My one-year work anniversary. Well, counting residency, I’d technically been a doctor for four years, but that July of 2021 marked something different, one year as a senior staff attending physician. One year of being fully responsible. No supervising attending to check my plan, no safety net above me. Just my judgment, my signature, my name on the chart.
There was a lot to celebrate. I had grown as a husband, a father, and a physician, often all in the same twenty-four hours. That first year out of residency is a different type of stress, because for the first time, the decisions are entirely yours. During that first year I had seen a few thousand patients. Written thousands of prescriptions. Reviewed well over 10,000 labs. Somewhere in there I had started to feel like an actual doctor, not just someone playing the part.
I had plenty to be proud of, and on paper, that anniversary looked like a milestone worth marking. The harder truth was quieter, and it lived underneath all of that. Primary care is hard in a way that is difficult to explain to anyone who hasn’t done it. Every twenty minutes, a new patient is waiting in the exam room. A new problem to solve, a new person to understand, a new set of fears to address. There is often no real space in between to think, let alone breathe. You learn to switch gears at a speed that starts to feel unnatural. Grief in room one. A medication question in room two. A frightened parent in room three. Twenty minutes each, and the clock doesn’t care how complicated the conversation actually is.
At home, I was a new father. I was walking in late most nights, missing the small parts of the day I had wanted to be there for. When I did get home, I wasn’t always fully there either. Some part of my mind was still in the clinic, still replaying the harder decisions of the day. Did I miss something with that patient? Should I have ordered the scan? What if she doesn’t get better on the antibiotic?
After spending time with family, I was back on the computer. Finishing notes. Answering nursing messages. Responding to patients. Sending in refills. Reviewing labs and imaging that had come back during business hours while I was busy seeing patients. Some nights I didn’t finish which meant getting up early the next morning to clear the backlog before the next wave hit. Because it always hit, right on schedule, at 8 a.m.
This is healthcare. Underneath the prestige of being a physician this is what the job actually looks like. As the newest physician in the clinic, I didn’t want to be the one who couldn’t keep up. I didn’t want to look weak, or soft, or like I hadn’t fully earned my seat at the table. So, I didn’t say much. I just kept going, the way I imagined everyone else around me was doing.
But somewhere in those late nights and early mornings, a thought kept surfacing, one I wasn’t ready to say out loud yet: this wasn’t the life I had pictured. Not when I sacrificed eleven years of vigorous school and training to get here. It’s not what I imagined being a doctor would feel like. Now, don’t get me wrong. There were countless moments during that first year that reminded me exactly why I’d chosen family medicine in the first place. Moments when patients gave me credit for an infection that cleared, for a marriage that somehow found its footing again, for a depression that finally, after months of adjusting and waiting and adjusting again, went quiet.
Moments that had nothing to do with medicine at all, like holding a patient’s hand and praying with them when there was nothing left in my toolkit to offer. No test to order, no medication to try, no procedure that would change the outcome. Just presence. Just being willing to sit in the exam room and pretend like there were no other patients waiting.
Those moments were sacred. Not sacred in a way that reflected in their chart or a bill sent to insurance, but sacred in the way that stays with you long after the visit ends. They didn’t erase the hard parts of the job or make the twenty-minute windows any longer. But in the moment, they were enough to remind me why I’d chosen this path in the first place, and why, even on the days it seemingly asked everything of me, I’d choose it again.
Unfortunately, the tension kept building. The realities of my responsibilities at home were only increasing. Several months after my one-year anniversary as an attending, our second child was born. So, I turned my focus to becoming more efficient. Now this naturally had occurred with time, but I intentionally sat down with clinic leadership and nurses to figure out how we could
streamline our processes. What could they do different to help me and what could I do different to help them. And here’s the thing. Looking back, it worked. I actually got faster and was able to achieve more in a day. Despite this, a hard lesson I learned is that when the workload has no actual end, being more efficient doesn’t change how carrying it feels. I don’t recall there ever being a single dramatic moment, but there was a growing realization that something bigger had to change. Not because I couldn’t handle the job, but because I was starting to understand what handling it was actually costing me. In fact, I arrived at the obvious solution fairly quickly, I should drop down to part-time.
