You do not have to be good.

I’ve long considered having these classic, profound opening words of Mary Oliver’s most famous poem tattooed on my body somewhere. Since I quit clinical medicine a month ago, I’m at that stage where I’m researching tattoo parlors.

It was just this morning, a late October Saturday morning, that I took my kids and the dog hiking in the woods, in the rain. My daughter was balking, and she had already turned to go back to the car, when a large flock of very loud geese flew low overhead. We all stopped to watch, and listen.

“Cool,” commented my son.

“Yep, they’re all heading down south for the winter,” I offered, wondering if this proof of the wonder of nature would impress Maria, lover and protector of all wild critters, to join us after all. The light rainstorm had brought with it some warmth– a balmy sixty degrees! and the entire forest emanated a fresh pine perfume. Obi the dog pulled and pulled, eager for the unhampered squirrel-chasing ahead.

Between the natural beauty of the outdoors and the promise of Dunkin’ Donuts post-adventure, my youngest trudged forward, and into the woods we went.

It was only four weeks ago that my Saturdays, and often Sundays too, necessarily included a block of work. Typically, my Saturday mornings were booked, with me logged in to the electronic medical record (EPIC, of course) reviewing labs, imaging, calling people with UTIs or something on the CT scan that couldn’t wait for Monday, answering missed or deferred patient messages from the week, filling urgent prescription requests… There was always something in the InBox, and usually a lot, that required attention.

This overflow workload extended to vacations, even our family vacation in Guatemala, last April. We hadn’t seen our family for two years, and I was logged in to EPIC every day, trying to catch up, anxious to clean up my InBox. Most PCPs can relate to this. You could ignore it for a day, or a few days, but God help you when you returned. Things build up, and those first days back are brutal. Worse yet, if things get missed, you’re ultimately responsible.

It was that trip that did it for me. The day we returned, I panicked, realizing that despite all of my hours of effort, all that time I could have (should have) spent with our beloved relatives, I wasn’t even close to reasonably caught up with the InBox.

That was the last rock upon the pile. The suffocating burden placed upon me (and all my physician colleagues) by high-minded people and a ‘healing’ system finally broke me. That day, the shell of resolve, sacrifice, duty, pride, and guilt that pushed me through medical school, residency, fellowship and practice— twenty years as an M.D. in clinic, teaching, and research— just crumbled. Trying to win at this impossible game, in the midst of a medical misinformation maelstrom and two kids struggling with COVID-related psychological and educational situations, was just too much. If I’d had been able to crawl away from all of it right then and there, I would have.

Instead I stood up and steeled myself through several more months, with any spare bandwidth poured into a career transformation effort. I reached out to former classmates, friends of friends, anyone I knew who had been able to move forward into a better situation. It was not enough to escape. I wanted to thrive.

So many doctors are doing the same, that there is a fairly robust industry built up around career transitions for burned-out clinicians. It’s easy to give yourself a “How to create a successful nonclinical career” crash course. I’ll save those details for another post.

After about six weeks, I had job interviews. Then a fantastic offer. Now, I’m in medical writing/ medical affairs at an area immuno-oncology biotech firm. The people are bright and motivated, the goals are worthy, it’s a regular workweek and normal working hours, I can work from home, and– this is the best part– it’s writing. All kinds of medical writing.

Yes, there is a learning curve. A very steep one. I’ve reviewed countless textbooks and ebooks and podcasts and presentations on immunology, oncology, industry. I’m cramming in new material every day. But it’s stimulating and, who doesn’t want to be part of the team that discovers a cure for cancer?

And, there’s space. It took a few weeks before I could wake up on a Saturday without the ever-present EPIC dread hanging over me. The thought– a very probable thought– that I was missing something important, that care would be delayed, that a patient would be pissed. My Saturdays are mine now, mine to spend hiking in the woods in the rain with my kids and the dog.

People have asked me– Do you miss patient care? Will you go back?

I can honestly answer– No, I regret nothing.

For those who aren’t familiar with “You do not have to be good”, it’s from Wild Geese by Mary Oliver. It was thirty-five years ago that I first encountered the poem, and it’s resonated with me every since:

Wild Geese by Mary Oliver

You do not have to be good.

You do not have to walk on your knees

for a hundred miles through the desert, repenting.

