Mindful Journaling for Re-Thinking Your Career in Medicine: Staying, Leaving, or Practicing Differently

There comes a time for many physicians when troublesome questions begins to surface:

• Can I continue practicing in this way?

• What needs to change to make my practice sustainable?

• Is it time to move on?

• Are there other ways to use my skills, knowledge, and gifts that I haven’t yet imagined?

These questions, which may arise at any phase of your professional life, don’t always yield easily to analysis. In fact, thinking harder, what we might call ruminating, often makes problems feel less resolvable. Instead of finding clarity, you may begin to feel more uneasy, more torn, caught in a whirlwind of what-ifs and afraid of making the wrong choice.

This is a good time to tap into your inner wisdom, and this is where journaling can help.

In my work with physician clients facing difficult questions, I often encourage journaling as a reflective practice. It’s a simple, analog way to get in touch with your own inner life. In many ways, it’s a form of mindfulness. Writing by hand often works best, as this tends to create a strengthen the mind-body connection and deepen awareness. But choose what feels most comfortable and accessible for you.

The journaling reflection that follows is not meant to force a decision. Instead, it is an invitation to listen differently, to slow down and give your mind the space it needs to breathe.

To begin, set aside anywhere from 10 to 30 minutes. Choose a time when you can take a quiet and uninterrupted pause, maybe at the beginning or end of the day. Let your intention be to meet your own presence rather than productivity.

Step 1: Name the Question (Without Answering It)

Write the question that keeps returning for you. Perhaps that’s:

• Is it time for me to change the way that I am working?

• Is there a way to practice that feels more sustainable?

• Who am I if I am not in my current practice?

• What would it mean to me to leave medicine altogether?

Your question could be something else entirely. Perhaps it’s very personal, or maybe it’s connected to your family. No matter what question you choose to sit with, choose something that matters to you.

Once you’ve acknowledged your question in this simple way, write:

Right now, I don’t need to answer this question. I am simply acknowledging that it is here.

Pause, breathing in and breathing out, before moving on.

Step 2: Notice How the Question Lives in the Body

Without analyzing, reflect on:

• Where do I feel this question in my body?

• What does it feel like? Is it tight, pressing, restless, dull, vibrating, sharp, or charged? Maybe it is simply a weight, or something else.

• What happens if I stop trying to solve it, even briefly? How does the sensation change?

Write what you notice. If an answer feels clear, sit with it for a while. If it doesn’t, give it time. Resist the urge to fix.

Step 3: Release the Urgency to Decide

Complete one or more of the following phrases:

• When I try to force an answer, I notice that I feel…

• What I am most afraid would happen if I don’t decide soon is…

• If I trusted that clarity will come in its own time, what would soften right now?

Allow your writing to be honest and unedited.

Step 4: Remember How Insight Has Emerged in the Past

Think of a time, whether personal or professional, when an important decision became clear without effort.

• What was happening around that time?

• What was my state of mind or body?

• How did that sensation of knowing feel when it arrived?

Write without trying to draw conclusions.

Step 5: Give the Answer Time to Grow

On a new page, write:

I am allowing this question to rest.

Then ask yourself:

• What helps me stay grounded while this question matures?

• What kind of space, support, or pacing allows clarity to emerge naturally?

• What would it mean to trust my capacity to find my way?

• Who or what might support me in staying present with this question, rather than rushing toward an answer?

A Closing Reflection

Before you stop writing, choose one sentence you can return to when stress or anxiety rises. For instance:

• I don’t need to have all the answers right now.

• I can rest here in this moment, and it’s ok.

• I trust myself and my inner wisdom.

Life is not a board exam. Some decisions are not meant to be rushed. They are meant to be lived with until, in their own time, they resolve themselves into something that feels steady, clear, and right. This is not the same as avoidance.

Keep this in mind:

• You are not behind.

• You are not failing.

• You may simply be in a necessary period of transition.

Allowing uncertainty to remain present is not procrastination or a dismissal of its importance. It is a necessary first step. Action taken without intention can easily lead you off course.

Return to your journal daily if possible; even a weekly practice can be transformative. With time and mental space, the next step often becomes clear. If the weight of the process feels heavy or unwieldy, a physician coach can serve as a trusted thought partner, helping you to reflect, stay grounded, and find your own way forward.

