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The Trade

Our most recent pod was all about The Trade—trading in your current career for another. For many of us, the idea of a career trade might conjure the image of a complete makeover: doctor to teacher, banker to boat captain, bartender to therapist.

But it's not all or none.

I like to break The Trade into three different levels because sometimes, only a tiny adjustment is needed.

My 3 Trade strata

Micro Trades: small changes within a current career that shift experience from unsatisfactoriness toward more satisfactoriness. 

Macro Trades: People in this category still have the same career, but their change would be apparent to outside observers. Examples include a change in location, type of work, and title. Macro Trading may involve moving to another facility and salary adjustments (often less than what they currently earn).

Both micro and macro trades fit the aphorism 'Don't just work in your career, work ON your career.' 

Tectonic Trades: This is the Big Kahuna. Calling it a day on the current job and starting an entirely new career. 

A proviso to this is that a Trade is only a Trade if you initiate it. If you trade for any reason other than improving your experience, it's not a Trade; it's just a trade.

The Pit

One year out of residency, I felt The Pit—a physical manifestation of dread. For me, The Pit was a sinking feeling in my chest and upper abdomen every time I went to work. Once I got there, there was no Pit. Before every shift, there was a Big Pit. 

I knew something had to change in how I was approaching my job.

Looking back, I didn't take the actions that would have reduced stress and burnout. If I were coaching my younger self, I'd focus on shift efficiency and documentation habits. The most significant stressors for me were pace and volume. Without tackling those two things head-on, any action I took to work on my job would be like using a cocktail straw to manage a massive hemothorax.

The Micro Trades

To prevent myself from burning out, I made multiple Micro Trades, giving me an incredible sense of purpose and professional fulfillment. 

I dove headfirst into education and had a bevy of wins. 

Committed to teaching at the local residency - win. Created an identity as an involved and interested educator for residents who rotated through our department - win. Developed protocols for my regional health system - win. Started an emergency medicine podcast - win. 

With hindsight, all of these endeavors were additive to the work I was already doing. None of them were long-term solutions, but little did I know they would feed the Tectonic Trade I'd make years later. 

Tolerating another yesterday

The additive activities shaped me into the educator I wanted to be, but the job was unchanged. Every day, I still felt The Pit. 

It's a strange paradox. I felt fulfilled as a teacher and miserable as a doctor, getting crushed shift by shift. It was like sitting in a refreshing spring amid a raging fire. 

I was in a continual loop of tolerating another yesterday — keeping myself in a cycle of the same shit, different day, this isn't working out, rinse, repeat. 

The Macro Trades

Twelve years into tolerating every yesterday, I knew I had to make a drastic change, or medicine was over for me.

I moved the family to Colorado, where I could work in a small community hospital, and Melissa transition to urgent care (she was also ready for a Macro Trade). 

My new shop had less volume, more trauma, sick patients, and a community feel within the medical staff. It was the best move of my medical career. 

I took a 50% salary cut, and it was worth it. 

The volume was low enough that I could keep up on my charts and had the mental space to start building shift efficiencies. In my previous job, I felt like I was being waterboarded with the onslaught of patients. Now, with space to breathe, I could look at every detail of my practice patterns and habits and optimize them.

My efficiency improved dramatically. I was getting home on time instead of the 4 hours late I'd been doing at my previous ED.

During this stint, I became increasingly involved in medical education until it became my full-time job. Twenty years into attendinghood, I was working five days a week in the podcast studio and three shifts a month in the ED.

Skill decay snuck in like a thief in the night. 

There was a fork in the road: return to full-time work in the ED or retire from clinical medicine. 

It's a hard choice but an easy question. 

Has this job given me all it has to give, and have I gotten all I have to get? 

The only way I could answer that was by projecting myself into the future, a few years. How would I feel giving up the identity I'd worked so hard to cultivate—a kick-ass clinician, a doctory doctor?

Ironically, I'd seen enough patients and performed enough procedures to feel I'd had my fill. But what about my identity? Could I give that up? Was it worth The Trade?

It was. 

Two Tectonic Trades

I gave my notice at the ED and became a full-time podcaster. I was shocked that they paid me to do it every day. For a year, I surfed a wave of delight. 

Until The Pit returned. This time, The Pit had nothing to do with stress; it had to do with authenticity. I was running a tip-of-the-spear medical education product and no longer seeing patients. 

What a fraud. 

I could fake it for years, and nobody would notice, but I would. I loved the job but knew it was time for another Trade. 

That one took me to where I am today, a story for another time.

Do I miss clinical medicine?

I get asked this a lot. Whenever the question arises, I go back to this: Did the job give all it had to give, and did I get all I had to get? 

For clinical medicine, it's still yes. 

I thought I would miss the patients. I don't. What I missed were the other doctors. That's a tribe unlike any other. 

I was a solid clinician, but I'm not sure I was born to do that specific work. 

What I'm doing now is the most 'on purpose' I've ever felt. Without the decades in the ED—doing the work, knowing what it's like, feeling the burn, and getting so much wrong, like working in my career rather than on my career—I'd never have known that this was The Trade I had to make.

The Trades never end. To me, a job is like a relationship. It requires continual attention to be excellent. A set-it-and-forget-it approach may work for some, but only for some. Many clinicians feel like what they're doing is not quite 'it.' They're probably right. 

In the words of Lon Stoschein, #JFDS (Just F-ing Do Someting). Make a Trade. It doesn't have to be a Tectonic Trade—it shouldn't be at first. Start small. Make it Micro.

Be well, my friends. And keep on rocking.

-Robbie O

Further reading

• The Trade by Lon Stroschein - I love this book. The Audible version is incredible.
• The phrases: Tolerate another yesterday, The Pit, Has this job given all it had to give, and did I get all I had to get? Were all taken from our podcast interview with Lon.

Upcoming Stimulus Podcast Releases

March 11, 2024: Phantasia Kataleptike | The secret skill of Stoicism

March 25, 2024: Thinking Outside Your Retirement Account with financial coach Elisa Chiang

April 8, 2024: A follow-up on the Zero Warning episode (which was all about creating frameworks for no-notice critical patients). In Zero Warning, we didn't cover how to create an effective ad hoc team in 10 seconds. On April 8, we'll do just that with Lon Setnik from The Center for Medical Simulation.

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