You only have to let the soft animal of your body

love what it loves.

Tell me about despair, yours, and I will tell you mine.

Meanwhile, the world goes on.

Meanwhile the sun and the clear pebbles of the rain

are moving across the landscapes,

over the prairies and the deep tress,

the mountains and the rivers.

Meanwhile the wild geese, high in the clean blue air,

are heading home again.

Whoever you are, no matter how lonely,

the world offers itself to your imagination,

calls to you like the wild geese, harsh and exciting-

over and over announcing your place

in the family of things.

44 thoughts on “You do not have to be good.”

  • Your posts are always so poignant, but never more so than this one. I too left primary care for many of the reasons you describe. Best of luck in your new career. And thanks for the poem- spot on.

  • I am so glad you will have your time with your family now. I completely understand, and I have made a similar choice. This is a real sign that we need to reform our health care system — we should not be burning out our best practitioners. I’m so glad you have found rewarding work, and so quickly, too!

  • Thanks for your post and the poem! I too quit clinical work two years ago after returning to “part-time” obgyn which was 40 to 50 hours a week instead of 70 to 80..after a 6 month hiatus for cancer treatment. Now I teach part time at a local medical school and try to finish writing projects. We bought a small RV and have been glamping a lot during the pandemic. I am grateful for the ability to sleep almost every night and many other daily life pleasures that most people take for granted.
    I tell my students that I donated my body to medicine before I died and encourage them to avoid that trap!

    • Omg “I donated my body to medicine before I died”— GREAT phrase!!! That needs to be the title of an essay you write! Thank you for sharing your story!

    • Excellent advice. We need to reform, providers need to be ok with practicing what they are supposed to be preaching! I cut my 40 hour work schedule which was 50 to 55 hours a week to 32 hours a week which still equates to 40 hours.
      I lost 40 lbs and am working out 4-5 days a week.
      It’s just sad I have to take a pay cut to get a reasonable schedule.
      I feel it is worth it for my health.
      Take care and thank you for teaching.

  • Dear Monique. Such a heartfelt post and I am so happy for you and your beautiful family. And sad for your pts who will miss such a gifted person caring for them. And sad for medicine. You and all these comments are spot on. I retired in June b/c I was too worn down trying to find my way, after 37 years an NP, thru all the crap. And I have never been happier. What’s next? Don’t know and that’s ok. All the best to you and how grateful I am for our time together. Maybe a coffee and a walk in our future? Cheers to the next chapter!

      • Eileen, I’ve been an FNP for 31 years and I wish I could financially retire. It’s not the patients, it’s the management and leadership at my nonprofit clinic where I work. This gives me hope!

  • Great post Dr.Tello! I hope your next chapter brings you everything you are looking for and sounds like it’s already off to a great start. I do miss you though!! But, genuinely very happy for you. Take good care!

  • Thank you for your post. As one of your former patients it is interesting to read what it is like for primary care physicians. However, my first thought is what about the patients? It seems like the patients are the ones that are suffering. I cannot even begin to tel you what it was like being reassigned a PC. I am now being seen by someone in Chelsea, I do not even live near Chelsea. It would be nice to have some of the doctors instead of leaving MGH maybe try to be a part of fixing this. Healthcare is fundamentally broken right now but if everyone leaves who’s left to help fix this? And aren’t you being just like them by going to a pharmaceutical company? Everyone knows that industry and biomed are all about making the money. It appears everyone is leaving for the almighty dollar.

    • Thank you, I really do appreciate your reading and reaching out. So many doctors are leaving clinical medicine nowadays. There already was a shortage of primary care physicians, and it’s getting worse. I wish there were enough doctors at the practice I left to take over the care of my patients; It was a heartbreaking situation, a debacle really. I’m sorry. Everyone is suffering, and I know there are doctors trying to fix the system or work with the system or go to other systems… But in the end, the healthcare industry is so dysfunctional, it’s pretty much impossible to provide good care, and to me it felt like I was doing more harm by staying in it—not just harm to me and my kids, but also to patients. And I used to have the same negative impression of biopharma, but witnessing the massive cooperative effort around creating the Covid vaccines in record time, plus personally knowing many phenomenal, ethical scientists and clinicians who made the shift ahead of me helped me to realize my prejudice wasn’t fair. I’m impressed by my new colleagues and feel good about the work we’re doing. Still, I’m sad for clinical medicine, and of course for the patients.

