I Quit Medicine – Why I Left28 min read

I’ve been thinking about this for years. This isn’t clickbait: I quit medicine. My name is Zach, and I was a resident physician in Internal Medicine in Boston.

I put 10 years into this, and, officially, I am done. Let’s talk about it. I want to break it down by:

• The journey to becoming a doctor
• What being a doctor actually was like for me (the good, the bad, and the ugly)
• Why I left and what’s next

So, about a month ago, I had my final shift in the hospital. I knew, however, one months into being a doctor, that I would be leaving medicine forever. A real shame because scrubs are soooo comfy, but good for, well, absolutely every other aspect of my life.

So, this will likely not be relevant to many, many, many of you, and, of course, this is uniquely my story. But maybe it will help you think about a tough decision or help you make the jump you need to make but are too scared to.

I was all-in until about the third year of medical school (eight years into my education). Then, the doubts began to pop up. However, it wasn’t until I was actually a practicing physician that my doubts were confirmed. And I knew I had to leave—for myself, for my colleagues, and for my patients.

Let’s talk about it.

1. My Story

So, I left medicine at 29 years old. For context, I did four years of undergrad, 2 years of post-bacc, 4 years of medical school, and one year of residency, which equals about 10 years of higher education. If I were going to stay in medicine, I would have gone into Gastroenterology, which would have been another ~6 years before I was a full-blown attending physician at 35 years old.

I’ve always loved the human body and the science behind it. Trying to understand how the heart works, or how your leg muscles actually help you walk. Being a doctor was the ultimate embodiment, pun intended, of this. You learn, not only, the intimate science of why it’s important for red blood cells to pick up and carry oxygen to different parts of the body, but, more importantly to me, you also learn how a person might feel, or look, when those red blood cells or the transport of those red blood cells isn’t working properly.

Maybe their limbs will become blue (cyanotic), or they will feel short of breath (dyspnea), or they will have a heart attack (Myocardial Infarction).

So, I started with biomedical engineering, and my absolute favorite thing to do was work on technologies that interacted with people. I developed circadian rhythm monitors that were essentially goggles on someone’s eyes that would change the brightness and wavelength of light in an attempt to prevent or help fix Jet Lag. I worked in a lab that tried to better diagnose and treat HIV by using ancient conserved markers that, maybe, could target and eradicate the always-mutating HIV.

What if I could combine engineering and medicine to make truly groundbreaking innovations? This is why I thought being a doctor would be the most amazing thing in the world.

Well, I knew I needed some courses and some more checked boxes for medical school. Which is a whole other story (that I find rather frustrating), but I dutifully checked my boxes, knowing the light was at the end of the tunnel. I became an EMT, I continued to do research, I volunteered, and I got better scores and grades than I ever got in my life because I had a purpose. To get to have that knowledge, that training, those interactions, that such a select few people have. To have the prestige of having “Dr.” in front of my name. There could be no other way Zach was going to live his life.

And, as I’ve discovered about myself, when I really, really, really want something, I can make it happen. It is just a matter of time.

I took three gap years—imagine that—three whole years to simply make sure I could actually get into medical school. The time and money that went into me getting into medical school was insane. I don’t regret that time, but the sheer resources, non-financial and financial, that went into that dream acceptance are staggering: at least half a million dollars and at least 40 hours a week for seven years.

Then, finally, the day came. I submitted my application to 35 MD mainland medical schools on the dreaded AMCAS, where all medical students who want to go to medical school in the US apply. Nothing I would do for the next year mattered to my application. The medical admission boards wouldn’t see or hear about what I did unless I told them (and I knew most update letters would likely end up in the trash). In one sense, I was supremely free; in another sense, I felt more trapped and stressed than I ever had felt in my entire life.

So, for that year, while I was applying to medical school, I worked at a venture capital firm and began learning about a whole different world; that it actually takes money, lots and lots of money, for medicines and therapies to be researched (#1) and actually get to patients (#2). I had my first experience in a real business, the corporate world. Given every TV show I watched, every inspirational tweet I saw, and the cooing and cawing of my doctor mentors, I always pushed that world away. It wasn’t me. It wasn’t what real life was about. I don’t want to sit at a desk. Or at least, everyone around me is telling me I don’t want to do that, and they can’t be wrong, right? The interesting thing was though, I kind of liked the business world.

