What should I do with my life and newfound freedom?
September 26, 2020 12:08 AM   Subscribe

I went "straight through" from college to med school to residency and the training highway is ending. Phew! I can choose to do whatever I want with my time! What? How?

Medical school and training was kind of all-encompassing for me, in that whenever I wasn't studying I felt like I should be studying, even when I wasn't necessarily enthusiastic about certain rotations I still had to show enthusiasm as a medical student, and whenever I wasn't seeing patients I was still reading all the time, thinking about my patients, writing notes or manuscripts. It took a lot of work and energy to get to where I am today. I love my job and the perspective on humanity my training has given me. But I also put off a lot of other interests - I did maintain them to some degree, but I wasn't really able to produce any substantial amount of creative work because I just didn't have the mental space or energy or time. I did not feel free to take some intellectual risks because medicine is a rather failure-adverse field. I attended one of those schools where everybody does something very impressive and shiny-sounding. I feel like everything I did, while existing in the space of medical training, had this component of "how will it look on a CV?" or "what doors will this open up?" Even though I did enjoy most of these activities, I never did anything that was 100% divorced from that value system. Even the freaking poetry I wrote that ended up winning a prize ended up on my resume at some point.

The end of training is the first time in my adult life where I can choose to do whatever I want with my time (and the rest of my life!). I'm not tied to grades or training obligations. It was for this reason that I ultimately did not choose to do a fellowship (more training), despite really enjoying that particular subspecialty and considering it seriously for my career, because I felt like it would be the "default" thing to do, to take that choice of how to spend my time/energy out of my hands again, and to stay within the comfortable familiarity of the academic training treadmill. I look at other research fellowships and prizes available to young, motivated, and highly trained people like myself, and reflect that over the years, I have learned to paint myself as a desirable candidate to those fellowships, but I also know that at this point pursuing one would do little to further my own understanding of myself and how to live a good and meaningful life. I love my work, find it fascinating, and care about doing a good job, but I'm not sure if loving my job means that I need to devote my all to my career. I don't think my job is taking over my identity, but I do feel like there is a risk of that happening if I don't pause and reflect on what I'm doing.

I am also nervous to leave the academic training bubble... my mentors are mostly people who have been in academia their whole lives. I can't tell if I'm walking away from something that I'd be insane to walk away from - like, what becoming a professor of x medical specialty at Ivory Tower Institution is the best job out there? I don't know. I ask because realistically, that's the main thing that my training has given me the opportunity to do - if I wanted to become a community doctor, I definitely did not need this academic pedigree. I feel like I could conceivably be interested in returning to academia later (if it's possible), but I can't will myself to continue in this system without understanding what the alternatives are, because without that understanding, I'd be "defaulting into" academia rather than actively choosing it.

I work in what is considered a "lifestyle" field so I have flexible hours and a good job market. My hunch is that I would be happy if I could work in medicine in such a way that I could also carve out time and space to work on creative pursuits. I'm nervous though, because I've never actually incorporated creative pursuits into my life in a systematic or sustained way since I've been in school/training for my entire life, and I'm afraid that I could leave my academic nest and then also be stuck at a non-academic job (I've heard they are higher-paying but also can be more of a grind) and have no infrastructure or roadmap to actually go forth and pursue my creative hobbies. What if medical training has really squeezed out all the creativity in me?

What do I need to do to move forward in my life? What steps can I take to transition to this new freedom, and to start to pursue my hobbies? Has anybody else has been in this kind of situation, maybe went through an intense time in training or school, had a type of all-encompassing career or a type of career in which many of their peers work very intensely, and then re-defined things for themselves? Anybody ever leave academia or academic medicine and come running back, or spend some years as an attending before returning to a fellowship?

I am kind of like this previous askme about being a doctor and having no life, except I don't feel burned out at my job, just maybe a little cynical about the rat race and the parts of me that I put on hold to get here.
posted by anonymous to Education (13 answers total) 7 users marked this as a favorite
Hello from a call room on the night shift! I'm a surgery intern, and I'm at the point where I feel like I am just barely beginning to comprehend what I don't know about medicine, however I most definitely did not go straight through from college to med school, so I think I have some insight about the whole "life outside medicine" thing.

I'm afraid that I could leave my academic nest and then also be stuck at a non-academic job (I've heard they are higher-paying but also can be more of a grind) and have no infrastructure or roadmap to actually go forth and pursue my creative hobbies. What if medical training has really squeezed out all the creativity in me?