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Overcoming Your Roadblocks: A Physician's Guide to Navigating Change When it’s Time to Move On

An earlier version of this article appeared on this website in December, 2023.

If you’re feeling stuck in your practice, torn between your current role and the pull toward something different, you’re not alone. In the old paradigm, physicians assumed they’d join a practice after training and remain there until retirement. Especially in private practice, moving locations, switching roles, or stepping away from clinical work altogether was rare and even stigmatized.

But the landscape has changed. Across every sector, more physicians are re-evaluating what fulfillment means—and realizing that staying true to your values may require reimagining your role, whether within your current system or beyond it.

It’s a deeply personal realization, and one that can feel both unsettling and energizing. And it’s becoming increasingly common.

In fact, a recent Mayo clinic survey reported that one in five physicians plan to leave their practices within the next two years, and one in three expect to reduce work hours. A second study found that amongst academics, one in three felt a moderate or greater intention to leave. And a 2023-2024 AMA survey of nearly 18,000 physicians from more than 100 health care systems reported similar finding across all physicians. What’s more, the number may be closer to 40 percent in some specialties, including Anesthesiology, Radiology, and Vascular and General Surgery. Burnout, excessive EHR requirements, and lack of support from their organizations were primary issues cited in these studies.

All of this is to say that if you're considering a change, you’re not alone. But that doesn’t make the decision easy. Physicians are often motivated by loyalty and compassion. But we are also creatures of habit, and veering off the well-worn path can feel daunting.

You’re someone who’s used to thinking independently and making critical decisions, but it’s likely that your roadmap was clearly defined from the start: college, medical school, residency, maybe fellowship. As long as you followed this straight and narrow track, and nothing unexpected knocked you off course, you would make it down the road. Waiting for you at the end of the trail would be a satisfying profession, a place of respect in your community, and a happy home life to balance it all out.

Over the past decade, that promise has faded for many physicians. Burnout due to lack of autonomy, higher patient demands, a sicker and older population, falling reimbursements, the unrelenting pace of EHR tasks: all have contributed. So have our increasingly disconnected healthcare systems. It’s not surprising that more and more doctors are reflecting on what they want from their careers, and what might need to shift.

Moving on is sometimes the best and healthiest choice. But change doesn’t always mean leaving your organization or giving up your practice altogether. Sometimes transformation begins by renegotiating how you work: seeking new roles, advocating for flexibility, or crafting a job description that better aligns with your strengths and goals.

Still, thinking about change of any type can feel like stepping into the unknown. The hardest part is often getting started. It may even feel as if your feet are stuck in quicksand. That’s normal. But once you begin, you’ll discover that your momentum will build and possibilities will unfold as you continue to move forward.

In this article, I’ll give you seven actionable steps that can help you move forward when you’re feeling stuck.

1. Self-Reflection

Before deciding what’s next, take time to reflect on what matters most, both professionally and personally. You don’t need to know the final destination yet, but clarity around your values, interests, and strengths is essential.

Journaling for a few minutes each day can help. Ask yourself:

❓What are my defining values? How do I want to manifest those values in my daily life?

❓What aspects of my current role energize me—or drain me?

❓What skills do I love using? And what would I be happy to give up?

❓How do I want to feel at the end of each day?

❓What would I regret not doing, both personally and professionally?

❓How will any change I make impact my loved ones, either positively or negatively?

Making time for self-reflection will lay the foundation for building a more aligned, satisfying professional life, whether that’s in a new place or a new role within your current setting.

  2. Recognize Your Triggers and Limiting Beliefs:

When you’re contemplating change, it’s natural for doubts to arise: “I can’t start over,” “I’m too far along,” “What would my colleagues/ family/friends think of me?” or “I’m lucky to have a job—why rock the boat?”

Instead of pushing these thoughts aside, examine them:

❓What stories am I telling myself?

❓What are these beliefs protecting me from?

❓Are they actually true—or just familiar?

❓What would it take to feel more confident in exploring a new path?

❓If there are meaningful limitations that are holding me back, how can I close the gaps?

Acknowledging and challenging these beliefs is a key step toward moving forward.