Thanks to having very supportive leadership in clinic, I felt confident if I asked, they wouldn’t stand in the way of allowing it. My wife certainly wouldn’t. The resistance was entirely internal which unfortunately still didn’t seem to make it any easier. For the sake of vulnerability, let me be honest about what it actually came down to. It would be easy, looking back, to dress it up as something more thoughtful than it was. To say I was weighing patient continuity, or the needs of the clinic, or some careful calculation only a physician would understand. That would sound better. It just wouldn’t be true. When I strip away every rationalization I told myself at the time, every reason that felt sophisticated in the moment, what’s actually left underneath is embarrassingly simple. It came down to two things. Pride and money. The pride part was centered on how would I be perceived by my colleagues and patients. I didn’t want to be the new physician who couldn’t handle it, the one who wasn’t cut out for the pace or couldn’t pull their own weight. Would patients think less of me? Would they question my dedication to the profession? After all, during residency training I was known as the “yes-man”. I was the one you could count on to never shy away from a task and was always willing to go above and beyond, no matter how inconvenient. That reputation was trying to follow me, and deep down there was still a part of me wanting to allow it to.
But life was different now. I had painfully learned every time I said yes at work and did extra, I was simultaneously saying no to something else. Back then that something else had been sleep, video games or time at the gym. Now that something else was my family. The money part was more straightforward. It felt good bringing home an attending’s paycheck after years of a resident’s salary that, once you divide it over the actual hours worked, felt comparable to making minimum wage. For the first time, the math finally made sense. Somewhere in watching those bank accounts grow, I started to find a piece of my identity and self-worth in the numbers themselves. It became proof that all those years of sacrifice had actually been worth something monetarily. Why would I want to slow down the one thing I was finally watching pay off…literally.
The friction between work and home was pressing me toward a decision. It is possible to be a great physician, a great husband, and a great father, all at the same time. I still deeply believe that. But I also learned something harder to admit. It’s just as possible to be praised while going above and beyond treating a patient in the exam room and then resented later that evening while sitting at the kitchen table. When work gets me at my best, fully present, fully committed and my family gets whatever version of me was left over when I got home. As it turns out knowing what to do and actually doing it are two entirely different things. I wrestled deeply with the part-time decision. Not in the sense of whether it was right. I knew it was. The wrestling was actually over whether I’d be brave enough to make it. Somewhere along the way “should I” had quietly turned into “can I”.
Of course, there was prayer, and there were long conversations with friends and family. The people you’d expect to lean on when making tough decisions. But one of the most helpful things, oddly enough, came from a source I hadn’t planned on. It came from my patients. At the end of the visits, I started asking my familiar older patients a question that had nothing to do with their chief complaint. If they could go back in time and talk to their younger selves, what would they say. What advice would they give. And then, gently, I’d ask the harder version of that question too. Did they have any regrets. Not to make the visit heavier than it needed to be, but because I realized that the people sitting across from me had already lived the answer to the question I was wrestling with. I was surprised by a few different things. One is it strengthened the physician-patient relationship. I learned more about who they were as a person and what they valued. Second, I hadn’t expected how much they would enjoy sharing this wisdom with me. Faces would light up mid-sentence, telling stories from decades back like they’d been waiting for someone to ask. Unlike anything they had previously experienced at the doctor’s office, for a few minutes they were the expert in the room.
Perhaps what shouldn’t have surprised me was the answer itself. We all know it deep down, we just rarely live like we do. Over and over, I heard some version of the same thing. They wished they’d done a better job prioritizing time with the people who mattered most to them. It seemed to be the universal regret. Best friends who they quit inviting over. A marriage they let fall to the background. Kids who grew up and left the house faster than anticipated. It genuinely got to the point I could answer the question before even asking it. It was always about relationships. In fact, never once did someone say they wish they would have worked more. These weren’t people who’d lived narrow, similar lives that I could dismiss as one perspective.
They were stay-at-home moms who’d spent decades raising children with little recognition for it. Blue-collar workers who’d spent their whole lives on their feet, working hard just to get by. They were people who had climbed all the way to the top of corporate ladders, and people who’d built successful careers in politics. Different backgrounds, different ambitions, and ultimately different lives but the one thing they had in common was time. A life long enough to look back and know what actually made it worth living.
So, I did it. I went part-time. The benefits showed up almost immediately. I stopped bringing work home, or at least stopped bringing nearly as much of it. Nights spent catching up on documentation after the kids were asleep, once routine, became rare. I noticed I had more energy, not just walking into clinic each morning, but also walking out of it in the early afternoon too. And most importantly, at home, my family finally stopped getting the leftover version of me. It’s now been a couple of years. Family medicine is still challenging. As healthcare continues to evolvecertain aspects of it seem harder. I still catch myself, every so often, wondering what other people think when they find out. That part never fully went away. But I have no doubt I made the right choice.
I have found a way to keep the calling of being a physician and a way to protect the responsibility of having a family. To have the exam room and the kitchen table.