Guilt is Not a Career Platform


Recently, I read a very interesting post by Kathy Caprino, entitled “Why You Remain Stuck in a Career You Hate.” In it, she gives eight outstanding reasons why those of us who are unhappy in our careers remain paralyzed and unable to move. The first reason on her list (“You Don’t Know Yourself”) resonated strongly with me. It took me eleven years in primary care medicine to come to the conclusion that I just don’t like being a primary care doctor. It’s not a good fit for my personality or how I tend to function in a work role. I’m much happier in a “specialist” model – where I can take more time and function in a niche rather than trying to cover a broad range of things in a very limited period of time.

This is just a simple fact I had to learn about myself. It’s not a judgment about the importance of primary care versus other specialities. On the contrary, I have enormous respect for my colleagues who are primary care providers and do it well. I think they have one of the most challenging jobs on the planet.  I just needed to do enough introspective searching to finally admit to myself that I wasn’t in the right field.

But why did it take me such a long time? The immediate obvious answer is that for those of us who spend the better part of our lifetime training for a specific career, it’s a hard pill to swallow to admit that maybe that career isn’t exactly the best one for you. Especially if you are one of those types who was born knowing you wanted to become a doctor/lawyer/etc. But, as I’ve alluded to in some of my other blog posts, I’ve never been one of those people. I’ve also never really viewed being a physician as a critical part of my identity. I am a person first, who practices medicine second. I know that is not the case for everyone, and that’s the point. We are all different.

In really taking some time to figure out what makes me “tick” as a career person, I came to realize something very important in the months leading up to my eventual resignation from clinical medicine. It turns out that I am one of those self-masochists who loves to turn a career’s worth of guilt inward. I was the stereotypical worrier, wondering what would happen to my patients. If I left, who would take care of them the way I did? How would they get what they needed from someone who didn’t know them like I did?” Looking back, these “guilt scripts” held me hostage for years before I finally took a good hard look at what was preventing me from being happy in my work.

It was actually the fiancé of a friend of mine who inadvertently helped me break through the last of my career shackles. My friend was a nurse practitioner in the clinic I worked in, and the two of us developed a friendship borne out of commiseration. We would often get dinner or hit the local bar after clinic was over and just wallow in the injustices of our work environment. We even had our own little book club so we could have some kind of pretense for getting together. We’d talk about the book for about three minutes, and then the conversation would immediately devolve into a first-class bitch session.

One day her fiancé happened to join us for dinner. He listened to us talk about how trapped we were working for an institution that refused to listen to its employees, and imposed all sorts of inappropriate constraints on us. We bemoaned how powerless we were to make change, despite the fact that we were two of the most outspoken faculty in the clinic. We complained about the unbelievable inefficiency and suboptimal level of care in our clinic due to administrative decisions that clinically left our hands tied.

After this went on for about half an hour, he looked at both of us and then asked quite frankly, “So why do you continue to work there?”

My friend and I of course had all sorts of excuses. Our patients needed us. No one else knew the issues our patients faced as well as we did. As I listened to myself spouting off 101 reasons why I couldn’t leave, I realized I had enough career guilt on board to fuel a Catholic mass for three weeks.

His question stuck with me though. He had planted a seed, and over the next several months it germinated into a big, blooming flower. Eventually I had to admit to myself that my patients somehow had found medical care before they met me, and they would after I left . Would it be the same medical care that I provided them? No. Would they get worse care after I left? Possibly. Or maybe someone would come along and do a better job than I had. Regardless, they would not be left lying in a ditch somewhere. Sure, they would miss me. I have several families that I still keep in touch with by email after having left clinical practice, and they do miss me. But they also are very pleased to hear that I am happy and thriving in my new work.

With due deference to Kathy Caprino, I respectfully submit Reason #9 for her consideration: Guilt Is Not A Career Platform. Certainly not for a fulfilling career anyway.



A Good Way to Measure What Works for You


12 thoughts on “Guilt is Not a Career Platform

  1. I just recently discovered your blog. I am a burned out ER physician who left the ER three years ago and started a career in phlebology because the hours are so much better. I have been doing this for three years and have been seeing first hand what corporate medicine is like and I hate it. I am the only bread winner for our family of two young boys ( 3 and 1). My husband is a stay at home dad while also getting his Master’s degree. I would love to work in advocacy of some sort but I need to find a job that allows me to still support my family (at least until my husband finishes school). How did you do it exactly? Any advice or networking leads?

    • Hi Roxana,

      I appreciate your candor about your current situation. I have had multiple requests at this point to write about exactly how I went about my own career transition, which I am definitely planning on doing in the near future.

      Having said that – I think it’s important to note that you and I have very different life circumstances, which always affect the decisions we make. I was not the primary breadwinner in my household as a physician, nor do my husband and I have any children. Obviously, these things factor in enormously. My story may very well not relate to yours in a functional way. What I think may be a nice place to start it to check out some available informational resources. The Internet is FULL of career-change advisors and life coaches who want your business, which may or may not be helpful. I don’t endorse any one person or organization, but there are two sites that have come up again and agin for me in my work circles and through my search for information.

      One is, which is spearheaded by Dr Joseph Kim, who left clinical medicine himself to revamp his career. It is specific to those looking for options who are currently in the medical profession. The other is, which is a resource and blog site for people who are looking to redefine their careers in general.

      I hope that is at least a place to start getting more information. Best of luck, and thanks for reading.


