Why I'm Leaving Medicine

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Mustafa Sultan
Mustafa Sultan
Friends,
I’ve found it interesting to see many of my friends enter typically prestigious careers — and just not like them.
After a grand total of four months working as a junior doctor, I’ve taken a giant leap. When consultants, registrars etc ask what I want to specialise in — I tell them that I’m leaving Medicine after foundation training.
I thought this would make me the black sheep of the department, maybe miss out on teaching/opportunities.
But it lands quite well. First there’s some confusion (“What do you mean?”). Then curiosity. And then sometimes they share stories about how they wish they’d left.
Below is a terribly self-indulgent account of the pros/cons of junior doctor life, and why ultimately, I’m leaving.

Lack of Autonomy
It’s really weird being treated like a child at 25. I was watching White Tiger; a film about a servant who becomes a successful entrepreneur in India’s Silicon Valley.
The way Balram (the hero) waited for his master hand and foot felt quite familiar to the F1-consultant relationship. What’s worse: The registrar-consultant relationship isn’t much different.
Comparing the F1-consultant relationship to servants in India is of course ridiculous (and probably offensive).
But there is something about being classed as a ‘junior’ for the next 10 years, and waiting on consultants hand and foot that feels really depressing.
'Using up' my best hours
I’ve become pretty concerned with how much time I waste as an NHS doctor. A typical morning looks like:
1) Turn up 40 mins early (unpaid).
2) Fight over a computer that works (2/3 attempts needed).
3) Print the patient list (printer may or may not work).
4) Prepare notes for the ward round (copy values from the computer screen onto paper).
Every time I do this, I see my life whisking away. I just think: “Is this really what I’ve been put on this Earth to do?”.
"It'll Get Better"
There’s a mentality of “It’ll get better when you’re a registrar/consultant” in the NHS. Crucially with this mentality — it’s always just around the corner.
John Davison
After 29 years work for the NHS, 23 for 1 Trust, 17 as a consultant, it’s been humbling to feel so valued and appreciated. https://t.co/0sKeHoeHiN
On the other hand...
I’ve been reading a book about fixing motorbikes, and come to realise that Medicine is really good for my health.
The book makes an interesting point: That maybe sitting in a chair for 8 hours a day with a spreadsheet and Zoom call open isn’t normal.
Compare this to traditional blue collar/manual work. Active. Meetings lots of new people. Lots of problem solving. And the satisfaction of making/fixing something with your hands from start to finish.
Strange thought. But read this account of fixing an old motorbike.
There is always a risk of introducing new complications when working on decrepit machines (kind of like gerontology, I suppose), and this enters the diagnostic logic. Measured in likelihood of screwups, the cost is not identical for all avenues of inquiry when deciding which hypothesis to pursue—for example, when trying to figure out why a bike won’t start. The fasteners holding the engine covers on 1970s-era Hondas are Phillips head, and they are usually rounded out and corroded. Do you really want to check the condition of the starter clutch, if each of eight screws will need to be drilled out and extracted, risking damage to the engine case? Such impediments can cloud your thinking. Put more neutrally, the attractiveness of any hypothesis is determined in part by physical circumstances that have no logical connection to the diagnostic problem at hand, but a strong pragmatic bearing on it (kind of like origami). The factory service manuals tell you to be systematic in eliminating variables, but they never take into account the risks of working on old machines. So you have to develop your own decision tree for the particular circumstances. The problem is that at each node of this new tree, your own unquantifiable risk aversion introduces ambiguity. There comes a point where you have to step back and get a larger gestalt. Have a cigarette and walk around the lift. Any mechanic will tell you that it is invaluable to have other mechanics around to test your reasoning against, especially if they have a different intellectual disposition.
I think Medicine, in the right context, offers most of these benefits.
When I think of what else I would do apart from Medicine — a lot of it sadly involves sitting on a chair on Zoom calls all day.
I just don’t think that’s a good life.
Camaraderie
It’s also nice moving to a new city and instantly having a pool of friends. There are moments, like getting through a short-staffed on call with a small group of you that feel good.
It’s also really satisfying to see a sick patient, work out what’s going on and then fix it all in one evening.
It's Actually a Pretty Good Job
Despite everything I’ve said, I think Medicine is a great career. But I think the NHS, as a monopoly employer, has really been allowed to the p*ss (there are no training programmes outside of NHS/HEE in the UK).
One exciting development is the opening of large US clinics like Mayo and Cleveland in London. Supposedly poaching top consultants on £300–400k salaries.
Maybe they’ll offer competing training programmes one day🤞
So What's Next?
I don’t know exactly, but the following are priorities:
1) Wake up and have autonomy over what I do.
2) Solve important problems creatively.
3) Close to 0 time spent on bs work. Feel like I’m using my time on Earth properly.
4) No feeling of “it’ll get better when X”. Strive to have a good working life immediately.
5) Still practice Medicine on my own terms.
Any ideas appreciated ???
Podcast
#073 To Be Interesting, Be Interested — Dr Imran Mahmud
With warmest wishes,
Musty
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Mustafa Sultan
Mustafa Sultan @mustafasultan

Thoughts on healthcare, human optimisation and productivity. A little taste of what I'm thinking and reading about.

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