    • In reply to Trudy: ….MY first thought is: What about the 400+ physicians who commit suicide each year? This is a vastly higher rate than that of the general public. My second thought, therefore, is to ask if anyone at all is considering the doctors’ suffering? And aren’t you being just as abusive to your doctor as everyone else in the system, by denying her moral right to take care of herself and her family? Is what amounts to your convenience more important than your doctor’s life? Her children’s lives?

      Trying to fix things? Doctors who speak out get put on “corrective action” or their contracts are not renewed.

      Lashing out at doctors is blaming the victim.

      • Thanks Shannon, for reminding us that doctors have a significantly higher suicide rate than the general public. I do think the unrealistic expectations put on all healthcare providers contributes… and the unrealistic expectations we put on ourselves. After all, we’re not superhuman.

  • Glad you have made your escape, but sorry for your patients who I am sure miss you. I retired at the end of 2019 after 38 years in family practice. The last 9 were with an EMR (not EPIC fail, thank goodness) and oh my gosh I get it. I don’t know anybody with any kind of EMR who doesn’t have at least an hour of work every night (including weekends) except for docs who have scribes, and that’s for rich specialists, not primary care folk like me who can’t afford another FTE. We were independent but the EMR was the straw that broke the camels back. If we’d still been on paper I probably would have worked a few more years, at least part time. Between the crummy EMR at the hospital and the even crummier one at the nursing home (never mind all the ageist crap at said nursing home) it had got to the point I just could not stand it another minute. I was so burned out I was crispy. My younger sister who is 60 and employed by a big hospital system (also on EPIC fail) is just counting down till she can get Medicare and get the heck out. Hospital systems and EMRs are driving good doctors out of clinical medicine and it’s the patients’ loss, but they won’t realize until it is too late. Hope the new job works out well. You are such a good writer so I’m sure you will do well. And the extra time with the kids is the very best investment you could ever make. You don’t get that time back.

    • I too retired before planned. Not only the 1) EMR thrust upon us by non-physician administrators, as a government, official or not, standard of care, then to pretend we are better defended in court, 1b) requiring the hiring of high cost internal auditors who penalize for overcoding,
      whether real or rubbish that must be learned to put on paper by the nonbusiness oriented physician, while often ignoring without recapturing undercoding 2) Doctors do their own coding- for free -instead of paying the low income coding department, – administrative decision to cut cost 3) type our own records – for free- then spend hours correcting our own typing errors, -and firing the low income coding department
      4) making the required 3 page office note at every visit, including mostly meaningless useless point and click, so that physician communication is disorganized, confusing, and grossly declined 5) tremendous added income for the endless stream of non health care workers and 6) millions upon millions of dollars to endless stream of new departments, their own new administrators, administrators whose goal is often to sell a hospital system in the way a small bank sells to a larger bank. And 7) how many bosses do we physicians now have?
      8) And there are educated lawmakers who pretend to wonder – why the increase burnout? 9) Why are the smartest people staying away from medicine? 10) Why do we have huge increase in health care cost? 11)Get real people. Most of us became physicians to take care of sick people, and be a decision maker, and a caregiver. 12) The American people vote for the lawmakers, and being a politician is a very very lucrative profession. A branch of Law School. Lawyers.

  • Wow, I am a PA and did PCP work for 15 years…all of this rings very true. I too have left. Thank you for just saying that it is ok not to miss it and that it isn’t quitting.

    • Thank YOU for reading and sharing your experience. It’s more than ok to leave an exploitative and unhealthy situation. It’s ok to stand up for yourself and walk away. Good for you!