It definitely hasn't, but creativity is a muscle, and you need to give yourself space to exercise it. You are a person who thrives on structure (most of us in medicine are), so find a way to incorporate that structure into your creative pursuits. Take a class--it doesn't have to be your one perfect artistic/creative hobby, just pick anything! In this area of life it is okay to be a dilettante. Just something that has a set schedule that is outside work--in person if safe in your area, or online but with live interaction. Actual interaction with other humans means you'll be more likely to do it than if you just should do it. And then, practice doing creative stuff just for the heck of it, without an end goal. Lately, I've taken to folding origami cranes on zoom calls. There's no goal. I'll probably throw them away later. But it's satisfying, and I enjoy selecting the paper, and it's not for anybody but me. (Although my nephew might commandeer them to play with.)

What do I need to do to move forward in my life?

Ask yourself what you want your life outside work to look like. Who do you want to be spending that time with? For me, I love medicine, but I want to spend my time outside work with family and non-medicine friends, primarily. Medicine is such a bubble, and I find that I feel best about myself when I exit that bubble when I leave the hospital doors. For me, hanging out with kids is particularly useful for this, because they don't give a crap about the nonsense of medicine, but are still super excited to learn about whatever random medical facts I can offer up. I taught my nephews about the existence of stomas the other day. They thought it was super cool. Spending as much time as possible with non-medical folks can help you recontextualize how you spend your time outside of work. Guess what? It's okay to be unproductive! It's okay to just go sit on a bench somewhere and watch the world pass by!

The biggest advice I can give is that it's okay if you try working outside academic medicine, even if on paper academic medicine seems like the obvious next step. Your gut seems to be telling you that you want to expand your life outside of this one defining thing, and it's okay to step off the success escalator onto the just being platform. Don't let the perfect be the enemy of the good. Get out there and flex your creative muscles. Make stuff and then throw it away. Talk to adults about things entirely unrelated to medicine. Share some random cool facts with kids. And give yourself permission to be lazy sometimes, and have no goal for the moment except just existing.
posted by ocherdraco at 1:12 AM on September 26, 2020 [10 favorites]

Astronaut? The coming decades will likely offer many opportunities in the private sector for a trained physician.
posted by fairmettle at 1:40 AM on September 26, 2020

Congratulations on nearing the end of training. That is huge. I also went straight through (including a 2 year fellowship) and allowed myself a month off the treadmill and went on a safari which was just absolutely incredible. Take a month. Take more if you can (pending health insurance, savings, etc).

I feel like there are two sub-questions lurking in your question. One is the academia vs private practice divide; I'm in academia as a clinician-educator, so can't speak to the community practice side of things directly, but make sure you are actively choosing that, too -- ask your program director if you can speak with former graduates who have gone into community practice, or find them yourself on LinkedIn or Doximity. I will say that being an *attending* in academia is not nearly as soul-crushing as in training, and I have heard some soul-crushing stories from colleagues in PP. As with anything, it probably depends on the specific culture of your department/division/employer.

It's also definitely possible to swap sides during your career: one of my favorite clinic attendings in residency had left PP to return to academia (mostly on the clinic side), and my division chief in fellowship had left industry to return to academia (mostly on the research side). I also know several people, both med school friends and professional colleagues, who worked a few years as an attending before doing a fellowship. It's more than possible. It's extremely common.

The other sub-question is how to rediscover creativity after a long stint away. ocherdraco is right, creativity is a muscle that needs to be stretched. I am a writer, and the first thing I did for myself after graduating residency was get a subscription to Powell's Indiespensables book club so that I could start READING again. I started inhaling fiction -- seven novels in the first month after graduating residency. That's how book-starved I was. The next thing I did was start writing again, with structure. I tried to do NaNoWriMo in 2016 but then the November election happened and I fell apart. I tried again in 2018 (same story, an idea that had been percolating in my brain since I was a resident) and "won." It was a good way to jumpstart the creativity engine for me, to have that end-goal of 50k words. Since then, I schedule 45 minutes a day of writing time and alternate between revising that novel vs new work. I've also taken a few classes, both local and online, which have been helpful for learning the skills I wish I had had the courage to learn when I was in high school/college, and especially for building a community of fellow "creatives with a day job."

Hope that is helpful. Feel free to MeMail me. And again, congrats on approaching the light at the end of the tunnel.
posted by basalganglia at 5:37 AM on September 26, 2020 [4 favorites]

I took three months off after fellowship. If I hadn't had to study for boards and get credentialed for my new job, it would have been incredibly liberating. I strongly recommend taking 3-4 months off before you start your new job.

