Supporting sustainable careers for doctors: when the bar is low, we aim high
Earlier this month, I went to a Lorna Breen Foundation ALL IN event for health workers' mental health. On the walls hung beaming portraits made from medical materials, the stuff we handle every day—vent circuits, cotton swabs, vacuum tubes, gloves—honoring colleagues lost to suicide. There was also a new portrait, unveiled that night, of recovery.
Then health workers stood up and told their stories. They spoke with the kind of vulnerability that is still rare in medicine, and one theme kept surfacing: the storytellers would not have gotten better without pausing their careers. (You can watch a shortened version of one of those stories here.)
The storytellers who recovered got real treatment, and they got time. The pause was necessary for recovery. When their organizations made room for that, it worked.
I left the event feeling moved. I also left with more clarity about what career breaks mean to me and my coaching clients.
The bar is on the floor
Somewhere along the way, we decided that the gold standard looks like this: a physician reaches a full-blown mental health crisis, and her health system lets her rest.
That's the good outcome, the story we celebrate.
It's also a very low bar. And most of the time, we aren't clearing it.
Physicians know what asking for help can cost. In a survey of nearly 8,000 surgeons, only about a quarter of those with recent suicidal thoughts had sought psychiatric or psychological help. Sixty percent held back out of fear it could affect their medical license. The Dr. Lorna Breen Foundation is still fighting to get intrusive mental health questions off licensing and credentialing applications. Thankfully, they’re making amazing progress. But that fight only exists because the problem is pervasive and ingrained in medical culture.
A distinction that matters
Burnout is not suicidality, and it isn't a mental illness. The World Health Organization classifies burnout as an occupational phenomenon, a problem with the job rather than a diagnosis of the person. Someone in a mental health crisis needs real treatment, and time away alongside it.
But burnout isn't harmless. In that same surgeon study, burnout and depression were each independently associated with suicidal thoughts, even after accounting for personal and professional factors. Burnout can be like a check-engine light. What if we let physicians pull over when it comes on?
What if?
What if we took breaks before we broke?
What if it were normal to take one when we're not all the way burned out, just "a little crispy"?
An emergency physician I interviewed for my sabbatical project described herself as angry, callous, and not herself. Then she realized her eldest daughter would be looking at colleges the following summer. "I'm never gonna get this time back." She asked for the summer off, and her employer said no. She took it anyway.
And what if we could take a break simply because we wanted one, with no diagnosis, no crisis, and no justification required?
Another physician I interviewed worked the system nicely. She had to frame her sabbatical around academic goals to get it approved. What she actually wanted was travel and time with her family, and the most valuable part turned out to be simply being more present with her son. We make physicians diguise rest as productivity before we let them have it.
I know how this sounds
We can't even reliably get the crisis response right. So proposing career breaks before crisis, or with no crisis at all, is radical. I know. I mean it to be aspirational. Aspirations set direction long before institutions catch up, and incremental fixes keep leaving us in the same place: physicians burning out, breaking down, and leaving.
And they're leaving earlier. A 2024 survey by AMA researchers, published this year in The Permanente Journal, found that physicians who left clinical practice did so at an average age of 48.1, nine years younger than a comparable group studied in 2008. Stress and the hassles of practice topped their reasons.
After Dolly Parton's death in August, I did a nostalgia rewatch of 9 to 5. In the 1980 film, three women take over their office and introduce flexible hours, job sharing, and on-site daycare, and productivity goes up. It's fiction. But the premise has a lot of face validity, and real-world evidence points the same way:
• An independent emergency medicine group in Michigan built a program of recurring, month-long paid sabbaticals. It saw sustained career satisfaction, extremely low physician attrition, and less burnout, and the authors argue other organizations could do the same cost-effectively.
• In a study of primary care physicians, those working part time reported higher satisfaction and less burnout, and they were no more likely to leave their practice. Their patients were just as satisfied.
• Outside medicine, 61 UK companies moved to a four-day week at full pay for six months, and 56 of them kept it afterward. Staff turnover fell 57% compared with the same period the year before.
• And the money: filling a single vacant physician position can cost more than $500,000 once recruiting and lost billing are counted. Some estimates run past $1 million. Flexibility isn't just the nice thing to do. It's smart business.
What I'm actually asking for
A physician's career should be allowed to evolve. We have more capacity and drive in some seasons than others. Rest isn't a reward for surviving; it's part of what makes a long career possible. Flexibility to work part time, and to take real career breaks, creates healthier physicians. Healthier physicians stay.
I took my own sabbatical after my department told me no, not because I was in crisis, but because I knew I needed it. I came back on my own terms. Since then, I’ve had the privilege of meeting and learning from a growing number of other doctors who took their own sabbaticals and shared their stories with me. I want career breaks to be ordinary, not an act of defiance.
The portrait of recovery I saw that night was beautiful. I want to live in a world where we need fewer of them, because fewer of us had to get that close.
If you or someone you know is struggling, call or text 988, the Suicide & Crisis Lifeline.
Not in crisis, but considering taking a break? Take my free 3-min quiz.
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