Beyond that experience, that year was the most stressful year of my life. I had put everything, nearly half a million dollars of my family’s money, 7 years of time, and all of my hopes and dreams into becoming a doctor. After submitting my application all I could do was wait. For months I couldn’t sleep, I couldn’t eat, and what I didn’t tell my family and friends, I was more anxious than I had ever been. I had my first (and luckily only) panic attack.

It’s hard to put this into words. But imagine, for most of your adult life, you tell everyone you are going to be a doctor. You think you are smart, talented, and special. The time finally comes when you are applying to medical school. Every single day, a family member, relative, or friend asks how your applications are going. Friends are getting acceptances to medical school. Your parents are telling their friends that their son is going to be a doctor. And you still—don’t—have—a—f******—SINGLE—acceptance. You are spending every waking moment preparing for interviews, reading every single book on how to answer “Why do you want to become a doctor,” or “Why this school,” or “Tell me about yourself,” or, one fantastically annoying question I got, “if you were a piece of furniture, what piece would you want to be and why?” Then after every waitlist or every rejection, the thoughts compounded:

It might not happen.

What if you actually don’t get into medical school?

What happens next?

What will you tell everyone?

I vividly remember one day I was on the most beautiful beach I’ve ever been on. My feet were resting on stunning golden sand that was nicely toasting my feet. There was a crystal clear blue ocean, and there was a light breeze. I was refreshing my Gmail application incessantly, oblivious to nature, and supremely, completely, unable to relax. This medical school stress had taken over every aspect of my life.

A couple of months later, I was at a breaking point. I remember I was in the office at the company I worked at, and I had recently interviewed at my dream medical school. The dream med school was near family, had an amazing reputation, and was in the city where I already lived. Half of my life at this point was reading student doctor network forums, Reddit, or Gmail, so I knew that if I had been accepted to this school, usually the dean of admissions would call me a week or two later.

Every phone call I received over that next week I picked up. Then, that day, in the office, there was a number, and the area code was a match to where this school was located:

“Hi, is this Zach?”

“Yes”

“Hi, this is Ms. Dean of Admissions, I just wanted to let you know we are happy to say you’ve been accepted to the best medical school ever”

“WHAT!! THAT’S AMAZING”

“We hope you will attend.”

“DON’T WORRY! I’LL BE THERE ONE MONTH EARLY!! THANK YOU SO MUCH!”

“Amazing, see you soon.”

Click.

After this conversation, I went to my knees—literally. I don’t remember when it happened, but at some point during the conversation, one of my colleagues said I started kneeling on the ground.

The wave of happiness and excitement I felt at that moment was like nothing I’ve ever felt before. After months of everything feeling so down, my whole body was full of this electric joy, and, you bet, the phone calls started going out. The texts. The future plans. That next week was pure elation. But, as all things go, even though I had spent 7 years sweating and grinding for that moment, the excitement passed.

I began stressing about preparing for medical school, where I was going to live, and what I wanted to specialize in as a doctor. Did I need more research? More volunteering? When was the soonest I could get clinical experience?

Can you f****** believe it?

Someone should have slapped me.

My mom always says she didn’t hit me enough as a kid, now I understand why.

Then, before I knew it, I was a medical student and I loved it.

Medical school was perfect:

• I was finally learning what I wanted to learn
• The content was useful, relevant, and interesting
• My classmates were smart, passionate, and damn funny, and we all had one goal in mind: to become a doctor

I was finally in it. I was finally going to become a doctor.

Before I even learned anything, I was given a white coat and took the crucial vow: I would keep my care confidential, I would do my best to take care of patients, and, first, I would “do no harm.” Well, I remember thinking, “Of course I would do no harm. Why is that even written there?”

There were orientation sessions where we went on boat cruises, bar-hopping, and having icebreakers over meals. These were my people. I felt at home. Was this real life? Someone pinch me.

Sure, I was studying a lot, but I was also having fun. Tons of fun. My friends were great, we helped each other do better, we had fun with each other, we were all in it to win it. My days were perfectly planned with Anki flashcards, watching lectures, practice questions, a gym session, some TV, and bed.

Those first two years of medical school I had a social network (I was never popular), a girlfriend that I thought was way too good for me, was killing it in the gym, my grades were great, and I was studying to become a frikin doctor, a doctor!

