149. From Fried to Fired Up | How One Doctor Rebuilt His Career

 Making a major career shift is never easy, especially when you’ve dedicated decades to a profession that has become part of your identity. The decision to leave clinical medicine can be fraught with self-doubt, financial considerations, and the lingering question – what comes next? But at some point, the balance shifts, and the cost of staying outweighs the fear of leaving. In this episode, we explore what it takes to walk away from a stable medical career, redefine success, and craft a life that aligns with evolving priorities. Finally, we dig into strategies for managing stress, investing in personal growth, and finding fulfillment beyond the bedside.

Guest bio:  Dr. Patrick O’Malley is an emergency physician with nearly two decades of experience in community emergency departments and high-acuity urgent care. Based in Columbia, South Carolina, he has recently expanded into entrepreneurial ventures, including The Laceration Course, in partnership with EB Medicine. He helps moderate the EM Docs Side Hustle Facebook group, a community of over 3,000 emergency physicians exploring side gigs and alternative careers. Dr. O’Malley is dedicated to helping physicians explore new opportunities beyond the walls of the emergency department.

We discuss:

The Decision to Resign

• Resigning wasn’t impulsive—it was the result of years of doubt, planning, and tough conversations.
• Transitioning to part-time was the first step, but it didn’t remove the barriers to his long-term goals.
• A sudden wave of anxiety, clarity, and urgency made it clear it was time to “rip the Band-Aid off.” The phrase JFDS—Just Frickin’ Do Something became a guiding principle for taking action.
• Submitting the resignation letter was a defining moment, turning years of internal debate into a concrete step forward.

Financial Readiness and the Role of Family Support

• Years of financial preparation made the transition possible—this wasn’t a reckless leap, but a carefully planned step. Maintaining a part-time revenue stream provided stability during the transition.
• Side projects were already generating income, ensuring it wasn’t an all-or-nothing career shift.
• Deep conversations with his wife were critical; she provided emotional support and a rational perspective on their financial situation. The process reinforced the importance of making big career decisions as a team, with clear communication and shared understanding.

Looking Back on a Career in Emergency Medicine

• After nearly two decades in the field, the decision to leave felt more like closing a chapter than abandoning a career.
• The sacrifices—missed holidays, night shifts, and emotional toll—created a sense of having “fought the good fight.”
• The nagging doubt of “Why are you quitting?” was real, but ultimately, personal well-being outweighed the sunk cost of years invested.
• Medicine will always be part of his identity. The skills gained—decision-making under pressure, communication, and leadership—translate seamlessly into entrepreneurship and other ventures.
• Leaving clinical work doesn’t mean losing the value of an emergency medicine career—it’s about applying that expertise in new and meaningful ways.

Redefining Work-Life Balance

• Emergency medicine isn’t sustainable for everyone, and recognizing that is okay. The intensity of the job can lead to emotional exhaustion, and even part-time work can feel overwhelming in certain environments.
• Some physicians thrive at 15 shifts a month; others find even two shifts too much—self-awareness is key.
• The circadian disruptions and cumulative stress of shift work have lasting effects, often requiring structured downtime to recharge. 
• Transitioning to part-time or locums work can be mentally and physically liberating, allowing for more control over scheduling and recovery time.

Transitioning to a New Identity

• The “Doctor” title is a hard-earned badge of honor, but over time, the need for it fades when fulfillment comes from other areas.
• Medicine provides a unique privilege—the ability to ask deeply personal questions and care for strangers in crisis—but that privilege doesn’t vanish when stepping away from clinical work.
• Leaving emergency medicine doesn’t mean abandoning service; it shifts from direct patient care to supporting and educating clinicians.
• Identity is fluid, and the skills honed in emergency medicine—quick decision-making, leadership, and adaptability—are powerful assets in entrepreneurship and beyond.
• Every career shift involves a transition period, a “liminal space” between what was and what’s next, requiring intentionality, self-reflection, and a redefinition of purpose.
• The years invested in medicine aren’t a sunk cost—they’re a foundation for new opportunities, whether in education, coaching, business, or leadership.
• True fulfillment comes from knowing who you serve and how you impact others, regardless of the setting.

