My Danskos literally disintegrated last month. I was in the hospital team room, finishing up my patient notes at the end of a busy hospitalist shift. I happened to look down at the floor, and there they were: black chunks on the carpet. I thought, “Who left such a huge mess under the desk?” I looked at the bottom of my black Danskos. There was a sizable chunk of the sole missing. Finally, the pieces came together. My Danskos were falling apart—even as I sat there writing notes. That night, as I threw them away, I remembered when I bought them in 2008. It was way back during my first couple weeks of residency. You see, I had been one of those Dansko holdouts before then. Like crocs, I hated the way Danskos looked. As a medical student, I had watched my attendings and residents wear Danskos everywhere. I had worn tennis shoes instead, vowing never to buy a pair of Danskos. When I moved across the country and entered residency in Seattle, however, somehow my view changed. I wanted to fit in in a way I had not wanted to in medical school. So I made my way down to the flagship Nordstrom store to buy a pair of plain black Danskos. No, I didn’t choose the tiger-striped shiny ones. I just chose the plain matte black. I wasn’t going to pretend they were stylish. It was all about utility. My Dansko purchase marked a shift in my identity. I was now a full-blown doctor. I’d left the east coast and moved to a new city for family medicine residency. I had my Danskos like everyone else. I’d fully embraced my identity as a physician. That was 2008. And now, 12 years later, my Danskos were gone, tossed unceremoniously in the garbage. My Dansko disintegration was marking a shift in my identity yet again. It marked the end of thinking of myself as a clinical doctor. I had taken on the identity of being a doctor, of taking care of patients years ago. Now, I faced the sadness and guilt of letting that identity go. So what had shifted in those intervening 12 years? What had led me to thinking of quitting clinical medicine, after so many years of investment? The fact is this: I had seen and experienced the suffering of doctors over those years. When I first entered residency, I had seen a lot of patients suffer. I had watched them die. I had been there to share devastating news with families. But what I hadn’t seen was the true suffering of the physicians. Sure, I’d noticed people were grumpy or cynical or even downright mean to each other. Someone had once whispered to me in medical school that the reason that some of the OB residents were so angry is because they helped their patients grow their families while they held off on growing their own. I’d felt a little more of the pain in residency. I experienced the stress of running behind in the clinic each day. I was coming to realize I could never meet everyone’s needs. I’d started to understand that I could never be enough for my patients, my attendings, my spouse, and myself. That didn’t feel good. But I thought it was temporary. It would get better. Right? I’d remained bright-eyed and bushy-tailed, not seeing the true magnitude of the problem, until I was in practice for a couple of years. Then, all of a sudden, my eyes snapped open. I saw exhaustion. I saw people working more than ever to make the money to support their families. I saw one of my team members physically falling apart from working so much. I saw how others determined our metrics and continued to pile requirements between us and patient care. I heard that the hospital administrators had called us all “dispensable” aloud, in a hospital community forum. Two of the people in our hospital committed suicide. At the same time all this was happening, however, I’d found a way to work only as much as I wanted to. I had gained back control of my life. Because: My husband and I had become financially free. I’d discovered real estate investing several years out of residency, and my husband and I had started investing all of our money into buying cash-flowing properties. Over the course of several years, we’d built up enough side income (in part due to sheltering taxes) that we were financially free. We didn’t have to work as doctors full-time. Instead, we could afford for him to moonlight and me work only half time. I loved my life working half time. I could still be a doctor. And I could use the rest of my free time helping other physicians achieve financial freedom too. I took up blogging as my husband and I learned how to build a business. I was constantly growing, trying new things, and learning new skills, all for the express purpose of helping other physicians. However, eventually, the business got so busy, A few months ago, I faced a choice. I was fulfilled because I was helping other physicians in really tangible ways through my business. I could see that I was serving. But I was working too much. Something had to give, and it would either be clinical medicine, or my business. I finally had to admit I was no longer fulfilled to the same level doing hospitalist work. So I made the decision to leave my clinical job. It was so terrifying that I put off making a decision for months. I thought about what it would mean for my blog readers that I wouldn’t be in the trenches with them anymore. I thought about how it would affect my family if our real estate portfolio ever fell apart and I needed to be able to make money. I had a lot of fears. But I’d made the decision, long ago, that I would never make decisions from fear alone. So I submitted my resignation. And I threw out my Danskos. Letizia Alto is a hospitalist and who blogs at Semi-Retired MD. Source
