed me to make a break from an eleven year career and start over.  While I certainly hope there are pieces of my experience that you may take away that allow you to gain some insight into your own lives, by no means is this a “Lumi Says” advice column.

In thinking a lot about what exactly led me to leave my career, I thought a lot about the factors that went into that decision.  I found myself going way back into much earlier parts of my life – parts that I though wouldn’t necessarily have any bearing on my adult decisions now.  What I realize is that, essentially, my decision to leave clinical medicine boiled down to an absurdly simple math equation:

Past Choices + Present Choices = Future

I know, this is about as satisfying as when the supercomputer at the end of the Hitchhiker’s Guide to the Galaxy, after 7.5 million years of calculation, spit out the Answer to the Ultimate Question of Life, the Universe, and Everything as….42.

I think the reason that this equation is so important to me is that I’ve noticed as a work culture, we put a tremendous amount of stock in our present choices, and woefully ignore the impact of our past actions.  That’s not to say that you can’t escape a terrible childhood and grow up to be a successful adult.  I just think that when we feel stuck, we tend to focus almost exclusively on our present circumstances, and not what led us to this place. Our past, while in the past, has consequences that actively affect us in everyday life, and to ignore this fact leaves us with a very incomplete (and unsatisfying) picture of our life situation.

THE PAST

In my situation, there were two major factors that had a tremendous impact on my flexibility in changing careers.

1. My husband and I have no children.  For those of you who either have no children or have been living under a rock your entire lives, children are a very real responsibility in life, both personally and financially.  If you are considering making a large career change, it is obviously much less risky if you are only accountable for your own expenses than if you are supporting five children under the age of twelve and simultaneously trying to save for college.  That is not to say that it can’t happen.  It just requires much, much more in terms of planning.  And by the way, there is nothing more that I resent than hearing someone scoff at my situation and say, “Well, that’s easy for you – you don’t have any kids.”  Please don’t use your kids as a weapon – it’s disgusting and not very parent-like.  And while we are at it, unless you had an extremely traumatic experience in your life, I seriously doubt anyone held a gun to your head and forced you to conceive a child.  Again, these are past decisions that factor enormously into present circumstances.  More about that in a minute….

2. My husband and I are both very judicious about money.  More importantly, we were long before we ever met each other.  We both attended in-state schools undergrad, which back in the early 90′s meant our parent could actually afford to pay for our education without taking out school loans (I know kids, times have changed.)  We also both attended an in-state school for our graduate studies: him on an educational trust from his grandmother that completely covered his costs since he was an in-state student, and me with an educational grant that I had applied for and won at the beginning of medical school.  What this boiled down to is that neither one of us brought any real educational debt to our relationship when it started.   

Flash forward to out lives now.  I said we were judicious, I didn’t say we were cheap.  The bottom line is that through our entire relationship, we have talked openly about what we want financially in life, and have helped each other to make good decisions all along the way about saving and investing.  Also, while husband loves cars, his “fantasy” car is more along the lines of a Mustang than a Porsche that costs as much as a house.  And I am definitely not one of those girls with a closet full of Jimmy Choo strutters.  It’s just who we are.  Not only are we compatible, we are financially compatible.  So the compounding of 16 years of collaborative good decision-making has left us with a house paid-in-full, two cars paid-in-full, and absolutely zero credit debt. We pay off our credit card balance every month.  This is not all just luck.  This is a combination of fortunate circumstances and hard work.  Our past financial choices have led us to a present that allows us an extraordinary measure of flexibility when it comes to things like career change.

The bottom line is that our past choices were influencing our future long before we ever knew they were.  You of course can try to tell kids this, but they have to figure it out for themselves a they grow up.  I happened to meet a life partner who was extremely sensible about money, and together we made even more sense as a couple.  We’ve made some good financial investments together, and live a very comfortable, debt-free life.  This is not just chance, or something to get angry over if it is not your particular situation.  It is a critical combination of fortune and wise choices.  And it definitely played into my ability to change careers eleven years into the field.

THE PRESENT

So this is the meat of the story.  Two years ago I decided to leave my position as an academic physician at a well-known University hospital.  At the time, my present day (which was, as we’ve established, an outgrowth of my past experiences) was an interesting amalgam of situations.  I had no children, and while I was a physician, my husband was clearly the primary breadwinner in our relationship, complete with insurance coverage.  Financially, I was certainly in a place where if I needed to make a significant change, I could.

My dissatisfaction with my job had building at a slow burn for several years.  I started bright-eyed and shiny coming out of residency, as most of us do when we finally finish all of our training.  I was working in academic medicine, which I cherished as an opportunity to work with students and residents and have teaching be a regular part of my job.  I had my own clinic, and it grew and grew over the years.