However, summer of 2020, COVID hit. The dream state ended. COVID woke me up. Zoom lectures, zoom meetings, my girlfriend broke up with me, my friends went back home to study online, gyms closed, and gains goblins were everywhere.

However, although it wasn’t my dream life anymore, I was still having a great time. I was still working to become a doctor, to innovate, to change lives, to change the world.

Then the clinical years of medical school began. I was finally in the hospital, wearing a white coat, and meeting patients as someone who could help them. My first rotation was an OB-GYN experience in the suburbs. All my friends felt bad for me, “Everyone hates this rotation, especially as a guy, and especially at that location,” they told me. Boy, were they wrong.

I was in bliss. I was delivering babies, performing c-sections, setting up laparoscopic surgeries, speaking to people, and helping people; this was really cool. However, the people around me didn’t share my excitement. Many residents seemed beaten down. No one was smiling. My first ever interaction with the chief resident at the hospital was a speech to us four medical students rotating in the on-call room, “you will be of no help, you know nothing, please stand aside and don’t get in the way,” before quickly walking away with her scrub cap and 17 pins attached to her white coat lapel that said “compassion, or American humanism society, or love everyone” in some pink or rainbow color composition. Attending physicians were complaining about being on for 24 hours on call, prior authorizations, lawsuits, administration concerns, notes, or having a black weekend.

I didn’t know what any of those words meant.

But no one could bring me down; this damn stuff was cool! And, people started to like working with me. I was asked to do surgeries, I was doing things 2nd or 3rd year residents were doing like inserting trocars or using the bovy ( a burning laser cutting thing) to start the c-sections. Sure, I was getting in at 4:30 am and leaving at 8:30 pm, with a 45-minute commute, but that was fine, right? Everything is sustainable if I wanted it enough!

My OB-GYN rotation continued like that for the next month.

Next was pediatrics, then internal medicine. The passion was slowly fading. I didn’t realize it at the time, but I was tired and stressed, and in the back of my mind, I kept thinking, “What impact am I actually making here?” “Are these doctors happy?” “Why are we doing things this way?” Sure, sometimes I’d have an absolutely amazing interaction with a patient or learn how to do something interesting, but most of the time, it felt like a slog.

My passion was restarted during my surgery rotation, and I thought, I was going to be a surgeon. Tying knots, getting handed things by the nurses and technicians, we were GODS. However, patients usually would show up to the clinic not feeling better. Or the cancer was somewhere else. Or they died on the table after a procedure that was meant to save their life. And these residents, these attending, were some of the most stressed people I had ever met in the hospital, ever. They were working longer hours than everyone else and wore it like a badge of honor. They were getting in at 4 am and leaving at 11 pm, or 10 am the next day. Every single one was drinking coffee, or a monster, or was taking actual pills that just had caffeine in them.

I knew I couldn’t be one of them, although being in the operating room was cool, I wasn’t willing to sacrifice everything else in life for that.

This quickly became the most important question for deciding a specialty. What are you willing to sacrifice for this? Little did I know, this was not just for surgery, but it was for every other specialty.

One of my mentors and one of the most inspiring physicians I ever met was a cardiothoracic surgeon named Dr. Okusanya. He had it all. He went to Harvard, was a CT surgeon, had a happy family, and seemed genuinely happy and excited to be in the hospital. All while being very, very good technically, and very good with his patients. All while working these hours. He was also doing research, teaching students, and saving lives. One day, in a moment of vulnerability that I normally would never EVER tell a resident or let alone an attending physician, given I needed honors to get into a good residency and have a good life, of course, I said, “I’m not sure if I want this. The OR is cool, medicine is cool, but looking at everything I will have to sacrifice. I’m not sure. Am I making that great an impact? I’m not sure I truly enjoy being with patients.”

He looked at me, smiling, tying off the sutures on a chest tube he had just put in a patient, without looking:

“Zach, all you have to answer is, ‘Is the juice worth the squeeze?'”

Was the juice worth the squeeze?

Was the JUICE worth the SQUEEZE??

Was the juice WORTH the squeeze.

Damn.

I didn’t know.

Without realizing it, my medical student, save-thyself, always-get-an-A mindset kicked in, and I said, “Of course!!! I couldn’t think of doing anything else. Thanks for the advice!”