 3. Seek Guidance

 Talk to mentors, colleagues, or others who’ve made career shifts, whether big or small. You may be surprised by how many have reimagined their roles without leaving their organizations. Others may have made audacious shifts and found greater fulfillment. And some may have dealt with regrets and learned from their mistakes. The point is not to recreate anyone’s story, but rather to understand that your own possibilities may be more expansive than you realize.

Tapping into others’ experiences can offer both perspective and inspiration. Just be thoughtful about whom you confide in—especially if your plans are still unfolding.

 4. Set Achievable Goals

Break your career change into smaller, manageable goals. This not only makes the process less intimidating but also gives you a way to envision the road ahead.

Rather than winging it and hoping for the best, create a timeline with defined milestones. These might include:

✅Gaining specific qualifications or licensure

✅Attending relevant conferences,

✅Researching places you might want to live

✅Identifying internal opportunities that might better align with your goals

✅Exploring part-time or leadership roles within your system

✅Updating your CV or LinkedIn profile

✅Reaching out to potential employers or colleagues in your desired field.

Use the SMART framework—Specific, Measurable, Achievable, Relevant, and Time-bound—to track your progress and stay motivated.

 5. Reframe Setbacks as Lessons

 Rejection can sting. And not every door will open right away. Setbacks are part of any meaningful journey. Instead of seeing them as failures, view them as data.

What did you learn? What might you do differently next time? What can you take with you to the next opportunity?

Stay rooted in your “why,” and let that guide your next move.

 6. Get Comfortable with the Unknown

 Uncertainty is normal. It’s uncomfortable, especially if you’ve grown accustomed to defined pathways. But the unknown becomes less intimidating when you ground yourself in research and preparation.

If you’re exploring a nonclinical role, learn the landscape. If you’re considering a new position, understand the expectations, workflows, and culture. And if your skills need to be refreshed, find out what you need to do to make that happen, then make a plan to get it done.

The more you know, the more confident you’ll feel taking the next step.

 7. Keep an Open Mind

You don’t need to have everything figured out right now. Stay open to possibilities while keeping your perspective grounded. Often unexpected new opportunities will present themselves while you are putting in the work.

Seek input from those you trust, but recognize that you’re the one who knows yourself best. Give yourself the space to grow into what’s next.

Final Thoughts

Redefining your path as a physician takes courage, clarity, and commitment. You’ve honed these skills over the past decades of training and professional practice. Now, it’s about using them to design the life that you want to live. Whether you're stepping into a new career, transitioning into a different role within your current system, or simply giving yourself permission to explore, start by addressing the internal roadblocks that stand in your way.

Be willing to ask bold questions and take thoughtful action. Most of all, trust in your ability to create a more fulfilling and sustainable future.

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If you’ve enjoyed this article and would like to stay in the loop for more insights on creating a sustainable, fulfilling, and happy life as a physician, sign up for my newsletter or reach out on my website. I’d love to hear from you.

And if you’d like to schedule a complimentary introductory meeting with me, click the link below.

Your Physician Job Offer Survival Guide: 40+ Questions to Secure the Right Deal

Whether you’re fresh out of training, looking for a new start, or advancing into the next chapter of your career, it’s essential to know what you’re signing up for before committing to a new job.

Back in the early 1990’s, the managing partner of my first practice seemed taken aback when I asked to review the contract before signing. He muttered something about the good old days, when business was done with a handshake. I doubt that was ever a good idea. But even when you have a contract in hand, it’s important to have a clear understanding of the implications of your decision. After all, it’s likely that you’re not just taking a job— you’re planning to build a life there.

To help you get started, I’ve compiled a comprehensive list of questions that you should consider before accepting a new position. These cover everything from compensation and call schedules to long-term growth opportunities and organizational culture. There is no one-size-fits-all solution. It’s important to understand that every contract and compensation structure is unique. Take some time to clarify what your own needs are, what you’re willing to bend on, and what is non-negotiable.

Even if everything sounds perfect, it’s a good idea to get multiple perspectives from current and past physician group members whenever possible. By asking the right questions, you can make an informed decision that supports both your career and your well-being. Before signing on the dotted line, always consult with a qualified healthcare contract attorney or advisor to review your offer and ensure your interests are protected.

