Years ago, I had what I thought was my dream job. I loved the people I worked with. I loved what I was doing.

But if I’m honest with you, that by itself wasn’t enough.

I’ve been thinking about that a lot lately, because I keep hearing a version of it from other physicians. Department chairs. Section chiefs. People who, from the outside, have everything they worked for.

Some of them have the next job on the table. A bigger title at another institution, which means uprooting themselves and their family and moving to a new city. The question they ask me isn’t whether they can get it. They know they can. The question is whether it would be worth it. Whether they’d actually be any happier.

If you’re successful but unfulfilled, you’re not ungrateful, and you’re not the only one. Below is why it happens, what the research says actually makes people happy, and the questions I’d ask before taking the next step up.

Disclaimer: This article is for informational and educational purposes only and does not constitute financial, legal, or investment advice. Any investment involves risk, and you should consult your financial advisor, attorney, or CPA before making any investment decisions. Past performance is not indicative of future results. The author and associated entities disclaim any liability for loss incurred as a result of the use of this material or its content.

Why do successful physicians feel unfulfilled?

Most successful physicians who feel unfulfilled aren’t burned out. They finished the climb they were trained for, and nothing took its place.

Think about how we got here. Somebody handed us a path. Get the grades. Get into med school, then residency, then fellowship. Become an attending. Make partner or get promoted. Run the section. Run the department.

Every rung had a next rung, clearly labeled. Nobody along the way stopped and asked, and then what?

So we climbed, and we got very good at it. That’s what the system selects for: people who can keep their head down and keep moving toward the next thing for twenty years. Somewhere in there, climbing stops being something you do and becomes who you are.

Then one day the ladder ends. You’re the chair. You’re the chief. There’s no obvious next rung, or the next one looks a lot like the one you’re standing on. And it gets quiet.

That flatness is not a character flaw, and it’s not ingratitude. You can be deeply grateful for your life and still feel it. It’s what happens when the goal was the climb itself.

I’ve written before about the arrival fallacy, the belief that I’ll be happy when I get there. This is the next chapter of that. It isn’t “I’ll be happy when.” It’s “I’m here. Now what?”

Is this a midlife crisis?

Partly, yes. And that isn’t an insult.

We turned the midlife crisis into a punchline. The guy who buys the sports car. The one who blows up his marriage. So nobody wants to admit they might be in one. But the pattern underneath it is real, and it isn’t just men. Women go through it too.

The research is surprisingly consistent. Economist David Blanchflower looked at well-being data from 132 countries and found the same U-shaped curve almost everywhere. Life satisfaction drifts down through early adulthood, bottoms out in midlife, and comes back up. In advanced economies, the low point averaged about age 47 (Blanchflower, NBER 2020).

So if you’re in it, you’re not broken. You’re roughly on schedule.

A few things tend to land at once in your forties and fifties. The career goals you set in your twenties are either done or clearly not going to happen. Your kids need you differently, or they’re about to leave. Your parents need you more. And your own body starts reminding you that you won’t be here forever.

For physicians, it can hit harder. We spent our twenties and a good part of our thirties in training. We told ourselves we’d live later. Then we look up, later is now, and we’re not sure we know how.

The sports car isn’t the crisis. It’s a bad answer to a real question: is this the life I want to spend the rest of my time on?

Will a bigger job make you happier?

Probably not for long, and the research on that is pretty clear.

Psychologists call it hedonic adaptation. We get used to almost every positive change. The raise. The new title. There’s a bump, and within months it becomes your new normal, with a bigger baseline to protect.

The classic example is lottery winners. In one well-known study, people who had won between $50,000 and $1 million were no happier than a comparison group just one to 18 months after winning. Job changes follow the same pattern. Managers who switched jobs got a rise in job satisfaction right after the move, and it faded within about a year. Researchers call those the honeymoon and the hangover (Fritz, Walsh, and Lyubomirsky, 2017).

The chairs and chiefs I talk with have already been through that cycle several times. Each promotion was a bump that faded. There’s no reason to expect the next one to work differently.

