I’ve been in medicine for over twenty years, and I’ve seen brilliant colleagues come and go. Some leave in dramatic fashion—burned out, emotionally depleted, they walk away in search of something gentler. Others vanish quietly, their departure marked only by a vacant photo on the department board. Yet through it all, I’ve noticed a surprising pattern: it’s not exhaustion or lack of passion that drives the very best physicians to leave. It’s something far subtler—and far more preventable.
When I left full‑time clinical practice, many assumed I’d burned out. After all, I juggled a heavy surgical schedule, served on multiple committees, and mentored dozens of trainees. By the usual metrics, I should have been on the brink.
But burnout alone wasn’t why I walked away. My passion for medicine remained intact. I still revel in the precision of a well‑executed procedure and the gratitude in a patient’s eyes. Instead, I left because the system around me made it impossible to be the doctor I aspired to be.
Here’s the truth: the best doctors demand more of themselves than anyone else. We invest years mastering our craft and carry an uncompromising commitment to patients. But when the system constantly undermines our best efforts—through bureaucracy, conflicting priorities, or misaligned incentives—it exacts a hidden tax on our excellence.
I remember spending nearly two hours after every clinic day wrestling with electronic health records. Each click, dropdown, and form was a barrier between me and my patients’ needs. My time became fragmented, my attention divided. The very systems designed to improve care instead left me questioning why I entered medicine in the first place.
Early in my career, I joined an academic center because of its commitment to underserved populations. Over time, that mission drifted toward revenue generation and publication counts. I watched colleagues shift focus from patient advocacy to chasing metrics—seeing fewer patients more quickly, billing more tests, and publishing more papers. Excellence was redefined not by patient outcomes, but by quantifiable throughput.
As physicians, we value our clinical judgment. Yet every decision—test ordering, referral, even simple lab work—became subject to layers of administrative approval or insurance constraints. The resulting delays compromised care and eroded our sense of agency. When my hands were tied, my expertise felt devalued.
It’s easy to quantify the hours lost or the pages of documentation. But the emotional toll of fighting a misaligned system is harder to measure:
Excellence thrives in environments of trust, purpose, and respect. When those pillars crumble, even the most dedicated physician begins to look for an exit.
Leaving medicine wasn’t my act of surrender—it was my act of conviction. I didn’t abandon my ideals; I affirmed them. By stepping away, I signaled that excellence matters more than mere endurance.
In my new role as a coach for physicians, I still see the spark of brilliance in those who remain. They haven’t lost their passion; they’re just drained by a system that no longer values their best selves. When top talent walks away, it’s not because they’re broken—it’s because they refuse to burn brighter in a place that insists on darkness.
If we want to keep our brightest physicians—and, by extension, provide the best patient care—we must address the root causes:
Medicine is at a crossroads. We can allow talented physicians to trickle away, propelled by disillusionment, or we can overhaul the systems that hamper true excellence. My departure was not an isolated event; it was a symptom of deeper dysfunction.
The best doctors aren’t leaving because they no longer care—they’re leaving because they care too much to stay in a system that undervalues their commitment. If we want them to stay, we must build organizations that empower their excellence, not stifle it.
I remain optimistic. Change is possible when we listen to the voices of those who know medicine inside and out—physicians themselves. Together, we can reshape healthcare into a system where brilliance isn’t taxed out of the day, and where the brightest of us can thrive rather than simply survive.