One of the biggest differences I noticed was that, as an attending, I no longer had to "hide" who I was at the risk of someone thinking I wasn't "dedicated enough." In training, I felt like I couldn't talk about my hobbies, or my significant other, or anything that would suggest I had any kind of life outside of medicine. The attitude you cite that when you're not studying, you're thinking about how you should be studying is VERY real for everyone. It was probably all in my head, but there is a pervasive mentality in academic medicine that if you're not giving 150% of yourself, then you don't really deserve to be there.

As an attending, however, I can talk freely about my personal life and hobbies with my coworkers without fear of judgement. I can make my SO my priority in life. I can go on vacation and not feel bad. My job is my job. It is a job that I take a lot of pride in, and that I take seriously, but it is still a job nevertheless. I'll read and study, but it is completely okay for me to have a life outside of work.

My hobbies also came back to me as an attending, since I have so much more free time. Don't worry about this. It will come.

As for academic vs private: This is for you to decide. You should know by now. Research is not necessarily a dividing line, because you can do research in private practice, esp if you're in a huge private practice. Do you want to teach and mentor? If so --> academia. Do you want control over your schedule and your method of taking care of patients, and do you value efficiency in your practice? If so --> private practice.

Starting as an attending is scary for everyone, so you're not alone there, but your training should have prepared you to ditch the training wheels. You know a lot more than you think you do. By this point, you are ready to start independent practice.

If you choose private practice, you can always go back to academia later. It's really a non-issue. Choosing private practice is not the moral failing that everyone in academia seems to frame it as. Academia is not some exclusive little club. Being at an institution will offer you a path toward certain career/research goals that private practice will not. Private practice offers you a path toward different goals. You have to decide which goals you want to pursue and then decide which route to take.
posted by aquamvidam at 6:33 AM on September 26, 2020 [1 favorite]

Spend some time doing "nothing" and explore the aesthetic you want your life to have. Do you want to have a life that involves putting on sturdy shoes and going out in the very early morning, being under the trees and hearing the birds twitter? Or do you want to have a life that involves good smells of amazing cooking, methodical bustle in a kitchen, interesting ingredients and savours? Or do you want to have a life that involves languages with a different rhythm and stress, people whose skin and hair and outlook doesn't resemble yours, their purpose and direction moving all around you? Or is music going to be key, the rising rhythm as your sink down into following the sound, attuning your breath and turning your eyes onto automatic while the notes create synergy that carries you upward? Or are words your thing, fingers flying on a keyboard, stopping to reread sentences, coming out of a wall of text disoriented because now you are back in your ordinary life again and there is a moment when you can't remember what season it is or what your own name is because you have been so deep in that other world?

Once you know what aesthetic is the one that appeals to you - carpentry workshop, gym and track, dance practice hall and auditorium, vernissage and canvas - at that point try to figure out two ways you can immerse yourself in that environment, one of which is active and one of which is passive. As a person with great organization and drive you have no practiced chillin' a whole lot, and chillin' is a skill you probably need to cultivate, or meaning can recede in your life while you focus on goals.

If early mornings outside in the trees is your thing you could be a runner, or a bird watcher, or a gardener, or someone who shovels snow for pleasure and makes snow sculptures or a hunter, or a photographer, or someone who collects leaves, or a volunteer who helps runners or someone who flies a drone. Once you have an aesthetic you get to figure out what you do in that aesthetic, and how many ways you can enjoy that aesthetic.

Let's say that you decide theatre is the aesthetic you want: if you throw yourself into being the best stock theatre actor you can be, practice for hours to audition let alone perform once you land a part you will be equally driven as you were while training for your profession. And you will likely succeed in getting parts that others envy. But you will only be experiencing the competitive and perfectionist side of theatre. So not only work on becoming an actor, but also go to amateur performances - the junior high school play, for example, places where you won't be called upon to do anything except be passive and enjoy, places where you won't be competing, analyzing and criticizing to build your own competitive abilities. See bad plays, good plays and excellent plays. Read plays. Screw around learning how to do stage make-up really badly. Make a model theatre and put in a lighting system from LED battery lights you pick up at Home Depot. Write to your city and ask them to designate a park for outdoor performances in the summer. Talk to costumers and wardrobe mistresses and let them tell you about their craft. Just immerse yourself as a supporter and as a passive audience and not just a do-er.