And look honestly at what the bigger job usually is. It’s the same job description with more of it. More meetings, more politics, more nights answering email. Less time with patients, which for a lot of these physicians was the part they actually loved. Then there’s the cost to the family: a new school for the kids, a new city for your spouse, and leaving the people who’d show up if something went wrong.

None of this is an argument against ambition. Some people should take the job. They should take it because it serves the life they want, not because it’s the next rung and climbing is the only move anyone ever taught them.

What actually makes people happy?

The best long-term evidence points to one thing above the rest: the quality of your relationships.

The Harvard Study of Adult Development began in 1938 and has followed its participants, and now their children, for more than eight decades. Robert Waldinger, the psychiatrist who directs it, says the strongest predictors of who stayed happy and healthy over a lifetime were the warmth and quality of their relationships (KUNC/NPR interview, 2023). Not how many people they knew. Whether they had people they could call in the middle of the night.

That’s uncomfortable for physicians. Relationships are usually the first thing we cut when work gets busy. We miss the dinner. We miss the game. We tell ourselves we’ll make it up later.

When I put that next to my conversations with these chairs, it clicked. What was missing for them wasn’t competence. These are some of the most capable people I know. What was missing was control over their own time and closeness to the people who matter most. Both had slipped, mostly without them noticing.

A bigger job, at a new institution, in a new city, takes more of both.

Questions to ask before your next career move

In those conversations, we talked about titles, institutions, and comp. We never got to the question that mattered most: what do you actually want your life to look like? Not your career. Your life.

These are the questions I’d ask now. Take your time with them, and write the answers down.

1. What three or four things matter most to you? Not what should matter. Not what your parents or your program director thought should matter. What actually does.
2. How much of a normal week goes to those things? Not vacation. A Tuesday. Pick a real Tuesday from last month and look at where the hours went.
3. How much time do you realistically have left with the people you care about? If your parents are in their seventies and you see them twice a year, that’s not a big number. If your kids are twelve and fifteen, the same math applies.
4. What would you do with the next five years if the title didn’t matter to anyone? If nobody was keeping score.

If your honest answers point toward the new job, take it, and take it with clear eyes. If they don’t, you have your answer too.

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Money is a tool, not the scoreboard

Most of us treat money like the scoreboard without realizing it. It’s a tool for the life you want.

What changed my thinking on this is that the window to actually use it is narrower than we assume. There’s a stretch when you have the health, the energy, the money, and the people, all at the same time. For most physicians, that window is open right now, in their forties and fifties. It closes on a schedule nobody controls.

Bill Perkins makes this case in Die With Zero. The idea that stuck with me is that experiences have a shelf life. The trip you take with your kids at 45 is not the same trip at 75. Your parents may not be around for the second one. Your knees may not be either.

So every year spent climbing toward a rung you’re not sure you want is a year out of that window. That’s the real cost. Not the money. The year.

This isn’t about quitting and going to travel. It’s about deciding on purpose. Take the job if it serves the life. Turn it down if it doesn’t. Just know which one you’re doing.

The best season of my father’s life

My dad was a surgeon. He came to this country after medical school, barely spoke English when he started residency, and built a private practice from nothing. After he retired, he did mission work. By any measure, a full career.

I asked him once when the best time of his life was.

He didn’t have to think about it. He said, “When you kids were still at home.”

He didn’t name the year he built the practice. He didn’t mention a title. It was the stretch when the people he loved were under the same roof, and he was mostly too busy to notice.

I think about that answer a lot, especially when I’m tempted to take on one more thing.

So here’s a question to sit with. If you had to name the best season of your life so far, what was actually in it? Who was there? And is what you’re building right now going to give you more of that, or less?

I talk through this in more depth on episode #340 of the Passive Income MD Podcast. If you’d like more of these conversations, you can join the PIMD newsletter.

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Peter Kim, MD is the founder of Passive Income MD, the creator of Passive Real Estate Academy, and offers weekly education through his Monday podcast, the Passive Income MD Podcast. Join our community at the Passive Income Doc Facebook Group.

Disclaimer: I am not a CPA, attorney, or financial advisor. The information in this post is for educational purposes only and should not be construed as tax, legal, or financial advice. Please consult a qualified professional about your specific situation before making any decisions.

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