Back into autopilot. Back into performance mode.

During this time, my YouTube channel started to take off. People were actually paying me to do something I did for fun. It felt like I was talking to my friends through the camera. What helped me? What excites me? What do I want to do better? How can I help people in this way? Surely, I can’t be making as much of an impact on people as I do on patients, but heck, this is fun! I hired team members, met people like Mr. Beast and Dr. Mike, went on YouTuber retreats, and had real moments of “damn, this is really, really cool.”

However, being a doctor. That was who I really was. That’s what I told all my friends, my family, and even the internet, that was what I was doing. This was the most noble profession. After the third year of medical school I had to pick a specialty. I picked internal medicine because I wasn’t super passionate about anything, and it gave me the most options. I also was interested in solving complex cases. Maybe I would become a gastroenterologist. I began shadowing gastroenterologists and seeing endoscopies and colonoscopies. I spoke to advisors about getting the best grades, research, and how to apply to residency that would set me up for fellowships in gastroenterology. I was already planning the step after the next step. But, the next step was residency.

Residency.

Being a real doctor.

Wow, that came out of nowhere.

Was medical school over already? No more group study sessions, or Anki, or wearing a short white coat.

Okay, I guess it’s time to become a real doctor. This is what everyone else is doing, and this is what I’m meant to be doing.

More applications, more stress, more boxes to check. Where do I want to live? How do I answer the question, “Why do you want to do internal medicine?” Because I think it’s what I want to do? I like understanding the body and maybe I’ll do endoscopies and colonoscopies when I grow up?

No way. I know better than to be honest. Let’s try instead: “When I met Ms. Felicia and diagnosed Diamond Blackfan anemia based on working through a thorough differential diagnosis and reading up on the most recent journal article from the American Society of Hematology, I knew internal medicine was for me. My dream is to become the best diagnostician, so I can go into hematology.” There, something like that is better.

“Why do you want to come to our special school?”

“Well, this is obviously my top choice residency program because of your fantastic specialty rotations, amazing clinical faculty who have solved why red blood cells are the color red, and your world-class oncology program.”

Repeat that answer 11 times to your 11 different residency program interviews.

Congratulations, now, create a rank list where you decide where the next 3-7 years of your life, 60-100 hours a week, will be spent based on a magical black box. Good luck!

Then, graduation was upon me. More robes, more speeches, more claims, and more promises to save the world. I was matched to my third-choice program in Internal Medicine in Boston. Not bad, not great.

All my medical school friends had a couple of final parties, and we all said goodbye. We all had excitement about being called a “doctor,” excitement about taking medicine into our own hands instead of having to ask a resident or attending before making a decision. We were smart, we knew it all, and we were going to be the best doctors ever. We were going to save and improve lives, be happy, start families, and make lots of money.

I had those same sentiments. But slowly, something inside of me was telling me this wasn’t the right thing. But things will change—they must change—when I become a real doctor, Dr. Zach, and have real patients who depend on me. They must. That’s when I’ll feel happy.

And so, I packed up my entire life, moved to a city 300 miles away, and settled in. I found an apartment, the local grocery store, gym, and met my newly minted doctor colleagues. Got the long white coat, very important. The longer the white coat, the more important you are. My badge said, “MD” in big green letters, clearly defining my status among the rest of the world, which I would occasionally forget to take off during my post-hospital Whole Foods visits.

In the hospital, there was no crash course, there was no “introduction to being a real doctor,” there were patients. Living, breathing, awfully sick, awfully scared, awfully angry, awfully sad, awfully happy, awfully confused, awfully in-my-I-have-no-idea-what-the-f***-I-am-doing hands.

I remember my first emergency situation. One of my patients had fallen to the floor and banged her head on the ground. Something that the hospital tries desperately to avoid with railings, 1:1 monitoring, and wrist restraints, yet often, patients go to ground.

Dashing to the room, with my medical student in toe, four days after being a real doctor, I acutely realized I had no idea what to do. There was a lady on the ground screaming and crying, holding her head, who was my patient, and about nine people asking me what to do next. They were nurses, technicians, and physical therapists.

“Can we just get her up?” I asked

“Well we should probably stabilize her c-spine, she might have fractured something.”

“Ok,” I said. Then I whispered to my medical student to go grab the senior resident and attending.