Then the other thing you want to do is find things that are people oriented - not just serving as a medical professional, but being part of a community, and being sometimes being the least competent, but one of the most useful people there, like the one who cleans up all the dishes after a community supper because you may not be able to do the logistics of cooking a community supper - or you may but you leave that to someone else who thrives in the role - but you can scrub pots, and it makes a greater whole and you are part of it and the community will belong to you and you will belong to the community. Especially do this with your family and in your friend network, but also do it with other places and people.

And finally - if you are American, right now there is a crying need for people to build community instead of to exacerbate the tribal and class divisions. For the next ten months or so, and hopefully not longer, there is a desperate need for your drive and your creative abilities in trying to make the communities that border on your own safer and more peaceful. Not YOUR community, The ones that are outside of your comfort zone, the places that feel like they belong to other people and yet are geographically near. Maybe after ten months or so there won't be a crisis, but until then that would be a very good place to turn your spare time and energy and love.
posted by Jane the Brown at 8:18 AM on September 26, 2020 [9 favorites]

If the number of residents I've seen fall asleep standing up during a case is a baseline indicator of any kind, don't underestimate how sleep deprived you might still be. Get some rest!
posted by jesourie at 8:23 AM on September 26, 2020 [2 favorites]

I went back to med school/training a few years out of undergrad, and I had a life before then. A flourishing, interesting life that had nothing to do with medicine. And then the demands of training took that away. I truly think medical training stunts a person’s personal development in ways many physicians don’t really understand. Those years of fucking around, being aimless—they’re painful but valuable. Lots of doctors don’t get that.

So, I just want to say: don’t be surprised and don’t be discouraged if you feel kinda down right now or on the next year. Or like, flailing around as a human being. Because you might. I did, and again, I did not go straight through. But when I finally pulled my head above water, I realized I didn’t really know who I was anymore. Sure, you’re a well-trained physician. That doesn’t actually mean though that you know how to live your life, or you know how to live a good life.

If you’re interested in something, anything—try it! See what you learn about yourself. That’s my main advice. Try/fail. Keep going. Hang out with people who are NOT doctors. And get into therapy. Preferably psychodynamic.

But don’t do this: don’t throw yourself into medicine because that’s what you know and that’s what you’re good at and that’s also how you’ve primarily identified yourself for a good chunk of your life. (I think that’s also why new grads sometimes stay in academia—too scary to leave). We all know the attendings who live like this

I used to be struck by how I thought doctors were kinda boring people, and honestly, many of them are. They aren’t my main social group, that’s for sure. But I understand now that they’re boring because training made them that way.

As for community vs academic. I am academic-adjacent I guess you’d say, will probably go into private at some point or community work. I like working with residents, I like how that in academics you’re expected to be on top of the research, etc. etc but you can do that outside of academics.

People in academia want you to think their work is more important. It’s not. It’s important, sure, but the bow-tie-wearing academic physician who works 2 clinic days a week and gets into departmental pissing wars about stuff that matters in only his tiny academic medicine world is NOT doing more amazing work and is NOT contributing more to humanity than the unsung primary care doc busting her ass seeing some of the sickest patients in her city 40+ hours a week. Or the dermatologist in PP. Or the psychiatrist doing cash-only therapy. Though the academic physicians would VERY much like you to think so.

And yes—you can go back to academia later. You might be surprised to know people are NOT clamoring for those jobs. (Unless you’re in the northeast, but that’s also why I fled that frigid tundra of hell as soon as I was finished with training.). If I ever went back to academia it would be as a volunteer when I’m like 105 years old.
posted by namemeansgazelle at 10:04 AM on September 26, 2020 [3 favorites]

Has anybody else has been in this kind of situation, maybe went through an intense time in training or school, had a type of all-encompassing career or a type of career in which many of their peers work very intensely, and then re-defined things for themselves? Anybody ever leave academia...?

Yes. A few times. What helped was being able to take some time off - weeks or months - and give myself wholehearted permission to do nothing and have no plans. Relishing the "guilty" pleasures, whatever those may be for you, and redefining them as "the things I want/need to do/not do now". Eventually, my mind figures out what it wants to do next and I enthusiastically develop new/old passions.