  • Dr. Tello, this article was fantastic!! Thank you so much for this! After 32 years of working on the “front lines” as a respiratory therapist, I finally realized that the hospitals I had worked for over the years didn’t care their employees or the patients. Covid placed an enormous spotlight on the flaws inherent in our medical system. We were not given the proper PPE (on one of the boxes of masks, it actually had a statement written in Mandarin “non-medical grade.”). Instead of caring about us, they put signs all over the hospital lawn: “Heroes work here.” It was so ridiculous that I suddenly felt as if I had been transported inside an absurdist novel.
    After contracting Covid and bringing it home to my loved ones, I realized I that no one cared about hospital workers. We were basically cannon fodder, and I decided I couldn’t be part of such insanity any longer.
    I was one of the lucky ones because I had a graduate degree in English, so I could escape. Like you, I went to work in a medical tech company, and I cannot believe the way “regular” people live. For the first time in 32 years, I will actually get to spend the entire winter holiday with my family.
    I wish you all the best in your venture, and I thank you for all your years of service caring for patients. People like you will elicit change because you have a clinical background, and that is precisely what is needed in the research world. Thank you and Happy Holidays!!!

    • Wow thanks so much Suzanne, for sharing your own very relevant story! It’s all healthcare workers who are suffering. The gaslighting by administration is incredible. I’m happy for you that you have some time to be with your family over the holidays! You’ve earned it.

  • I am so happy for you that you were able to find joy again. Thank you for sharing this important lesson. It is so easy for us to get pulled into our duty and away from our families, our greater duty. I’ve been on a 6 month hiatus and this lesson is paramount in my future work. God bless your future!

  • Monique! I stumbled across this post on Doximity! It is just beautiful, so well told, and resonates way too closely. Sending lots of love to you and the family. xoxox

  • Dr. Tello Thank you for your post. I saw it on Doximity! I related to the dot. I am a solo family physician doing piles and piles of administrative work. Daring to take a minute to post this comment and say thank you for letting me know that I still have the right to be a human being and a physician. Enjoy your new job! Hopefully I will be able to say the same one day.

    • Thank you Maria! Yes we are not superhuman, though everyone puts that expectation on us— including ourselves, at times. If someone needs to be heroic in order to do a job, then the job isn’t really fair is it? Why are we expected to accomplish the impossible in order for the healthcare system to function? Just say no.

  • That was very inspiring and really hit home. I have had only a 19 year career in internal medicine because of going to medical school late in life. I didn’t work long enough to pay of student loans nor other bills, but the thought of returning to practice fills me with dread. The EMR has stretched normal days and workweeks into 80-100 hours which eats into all personal time leaving no time for maintaining health let alone family and friend time.
    I am looking for something else and have thought about writing. I am glad you found a good fit which is intellectually stimulating while allowing a normal life.

    • Many docs are trapped by student loans. It took me 18 yrs to pay mine, and I shudder every time I think of the interest and the ballooning of that debt. It’s a whole other post how loans hold many physicians back in their professional fulfillment— the ones whose families couldn’t pay up front, that is. There are def non-clinical options out there for you, I’m going to feature a post about the transition soon.

  • Your comments are inspiring and really mirrored what I felt and experienced as a NP in primary care for 20 years. The EMR, the relentless demands of inbox of messages could not be overcome! I decided that ws no way to live. I too left primary care in 2021 and I discovered that life can be peaceful and joyous again! I work in pre-op clinic once a week and work primarily in an administrative healthcare job 4 days a week now and I am loving it.! Best of luck to you!

  • Great. Good for you. You made the right choice. I wish you the very best in your new life. The rest of us are, well, trapped. After 37 years and counting, I wake up angry, trying to wish the day away. So sad, to live the life we do because of our calling…Again, best wishes for you and yours;-) By the way, your writing is superb, picturesque; you will do very well.

    • I’m so sorry you feel trapped! Believe me there are nonclinical options galore, many working from home… Please look into alternatives for yourself, or consider that. See my most recent post w some practical guidance, maybe helpful for you.

  • What a great article along with all the posts following it! I’ve been a nurse for neaP.S. rly 28 years and have loved taking care of the patients until recently when I became a FNP. Over the past five years working first in Urgent care and now as a wound care specialist I have felt nothing but regret. The increase in my income was beneficial but the responsibility that came with it was not worth it. I turned 60 years old this year and the thought of working for the next five years as an NP feels dismal. I still have a school loan to pay back and now a mortgage to pay off (purchased a house 2 1/2 years ago after the increase in my income) so not working is not an option right now. I can’t seem to brainstorm at this time about other options and would love suggestions. Working remote would be awesome!

    P.S. Thanks for sharing the poem : )


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