The Physicians Who Can Walk Away Are the Ones Who'll Save Medicine. Here's How to Become One of Them.

I didn't plan to resign from my academic position. I'd asked my department for approval to take a sabbatical – unpaid time to step back, reassess, and return part-time but the answer was no. So I resigned and took the time I needed.

But something shifted once I'd actually decided to leave. Suddenly, the part-time position I'd requested – the one that originally couldn't be accommodated – materialized. My institutional allies who wanted to keep me suddenly found a way to maneuver around "the system." I came back on terms I was happy with: 0.3ish FTE, enough to stay connected to the work I love, including directing my hospital’s Faculty Well-being Champions Program while building my own passion practice outside the system.

That experience taught me something surprising: that part-time role would have never existed if I hadn't demonstrated I didn't need it. There was power in my willingness to walk away.

The Wellness Trap

Here's what troubles me about how most institutions approach physician well-being: they focus on helping individuals cope with broken systems rather than fixing those systems. Resilience training, mindfulness apps, yoga – these programs inadvertently send the message that if you're suffering in medicine, the solution is to manage your reaction to the problem, not change the problem itself.

Institutions love this approach. It's cheaper to offer stress management workshops than to address unsafe staffing ratios or the fact that insurance companies are practicing medicine without licenses. And it keeps the locus of change squarely on the individual physician, never on the system.

But I see coaching as something with the potential to be truly transformational - not just for individual doctors, but for the whole system. The coaching I practice isn't about helping physicians cope better with intolerable conditions. It's about helping them build the capacity to refuse those conditions - and in doing so, become part of the collective force that will actually change healthcare.

What Physicians Tell Me

When clients come to me for coaching, they often feel stuck between two options: stay in a soul-crushing job or walk away from medicine entirely. They've tried the wellness apps. They've set boundaries that got trampled. They know the system is broken. But they can't see a third path.

What I propose to them is that the willingness to walk away is exactly what empowers them to fight for change. Not the actual walking away, necessarily, but the freedom that comes from knowing you could.

The System Will Never Change If We Aren't Willing to Walk Away

Empowering individual doctors alone won't fix healthcare. We need collective action – professional organizations with actual power, unions, coordinated physician resistance to scope creep and insurance company overreach.

But we can't build that collective power from a position of total dependence. Physicians who are completely reliant on a single institution for their livelihood, their identity, their health insurance - those physicians cannot risk challenging that institution. Their rational choice is to keep their heads down and survive.

Healthcare institutions will not voluntarily reform themselves. They change when the cost of not changing exceeds the cost of changing. Right now, that calculus doesn't favor physicians. As long as institutions can count on our compliance, they have no incentive to improve conditions.

What Keeps Physicians Feeling Stuck

When clients first come to me for coaching, they typically feel trapped by financial obligations, a deep sense of duty to patients, and limiting beliefs internalized over years of training.

The financial piece is real – I'm not dismissing it. But physicians often overestimate how trapped they are. They tell themselves "I can't afford to go part-time" without running the numbers. They convince themselves they have to stay at their current job until they reach public service loan forgiveness, when actually they could work at any qualifying nonprofit.

The sense of duty runs even deeper. We're trained to see leaving – or even reducing our clinical time – as abandoning our patients. But staying in a role that's destroying you doesn't serve your patients either. Burnt out physicians make mistakes. The myth that self-sacrifice equals good doctoring keeps us stuck in situations that harm everyone.

And then there are the limiting beliefs: "I can't go part-time because I'll lose credibility." "Leaving would mean I wasted all those years of training." These stories feel true because we've been marinating in them since medical school. But they're narratives we can interrogate and change.

Building the Capacity to Walk Away

You can start this process on your own. Write down your top three Core Values (Mine are Integrity, Joy, and Freedom. You can find a great comprehensive list of Core Values here.) Now list your current role's demands. Where do they conflict? When you know your core values, you can evaluate whether your current role honors them.

Then write an intention statement: what you want your medical career to look like. Not a fantasy, but a realistic vision that honors your values and boundaries. This becomes your North Star for decision-making.

Ask yourself: If I stay in my current role for five more years without changes, who will I be? What will I have sacrificed? Now flip it: If I make the changes I'm afraid to make – go part-time, set real boundaries, develop income outside my institution – who might I become?

When you get clear on your values, articulate your intention, and honestly envision both futures, something shifts. Part-time schedules that "aren't available" suddenly become possible. Contract terms that were "non-negotiable" turn out to be flexible.

This is what happens when you stop negotiating from a position of desperation. When you've built even modest independence – financial, professional, psychological – you become harder to constrain.

Individual Agency Creates Collective Power

Every act of individual agency chips away at institutional dependence. When you build a side income stream, you reduce your employer's leverage. When you go part-time, you demonstrate you don't need an institution to define your worth. When you enforce your non-negotiables, you prove institutional displeasure isn't fatal.

The physicians who can most effectively advocate for systemic change are the ones who have built some independence - who have already practiced saying no and proven they can survive on their own skills.

A physician who knows they could leave is a physician who can demand better. A physician who has other options is a physician who can organize without fear.

That's why I'm building my coaching practice alongside my part-time institutional work. Not to help physicians cope with broken systems, but to help them build the courage and capacity to challenge those systems.

The question isn't whether you should stay in medicine or leave. The question is: are you free enough to choose? Because until you are, the system has no reason to change.

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This essay was originally published in the On/Offcall newsletter, where it was the most-clicked article by far!

Physicians who want to build the agency and courage needed to transform their careers can work with me! Get started by booking a free introductory coaching conversation here.

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