  2. Hi, Lumi,
    I have asked this question on another blog. (Cant help asking, as a Life Coach). If you had received coaching, while you were still there, and had developed tools to help you either change your perspective, or in other ways, cope with the things that you did not like about the profession, would you have left it?
    You must have like something about it, to start of with, and there must have been some degree of satisfaction in the job of helping people.
    As a person who went through depression and burnout, but got through it, and rediscovered my love for my job, I think that a lot of people end up blaming their jobs, simply because they are unable to figure out how to manage the stresses in it. If they could be coached before they reach this stage, we could prevent the loss of all those caring people, in the profession.

    • Hi Raji-

      I think you raise a very important point. There are definitely other things in life that can masquerade as burnout. Blaming the job is easy and doesn’t take a lot of soul searching and introspection. While I wasn’t formally coached during that time, I have a educational and clinical background in mental health, and made a point of going through a number of steps to really self-evaluate and find out what was making me unhappy.

      I think it’s critical to remember that while burnout is often a “rescuable” situation, that isn’t the case (and quite frankly shouldn’t be the case) in every situation. Sometimes your job really is the problem. I knew in the middle of my career that there were other skills and interests pulling at me, and I followed and developed them so they were ready for me when I made the career shift. In my particular situation, I have a level of job satisfaction now that I never experienced before as a clinical physician (even during the “good times”), which speaks to the fact that there was a goodness-of-fit issue for me that was job-related.

      I think coaching is a valuable tool that physicians don’t have enough access to in an increasingly challenging field. I also think that it is not a blanket panacea for every situation. Thanks for your valuable input and as always, for reading!


      • Hi, Lumi,
        Thanks for the reply. It does seem, in your case, that you were able to do the self-reflection and soul-searching on your own, and make the right choice after all! A coach only helps with the same self-reflection, after all.
        I find your views very refreshing. Do keep writing.

  3. Hello,

    You are certainly not alone in your frustration, but I wonder if it is the system rather than medicine that pushed you out. “Burn out” is a term that should be abolished. I doubt you had burn out helping people get better without the insurance company interference.

    I’m an emergency physician who has lived the insanity for 9.5 years, and just started a direct-pay medical clinic. My patients are mainly uninsured and high-deductible patients watching their budgets. I schedule 30 minute, 60 minutes, and quick visits and charge a reasonable rate which is much less than the insurance system. Everyone is happier!

    Direct-pay is challenging because you are taking on an entire system, but there are growing numbers of Americans, doctors, and businesses fed up with the mess. Don’t give up on medicine! Medicine is a great field, it is the system that needs work!

    Tom Malinich, MD

    • Hi Tom-

      Thank you so much for sharing your perspective, and I appreciate the words of encouragement! I had a chance to check out your website, and I’m impressed that you are making a direct-pay care system work in a medical culture that it not exactly supporting a fee-for-service model. I hope you have continued luck with your practice.

      In some ways, I agree about the term “burnout” – it can be misleading and easily used to label other problems. However, as a descriptive term, I think it’s perfect: I was frying, there is no better way to put it. I definitely see your point in that if I had been working in an environment that had supported me instead of thwarting me at every turn, I probably would have felt very differently about my job.

      At the same time, there were aspects of my work that just weren’t a good fit for me, regardless of my environment. Trying to tell myself I enjoyed primary care when I didn’t was something that took me a long time to recognize. And being open to other ways of functioning has brought me tremendous job satisfaction, which I can’t really complain about! In all honesty, I haven’t completely abandoned medicine – I still do a tremendous amount of work in the educational arena of medicine and continue to work with peers, residents, and students. The clinical part has been on hold. I may dip my foot back in the clinical waters soon (on my terms this time around!), but either way, medicine is still a very important part of my life. I think it’s important to recognize that there are lots of different way to do things, and we aren’t always encouraged to seek those out.

      Thanks so much for reading-


      • Best wishes! Keep in touch as I think medicine is still a great field. The environment stinks, but that just means we need to find a better way. Who knows, maybe we can join forces someday and fix the system together!

  4. Thanks for your great post, Lumi, and for sharing my Forbes post on Why You Remain Stuck In A Career You Hate. What you experienced – a long, protracted delay in making desperately-longed-for change, is extremely common, especially in women. Extreme guilt about leaving our careers often comes from an erroneous belief that we’re letting others down if we leave our line of work and is something the majority of career changers experience, especially those in the helping professionals. Personally speaking, after I left my 18-year corporate life and became a marriage and family therapist, I waited far too long to realize I didn’t want to be a therapist any more (which came as a powerful “aha” after a client called me to tell me she was going to kill herself that day by wrapping her car around a tree). I realized then that I didn’t feel equipped to deal with these deep and traumatic experiences, and simply didn’t want to. I felt ashamed at my realization, so I didn’t act soon enough. Finally, after getting empowering support from others I trusted, that it’s truly egotistical and misguided to believe for a moment that the profession can’t do without us. If you don’t like your work, leave it! There are many others who are much better suited to it and who will thrive in the work and be of greater services to those in need.

    Now that I’m in a career I truly love and I’m well-aligned with and suited to, I know what it feels like to do work that feeds your passion, power, and purpose. Keep up your writing, and thanks for openly sharing your journey so others can explore and examine their own. All best, Kathy Caprino

    • Thanks for such a thoughtful post Kathy! I appreciate you sharing your own personal story – I had a very similar experience once I realized I had reached my limit. There were plenty of days before I left that I worried if I was going to miss something with one if my patients while I was struggling. The guilt can be paralyzing, and I think there is a well-developed work culture of relying on that very fact as a way of retaining employees.

      Thanks for reading!


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