Eventually, though, the shiny wore off, like it does for all of us, and was replaced with a cold dose of reality.  In my case though, I also happened to be working in an extremely dysfunctional system.  All systems, to some effect, put the “fun” in dysfunctional, but my hospital was a really unique place when it came to devaluing its faculty.  The hospital functioned in an “eat what you kill” model, so primary care departments like mine suffered.  The surgical subspecialties were constantly bringing in money hand over foot, and therefore had budget to actually pay their faculty what they were worth (or close to it).  Primary care departments NEVER make that kind of profit – our value lies in that we provide a solid patients base so that the specialists have patients to work with.  But that doesn’t translate into direct dollars for administrators, and so we are left to work with whatever marginal profit is left at the end of the year, if any.  In the six years I was an attending physician at my last hospital, I (along with my department colleagues) received a TOTAL of a 4.4% raise.  There was no cost-of-living adjustment for us.  That was it because that’s all the department had to work with.  Not a really sustainable economic model for retaining staff.  Especially at an institution that already paid us on average 37% less than our colleagues across town (MGMA 2011 Physician Compensation Survey).

So as my clinic grew and the department continued to cut staffing more and more, I found my daily job description looking less and less like medicine, and more like administrative work I certainly had not trained for in medical school.  I spent hours arguing with insurers, as we only had one managed care specialist for the entire general and subspecialty clinic.  We switched to a new EMR system that, despite having a tremendous amount of input from the faculty about what they needed, was one of the oldest, cheapest, and inflexible systems available.  I spent many nights charting at home until 11:00pm so that I wouldn’t get too far behind.  Our scheduling system was from the dark ages, and constantly ended up with patients overbooked, bumped, or just dropped from the system.  Angry patients were a given that we walked into work ready to face every day.

I would say I tolerated and tried to internalize this every-growing disintegration of the job I loved for a good two or three years.  After all, guilt and sense of obligation can go a long way, and as physicians we often have an overdeveloped sense of both.  But I was unhappy.  I started resenting having patients on my schedule (wasn’t that the whole point of me being there?)  I would secretly rejoice if a patient didn’t show up for their appointment, as it would free up my schedule for a few blissful minutes.

The day  I decided to resign was one of those days where I experienced what can only be called a shocking moment of clarity.  I was running around as usual, doing things that weren’t medical, getting yelled at by patients that weren’t even mine, and trying to keep my hair from completely catching on fire.  In the midst of all this chaos, I got a message that one of my patient’s parents had frantically called saying that they were at their child’s specialist appointment now, but the authorization form I was supposed to fill out for them hadn’t been sent to the specialist, and now they were in danger of having to pay for the entire visit themselves or lose their spot.

I knew I had filled out the form personally several weeks before the appointment date, and had placed it in our “Stat Fax” box (STAT in this case usually meaning “Some Time After Tomorrow”).  Still I figured a 2 week heads-up would have been enough.  I went to talk to Miss Lucy, who was the staff person who had been working in the department for the past 30 years.  Miss Lucy had essentially been marginalized to running the fax machine as her entire job, rather than develop a plan for her resignation when it was realized that she could simply not keep up with all the technological changes that were happening in the department.

I asked Miss Lucy what happened to the fax I put in the box two weeks ago.  She stared at me blankly.

I asked her again, and let her know that now this had become my problem as I had a panicked parent on the phone at the specialist office right now.

Miss Lucy went over to a three-foot stack of papers on her desk, and started muttering, “I’ll find it for you, I’ll find it for you.”

I’m sorry Miss Lucy, is that pile of papers stat faxes you HAVEN’T SENT YET?!?!??!?!?!

It most certainly was.  Apparently, Miss Lucy’s method for dealing with faxes that needed to be sent out immediately was to move them out of the box and onto her desk, which would at least make it look like something had been done with them.

I nearly swallowed my tongue.  How much other time-sensitive information was in there?

Seeing as how I had no assigned staff to help me, I had to try to coordinate the specialist office sending me another authorization form so I could fill it out on the spot and send it back.  While I was doing so (and getting more and more behind on my patient panel), Miss Lucy suddenly burst out of the back with the paper and a triumphant smile on her face.  ”I got it, Dr St Claire, I got it!”

Wonderful.  Give it to me.

“Oh don’t you worry Dr St. Claire, I’ll take care of this for you this afternoon.”

THIS AFTERNOON?!!?!!!?!??  Clearly, despite the numerous conversations I had with her about the time-sensitive nature of this issue, she was going to go PUT IT BACK IN THAT GOD-FORSAKEN STACK OF FORMS.

I told her to please give me the form.

Again, the blank stare.

“Miss Lucy, your lack of organization has made this my problem, and it stops now.  Please give me the form.”

Slowly, she handed it over to me.

I walked over to the fax machine, fuming, punched in the numbers, and sent it myself.  It wasn’t that this task was “beneath” me – I’ve self-faxed more times than I can count because it was just easier and saved some time where it was needed.  This was different.  This was how my clinic ran every single day.  And it was at the expense of its patients and its physicians.  And it was just supposed to be ok with everyone.

I sent the fax, and spent the rest of the day trying to dig out from getting behind on my patient panel.

I then walked into my office, shut the door, and sat down in my chair.

I tried to envision myself working in that system for the next twenty years.  It made me sick to my stomach.  Literally.  I couldn’t even envision myself there for the next two.  How was I supposed to make a career out of this, when I was constantly being punished for the most trivial molehill inadequacies blowing up into mountains every day?  How could I run a clinic that grew and grew every day, and yet my support staff had already become nonexistent due to “budget constraints”?  How could I thrive in a place where my administration really didn’t care if I lived or died?

I sat in my chair for what felt like a long time.

And then I picked up the phone and called my husband….