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  • Tracy Asamoah, MD

Anatomy of a Choice


Have you ever been faced with a choice that can significantly impact your well-being? With limited information on which choice is best, your struggle with your decision might leave you feeling stuck. However, even when forced to venture out into the unknown, making a thoughtful choice can lead to a major turning point in life.

A Fork in the Road

Five years ago, I made a choice. I decided to leave my job as a staff psychiatrist at a non-profit integrated healthcare organization. I left because I was withering away in a job that was extinguishing the spark that inspired me to become a physician. I could only make such a drastic choice after careful consideration. So, I made a list. I love lists! There are few things as gratifying as seeing my thoughts scrawled in black ink on a crisp sheet of white paper. Here are a few thoughts on my list:

One list was clearly longer than the other. With smoldering resentment, detachment from my work and frustration due to feelings of ineffectiveness, I chose to leave. I understood that I needed a dramatic change in career direction and only now recognize that these were early signs of burnout.

Burnout occurs in situations where there is an imbalance between supply and demand for resources. It is reaching crisis levels in the medical field with some studies citing greater than 50 percent of physicians expressing burnout symptoms.

Burnout is not limited to physicians. High rates of burnout are also seen in nurses who often deal with large numbers of patients and work long shifts. Social workers, who handle large caseloads with complex and often distressing life stories, also experience burnout. Teachers increasingly experience burnout, at times driving them to leave the profession.

Your Emotional Response

At the time, I felt like this:

Self-doubt, anxiety, fear, excitement, and relief jockeyed for position in my mind. What if my husband couldn’t work? What if I never figured out what I wanted to do?

There were many of these:

More importantly, what I didn’t have was regret. While I chose an uncertain future, I also realized it was a path towards self-preservation.

Exploring Your Options

So how did I decide to leave a well-paying job in the field with no destination in mind? I made sure to start on a firm foundation. For me, this was social support from my family (including a husband who supported me emotionally and was able to float us financially while I disentangled) and from friends. I can’t overstate the value of a supportive social network. This can be friends, a spouse/partner, family or colleagues. These are the people who will help you return to your center when you feel yourself start to unravel.

These were the building blocks of my foundation when I began my journey:

  • Supportive social network

  • Stable finances

  • Permission to imagine a different future

The third point deserves a bit more attention. In plain terms, I had to embrace failure. I had failed to progress down the career path I had once envisioned. I needed to understand the shortcomings of my present job to gain greater clarity on why it was not ideal for me. The power of failure is that it gives us the chance to identify what went wrong. We can use this information to make different, and hopefully better, choices in the future.

After some days of panic that I would never figure my life out, I decided to find temporary work while I pondered my long-term plan. I needed time to think things through without the pressure to commit.

Another list!

OK, so I don't have any training as an interior designer, but sometimes you have to think outside of the box. I settled on the position that I was able to get most quickly and allowed the greatest flexibility to continue exploring my long-term options.

Utilization review

It turns out that during my stint in utilization review, I gained even greater certainty about workplace priorities. I learned that some jobs weren’t quite right even if they allowed me to work from home. I considered my must-haves:

  • autonomy

  • time with patients

  • freedom

  • flexible schedule

  • decision making

  • collaboration with others

And those things to avoid:

  • working for others

  • unrealistic productivity expectations

  • administrative interference in clinical decisions

  • cramped workspaces

  • unsupportive work environments

  • electronic medical record systems (some things can’t be completely avoided)

The list grew. Some things were added while others dropped. Working as a chart reviewer helped me realize that even working from home there were some things I was not cut out for.

Next, I began to imagine what an ideal workday might look like, and it looked something like this:

OK, so maybe not exactly like this. But this is how I wanted the patient-doctor experience to feel like in my office. Calm, safe and connected. I wanted an environment where I could spend time with my patients and their families to help their lives flow a little bit better. That was it.

From my must-haves list, I realized that most important to me was time to develop a relationship with my patients, autonomy, and schedule flexibility. It was equally important that I work for myself and that non-clinical factors (such as paperwork) did not interfere with clinical care. This is how I landed in private practice.

The anatomy of a choice starts with acknowledging that a change needs to be made. You may experience a variety of emotions, so acknowledge these and how they inform you about your experience. Spend time exploring your options and the benefits and drawbacks associated with those options. The final stage in your process is accepting the outcome of your choice. As in the case of addressing burnout, these choices can have a drastic impact on our emotional, psychological and physical well-being. While not all choices are as dramatic as quitting a job, every choice carries with it the weight of what we will gain and what we will lose. However, our choices give us power and that power allows us to be the navigators of our own lives.


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