Making a Change
The Hardest Question of All: To Stay or Leave

Kristin E. Harkin, MD FACEP, Assistant Professor of Emergency Medicine, Albert Einstein College of Medicine

Some may have mapped out their whole career by their last year of medical school; others may have graduated residency only to ask themselves, “Is this it? Is this all there really is?” Or maybe you are at a crossroad in the middle of your life, mid way into your career, and are reflecting upon the paths you have already traveled.

Medical school and residency are for a discreet amount of time, and almost everyone enters into practice hoping that this will be a long-term commitment. Yet, at the same time, you do not want to feel like you are in a bad marriage!

You really have to plan your career; do not let it plan you. You should sincerely love the job you choose and feel good about the work you do. Otherwise, it is not fun, and you will not last. If you think you can stomach a job for a certain amount of time just for a short-term reward, think again. The cost really is too high and it will eventually come out in the long run, in ways you may not expect or even realize. After all, “It’s not the years in your life that count. It’s the life in your years,” Abraham Lincoln.

Take an objective look at what you have done with your life and reflect upon the decisions you have made thus far. This is not easy in regards to the professional decisions, and even the more complicated personal ones. Many people feel that they have no other options, for a myriad of reasons. Some of these are true and compelling, while others are not. Enjoy your freedom, and embrace your choices.

Training in emergency medicine opens the door to many exciting opportunities. The variety of practice patterns and locations provides options for everyone. There is no “best,” “right,” or “wrong” career path. Nothing is perfect. The key is to find a match between you and the career path of your choice.

A good way to begin is by honestly evaluating your goals. Ask yourself if there was one thing you could change about your life, what would it be? What is and isn’t working in your life? Be honest with yourself. Realize that compromise is often required, so be realistic.

Ask yourself what are your absolutes—your basic requirements to being happy. This is different for everyone. Take the time to think these through. It will help you discern your way through the many crossroads you will encounter in life.

Continued growth is vital. Cultivate your interests, inside and outside of medicine. First start with considering what expanded types of emergency medicine practice are available. Then, take a good look at them and see if you have a genuine interest in them. Think about what the training entails, if needed.

Think about whether you can afford the change financially and how secure the field is. Then, think about whether you can afford to not make that change mentally! The flexibility of scheduling in emergency medicine allows individuals the opportunity to pursue many other personal and professional interests while maintaining a viable clinical practice. It may be possible to work part-time in this new endeavor with a decrease in your clinical hours. It is also possible to integrate an avocation into a career in emergency medicine.

This may lead some to pursue an advanced degree. There are three areas of particular interest to physicians: public health, administration, and education. But, is it really worth it? Only you can answer that for yourself, and there are some important points to consider. Graduate programs require a considerable amount of time, determination, and money. The commitment is not to be taken lightly. Attending classes, reading assignments, completing homework, preparing for exams, and designing projects is consuming. Nevertheless, investing in an advanced degree may make the time one does spend in his or her career much more productive and enjoyable. Those seeking advanced degrees will be happiest if they do so as a means of achieving a goal, rather than avoiding the pressures of clinical practice. Those seeking to escape the business practice of modern medicine by going into administration may be even more dissatisfied with management jobs.

Once you have decided on a change, make a list of steps needed to achieve this goal. Prioritize the steps. Remember that it is ok to say “NO” when necessary to competing entities for your time and then focus on your highest priorities. Put things in perspective— will it really matter in a month, in a year, in five years?

The power of choice is a mighty responsibility. It is completely up to you to know when it is time to exit. Do not worry what others think. You are the one that is going to have to live with your decision to stay (or leave). As Mary Anne Radmacher has said, “Just because you bought the ticket doesn’t mean you have to stay for the second act.” So, forget about what others think of your desire to change because the best way to predict your future is to make it.

These decisions are complex and multifactorial. Only you can rank these issues as to their relative importance, and only you can decide what, in the final analysis, is the best fit for you and those you care about. Realize that it is never too late to start formulating these thoughts.

Be open to career transitions and alternative work opportunities in emergency medicine. Be willing to make modifications. Opportunity knocks every day—it’s just a matter of recognizing it! Consider ALL of your options. Weigh each carefully. Live with intention. Inevitably, however long the road, there comes a turning. It is very important to continually assess yourself and realign your goals as needed. They may change over time. As Jim Miller has said, “The road to success is always under construction…”