Investing in Yourself

• Physicians are often hesitant to invest in personal growth, prioritizing professional development but neglecting their own well-being.
• The shift began with hiring a health coach during a low point—COVID-era stress, weight gain, and general burnout made it clear that change was needed.
• Having skin in the game—financially and emotionally—created accountability and led to lasting improvements in health and mindset.
• Working with multiple coaches, from leadership mentors to video production specialists, reinforced the idea that expertise is worth paying for. The perception of spending on oneself changed from an unnecessary expense to a necessary investment with real returns.
• Learning to view time, money, and energy spent on self-improvement as an investment rather than a cost is a game-changer for career and personal fulfillment.

Burnout, Coaching, and the Road to Change

• The relentless grind of emergency medicine, combined with side projects, led to severe burnout—both mentally and physically.
• A turning point came from hearing this podcast on burnout, realizing, this is me, and recognizing that change was necessary.
• Despite years of resisting outside help, there was a breaking point: “I need help. I cannot do this.” Saying those words after 15 years was the first step toward change.
• Hiring a coach felt like a huge decision—was this worth it, or could that money go toward something tangible, like a vacation or new kitchen countertops?
• Coaching wasn’t just about advice—it provided immediate, actionable strategies for managing stress, balancing work, and maintaining focus.
• Learning to separate stimulus from reaction helped prevent the instant frustration that can build into burnout. Identifying triggers allowed for more measured responses to stressors.
• Simple but effective techniques—like deep breathing, stepping away, and shifting perspective—had a profound impact on handling stressors.

Finding Joy in Medicine: Small Moments, Big Impact

• Even in the toughest shifts, finding one meaningful patient connection can shift the entire day.
• A small gesture—sitting down, holding a hand, offering reassurance—can make a difficult job more fulfilling.
• Not every shift is perfect, but prioritizing human connection helps ease the sting of stress and burnout.
• Physical connection, like a hug, can be powerful—when appropriate, recognizing when someone truly needs that moment of care is a skill in itself.
• Bringing warmth and empathy to clinical work extends beyond the bedside, reinforcing the value of service in any career path.

Living Another Yesterday

• Medical training builds in automatic changes, but post-residency stagnation can set in. Feeling stuck in a repetitive cycle signals the need for career reassessment.
• Inspired by Lon Strohschein’s book The Trade, the question “Do you want to live another yesterday?” became a guiding principle.
• Acknowledging that change is hard but necessary is key to personal and professional growth.
• The decision to leave emergency medicine wasn’t about escaping, but about refusing to stay stuck in an unsatisfying loop. Recognizing the power of choice—whether in medicine or beyond—can transform not only a career, but overall well-being.
• Personal fulfillment should take precedence over sticking to a career out of obligation.

Crafting Your Own Path: Empowering Clinicians

• Emergency physicians have an incredibly versatile skill set—one that extends far beyond the walls of the ER.
• Many colleagues are exploring creative, non-clinical careers, proving that reinvention is possible with the right mindset and effort.
• Transitioning away from full-time clinical work doesn’t mean leaving medicine behind; it means applying those skills in new and meaningful ways.
• Like getting into med school, building something new takes persistence, sacrifice, and a willingness to start from the ground up. Side gigs and non-clinical opportunities provide creative outlets and financial flexibility.

Newman and John Marks: Managing Stress and Calm

• Identifying personal triggers is key to handling stress—naming them makes them easier to manage.
• Seinfeld’s Newman became the perfect avatar for frustration, the embodiment of antagonism and irritation. Seeing a Newman moment for what it is—an emotional reaction rather than reality—helps diffuse anger and regain control.
• On the flip side, John Marks represented unshakable calm, a model of steadiness in the chaos of emergency medicine.
• Having clear role models for both stress and composure makes it easier to choose how to respond in difficult moments.
• The lesson? Newman may always be there, but you don’t have to react to him. Recognizing stress is inevitable, but responding with intention is what matters.