“What happened?” I asked the patient?

She didn’t respond to me, just tears and crying.

More pondering looks from the staff, I imagined them thinking, “is this guy a real doctor?”

In 30 seconds, which felt like 30 years, my saviors came and proceeded to get x-rays and check the patient with some physical exam maneuvers I had never seen in my life or, in actuality, simply forgotten from one year ago. She ended up being fine. The 13 people in the room proceeded to file out. The patient calmed down. The nurses wrote on their secret whiteboard in their lunch room, “Never call Dr. Zach for help again.”

Going to my computer to record the event that just happened, I noted the patient had been there for 135 days. 135 days. How could someone be in the hospital this long? Asking my fellow doctors about patient, they revealed that everyone knew who she was. She was a “regular” at our medical center. What was a traumatic experience for me, was a normal Thursday afternoon for every other doctor in this hospital.

“Why is she still here?” I asked

“We can’t find placement, because no one will take her with her alcohol abuse and other medical conditions.” A resident replied to me, almost as if he was telling a drive-through patron at McDonald’s that they were out of fries.

“But we aren’t administering any medications, she has no surgeries coming up, no further diagnostics to be done, so why is she here?”

With maybe a hint of emotion, like the McDonald’s can give me an extra ketchup packet for my distress he said, “Yeah that happens sometimes unfortunately, maybe we can transfer this patient to the non-teaching service, that’s what we should do, you aren’t really learning much from this right?”

“Well, honestly, I don’t really know anything, I’ve been here 4 days, so everything is a learning opportunity.”

“Yeah, let’s transfer her, sorry about giving her to you.”

“Uhh, don’t worry about it.” I responded.

And, just like that, my first-ever patient with an emergency under my care was transferred to another team.

I very quickly learned there was a lot of this: difficulty in discharging patients due to placement, fierce strategizing and fighting over who would or would not take the patient based on little discrepancies like when was the last surgery or if they at one point had a stroke. And there was lots and lots, I mean lots, did I say lots? of apathy. This was not the medicine I expected.

Importantly, I don’t want to say in any way, shape, or form my colleagues were bad doctors. They were some of the brightest, most compassionate, and most driven people I have ever dealt with in my life. But even the smartest of them, when they hit their head against a brick wall, it was still a head against a brick wall. And, usually, after that hit, they were a little woozy, they might need a rest, and they might not feel so passionate about hitting their head against the brick wall again. It seemed to me, at most, that maybe 25% of the doctors actually enjoyed their time in the hospital.

I had some amazing interactions with patients. Some wrote me letters. I think I actually saved a patient’s life by realizing they were likely going into anaphylaxis and quickly getting the anesthesia team involved. I learned about people’s dreams, fears, and traumatic experiences at their most vulnerable points. I was truly lucky. I was truly honored to be given such a privilege to be with these people during their lowest points.

My biggest issue, and I will get to this point later when we get past my story and into my reasoning, is that this felt like, at most, 5% of my time as a doctor. The other 95% was spent on electronic medical records, patient disposition, nurse or technician communication, medical education, or insurance and billing strategizing.

Was the juice worth the squeeze?

2 months in, I knew it wasn’t.

So, I had many conversations with many people. My family, doctors that were happy, doctors that were unhappy, corporate workers, big YouTubers, nurses, woodworkers, why did they choose to do what they did? Was it driven by money? Something that wasn’t money? A little bit of both? Are they happy now? Are they unhappy now? For the next 3-4 months, I spent nearly every moment thinking about my potential decision to leave medicine. I also realized that I had been actually thinking about this decision for the past 3-4 years.

I learned a lot about sacrifices, the actual impact they were making or thought they were making, and how they felt. I critically examined every patient interaction I had, the treatments, the evidence around the quality of life, and the mortality impacts we as a medical community have made in the past 100 years.

I learned infection control has had a good impact. However, most everything else hasn’t really pushed the needle. I wondered what impact I, Zach, an Internal medicine first-year Intern, was making. And if that impact would be that different 10 years from now. Also, If I did this another 20 times (because I just completed 6 months), what would I feel like? I knew that answer instantly. If I did it another 20 times I would be a shell of a human. Barely alive. A zombie. And zombies can’t perform good medical care, unless we end up in a world ruled by zombies, then I guess I would be a good zombie doctor? Bite him! Not him! No no, moan like this…

I was told over and over again that intern year was the hardest year, and that it gets better after this. I should just stick it out. But why, everywhere I looked, did I see zombie senior residents? Zombie gastroenterology fellows? Zombie attendings? Who is biting all of these people?!