I left academia under different circumstances and never completed my PhD which I started straight after my first degree. Eventually, I became a teacher and now I'm doing an MA in education and loving it. What's struck me is that I now have a bunch of skills (organisational, emotional, etc.) I needed when I was doing a PhD and I know I can come back to academia if I choose to. This would have been a big deal to past-me. So now I'm a big fun of sometimes walking away with no expectations and if you circle back to something, you do and you're stronger for it. If not, that's fine too - something else was more worthwhile to you.
posted by mkdirusername at 10:43 AM on September 26, 2020

I did something similar: I went straight through from undergrad to a job as a tenured professor in a STEM field, then shifted gears to a less all-devouring role, and started writing and publishing a lot more poetry. The things I needed were a bunch of unstructured time, friends who were also interested in writing (or drawing or painting), and mental permission to try things for no specific purpose.
posted by yarntheory at 11:29 AM on September 26, 2020 [1 favorite]

It seems to me that under your question is a search for a sense of self that is not governed by external markers. I come from a different profession but a rat race and a drive for elite appointments that is similar and most of the time requires a similar pedigree.
These routes through pedigree in the United States are also markers of a degree of privilige, and they reproduce themselves and call for conformity, which is why you've felt straitjacketed.
The first step might be to think through where your way of being lies, what do you not like about the mainstream path you've followed? Is it the narrowness of conversations with your colleagues, the hierarchies, the tunnel vision etc... which future path is likely to put you through unpleasantness that you absolutely cannot bear, and start weeding out options that way.
Like in everything in life, avoid the sunk cost fallacy, yes you had this training and for most people a certain path follows from it, but why should you commit another 2-3 decades because you spent one in a certain direction.
I work in a creative field and have aspirations in other creative fields. Do what you will as a hobby but being truly creative takes the same grind as training as a doctor. We don't have half-assed doctors because that could do real damage to people as compared to a bad novelist. But a good painter, good writer or musician operates at the same level excellence as a brilliant doctor, and that takes serious work.
If you're after a balanced life, which really is an art form in itself, build freedoms into your life that allow you to live your own best version of it. Good luck, you have a stable and lucrative career ahead no matter what and you're trying to live a wholesome life. All things considered this is a very good problem to have.
posted by whatdoyouthink? at 12:24 PM on September 26, 2020

I would go to therapy just for kicks. Time to weed the garden!
posted by St. Peepsburg at 12:49 PM on September 26, 2020 [1 favorite]

First, congratulations! Second, lots of great advice already that I second!

Third, might you interested in dating? If so, this is a good time to make a profile and start swiping: not because you “have” to or need to make up for lost time (not true but sometimes we think these things & need to try it out!) Instead, it’s because dating can be fun and a chance to get to know people you wouldn’t meet otherwise! As a teacher, I love being at school but I also love getting out and hearing about people’s lives that are not necessarily “exciting” per se but oh so interesting because they’re very different from my own. If you’re new to it, create a profile with the help of an experienced friend. Regardless of your gender and sexual orientation, watch some YouTube videos on dating: texting advice, first date tips, etc. (I’m a super experienced dater but found myself learning great new insights just the other day!) Have a positive attitude but also low expectations other than meeting new people.

A lot of people see your job title and are impressed (if perhaps a bit overly so and/or for the wrong reasons but that’ll be obvious pretty fast) who aren’t in the medical field and don’t understand how hard medical school is or that you’ve sacrificed so much to reach this point. BUT most people are curious, many are kind, and you may find a great connection. You might make some good friends and/or go on some good dates; you might also realize you haven’t been missing out on much and happily to go back to focusing on the other things that make you happy. It’s all OK when you have a growth mindset!

Whatever you end up doing, I’m sure you’ll find multiple new sources of joy and fulfillment, which you absolutely deserve!
posted by smorgasbord at 8:50 PM on September 26, 2020

one thing to consider is that you will probably not be able to succeed at your creative pursuits to the level you're used to. as you observe, your brain is stuck in success/prestige mode, you've had to be excellent (or at least convincingly appear to be excellent) at everything you do for years, and even just being mediocre at something may feel incredibly uncomfortable. let alone being actually bad at something.

This is actually a mental habit that might make sense -- as you say, medicine is very failure-averse along with many other high-prestige fields -- during a period in your life when everything you do is related to your medical career, poor performance anywhere might have serious consequences.

But if you have these mental habits, they could make it emotionally tough to make hobbies and creative pursuits part of your life at first, because you're just not going to be as good as people who have devoted more time to them. It is possible that you might experience feelings of panic, embarrassment, and impostor syndrome if you have to interact with people who are more skilled than you are. Maybe worth preparing for.
posted by vogon_poet at 11:17 AM on September 28, 2020 [1 favorite]

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