Even if you’re happy in your current position, consider bookmarking this article. Most physicians change jobs at least once during their careers, often for reasons that go far beyond salary. As a coach who supports physicians through these transitions, I’ve seen how having the right questions in hand can save enormous time and frustration. The better prepared you are going into negotiations, the more likely you are to land in a role that reflects your values, supports your professional growth, and fits your personal life.

1. Role and Responsibilities: Know What You're Signing Up For

• What are the specific expectations for this role?

• What is the call schedule like? How often will I be on call?

• What’s the breakdown of clinical vs. non-clinical duties?

• What does a typical day or week look like?

• How is research time and support structured?

• Are there opportunities to shape or evolve the role over time?

2. Compensation and Benefits: Understand the Full Package

• What is the compensation structure (salary, RVUs, bonuses)?

• Is the salary guaranteed or productivity-based? Are there annual increases?

• Are there sign-on bonuses, relocation assistance, or student loan repayment options?

• What are the retirement plan options (e.g., 401(k), 403(b), employer match)?

• Is malpractice insurance provided? What type (claims-made or occurrence)? Is a tail provided if I leave or retire?

• What health, dental, vision, life, or disability benefits are included?

• How is paid time off (PTO) structured? Is it separate from sick leave?

• Is there a maternity/paternity leave policy?

• What are the CME benefits (time off and stipend)?

• Are there additional income opportunities (moonlighting, teaching, consulting)?

• What expenses are reimbursed (licensing, board fees, memberships)?

3. Career Development: Beyond the First Year

• Are there opportunities for leadership roles or academic involvement?

• What is the pathway for promotion or advancement?

• Are mentorship or onboarding programs available for new physicians?

• Does the organization support continuing education or conference attendance?

4. Practice Environment: Assess the Day-to-Day Reality

• What is the patient population like? What are the common conditions treated?

• How are new patients assigned? Can I build my own panel?

• How many patients am I expected to see per day or week?

• What is the support team structure (RNs, PAs, MAs, scribes)?

• What EMR system is used? Are physicians involved in EMR decision-making?

• What quality metrics are tracked? How are they measured and used?

5. Organizational Culture: Find Out What It’s Like to Work There

• How would you describe the culture of the organization or department?

• How is physician well-being supported?

• What is the leadership style? How accessible are department and executive leaders?

• How are conflicts or concerns typically handled?

• How many physicians have left in the past 5 years? Is it possible to contact them?

6. Long-Term Prospects: Look Ahead

• Is there a path to partnership, ownership, or becoming a shareholder?

• If I can’t become a partner, will I still have the opportunity to serve on committees or vote on important changes?

• What are the organization's strategic goals or planned changes over the next 3–5 years?

• Is there flexibility for role changes down the road (e.g., reduced hours, academic time, admin focus)?

7. Community and Logistics: Make Sure It Fits Your Life

• What is the surrounding community like in terms of cost of living, schools, and lifestyle?

• What support is offered for relocating (e.g., temporary housing, realtor support, moving expenses)?

• Are there opportunities for physicians to connect socially or professionally outside of work?

• If you have a spouse or significant other, will the community suit their needs and interests?

• If your spouse or partner needs to find a job, will the organization provide assistance with this?

8. Exit Clauses and Contract Flexibility: Read the Fine Print

• Does the contract include a non-compete clause? What are its terms?

• What happens to bonuses or relocation benefits if I leave early?

• Is there flexibility to renegotiate compensation or scope after the first year?

• Are there limitations on outside paid non-clinical work like medical writing, speaking, legal consultations, or industry collaboration?

• What is the termination process—by either party?

Final Thoughts

Choosing your next position is about more than just the numbers. It’s also about the way you feel when your alarm goes off in the morning, your career trajectory and the people who support it, and the life you want to build outside the hospital, clinic, or lab. Leaving a job that’s a poor fit is incredibly stressful, not to mention a financial hit, so take the time and effort to ensure the opportunity aligns with your values and goals.

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If you’ve enjoyed this article and would like to stay in the loop for more insights on creating a sustainable, fulfilling, and happy life as a physician, sign up for my newsletter or reach out on my website. I’d love to hear from you.

And if you’d like to schedule a complimentary introductory meeting with me, click the link below.