And, around the 8-month mark, I was 99% sure I was going to quit medicine at the end of my Intern year. So I sat down with my program director and told her I was going to quit. She was astonished at first, but then, graciously, tried to help me plan my life after. No offense to her at all, she is an amazing physician and knew how to excel in the academic medical world very well, but she really had no idea what advice to give for what I could or should do after leaving clinical medicine.

I submitted my resignation letter later that week. I told my coworkers and some nurses I had become friendly with that I was leaving. And that was that. The news spread like wildfire, with probably 60 people in the hospital within a week asking me, “Why?” There was never enough time to give the real answer, which is what this post is for. For the next couple of months, I still did the best work I could for my patients, but I knew I was leaving, and I was so relieved. I said goodbye to a few residents sitting in the lounge on the last day. I attended the intern “graduation” party, but I knew I was leaving their world. I felt like an outsider at that party. Many people wondered what I was doing next. Many people said they knew it all along. Many people were happy for me.

I returned my rented furniture, sold some things, and flew back home. I felt happy but also scared.

This brings us to the present day. I still feel happy but also scared. I left medicine about one month ago, today. I do, however, feel healthier and more energized. For the last six months of residency, the metaphor I give is that I was operating at about 15% battery savings mode, and I didn’t even know it. After being home for two weeks, with sleep, family, and projects that excited me, I felt like a new human.

For now, at least, this is the right decision for me. Who knows, maybe I did seriously screw up. I am throwing away a career that hundreds of thousands of students dream of but never attain. I am throwing away guaranteed good money, guaranteed status, and guaranteed career. And, not only that, I am giving up on actually saving lives. I am sure the internet, similarly to some personal reactions I’ve had, will think of me as selfish and stupid. And, this scares me. Not so much what other people think, or the money, but the thought that I am a bad person for making this decision.

All I know is I don’t want to be a zombie.

2. Why I Left

In the end, the decision really came down to the question, “Was the juice worth the squeeze?” And it wasn’t.

Please keep in mind, that I was only a doctor for a year, but, during that year, I want to tell you about the good, the bad, and the ugly I experienced during the fateful year:

The Good

• Camaraderie
• Patients
• Continued learning and growth

The Bad

• Sacrifices
• Patient interactions
• Time burden in and out of the hospital

The Ugly

• Opportunity cost
• The destruction of brilliance

The main reason I left was because I wasn’t sure how much of an impact I was having, and I was unhappy. I felt like a cog in the wheel. Most importantly, I knew that if I wasn’t committing 100% to this, I was letting down my colleagues, my patients, and myself. If I continued to do this I would not only become insanely unhealthy myself, but if I was unhealthy, it meant I wasn’t operating at the best level I could be, which meant I wasn’t working with, teaching, or training medical students or new colleagues the best I could, and, most importantly, I wasn’t treating patients the best I could.

3. Next Steps

When talking about my decision to a prominent CEO of a medical company, who also left residency (he only stayed a month), he said, “you are still a doctor.” I am still a doctor. I am not a practicing clinician, but I am still a doctor. This medical company now saves and improves 1000s of lives a year. He is having an amazing impact, without using a stethoscope. And I think he is right. I am still a doctor, I am just going to be one in a different way than 99% of my peers. I won’t be a practicing clinician, but I hope I will have an impact on people’s lives in a way that is better for me, my colleagues, and, therefore, the people I touch.

So, what is next? Well, honestly, I’m not really sure. I am very lucky to have this YouTube thing, and you all, but I don’t think I would ever become only a YouTuber. My favorite thing to do is to try things and bring you all with me to see what works and what doesn’t work. To inspect the evidence. To win. To fail. To share my adventures. So my next steps, right now, still look like a full-time, classical career. Where will I work? I have no idea. What will my life look like? I’m not sure.

What I do know is I don’t want to be a zombie. I want to help and impact people across the world in some way. If I am a zombie, I can’t help people.

If you made it to the end, I am amazed you could listen to me for so long! Thank you, it means a lot. I will see you on the next one.