The Hidden Regret Many Physicians Have in Their 40s

Many physicians in their 40s don’t regret being doctors. They regret not having built more breadth, optionality, and intentionality around medicine earlier.

What does a physician in their 40s feel after a busy but ordinary workday?

How often have you found yourself during a busy day in the clinic checking the clock repeatedly, not just to make sure you’re on time with your patient appointment slots, but also just to see how much of the day has elapsed? You peek at the clock icon in the lower right hand corner of your computer screen - 2 p.m. - and the thought pops into your mind before you can suppress it: I still have a handful of hours left to go … how many more of these days can I string together? What’s going to break up this routine? Although there are some spikes of satisfaction and meaning during the workday and the workweek, you can’t shake the question that surfaces from time to time:

Is this going to be the repeated pattern for the next 10, 15 or 20 years? And then you allow yourself to be distracted from that thought by the patient that is in front of you that requires your attention and expertise.

Those thoughts - the ones you quiet and suppress before they fully form - is where this essay begins. There is an increasingly common regret that many physicians have as they enter their 40s. It isn’t a regret about being a physician or the impact they have on patients. Rather, it’s a regret about how little of themselves they were able to put into their career.

Let’s break down a little more about what this regret is and what it isn’t.

What the regret is NOT about:

The regret is not about being a doctor. It’s not about burnout. It’s not about being ungrateful for your position and all the benefits that you have. It’s not a desire to have gone down a different professional path.

What the regret IS about:

The regret isn’t about medicine; it is about what traditional medical practice crowded out.

The regret is about realizing that you could have expressed yourself professionally in different ways; you could have explored different opportunities and run different experiments, but for different reasons, you chose not to. It’s the sense that your career is somehow narrower than your capabilities, skills, and interests should really allow.

You didn’t cultivate external relationships that you could have, you could have taken more risks, you could have made your skills and expertise more visible to the broader world.

That version of your professional self - the one that represents who you really are - never fully manifested because the default physician career script didn’t allow it room to grow.

WHY THE 40s?

Interestingly, the 40s tends to surface this feeling because it stands at the crux of several converging factors. The first is that your natural career arc can potentially plateau at this point. You are past the initial training phase, and generally you have integrated yourself into your practice, potentially having formed partnership or some leadership roles. There’s a sense of some stability for how you practice and your place in the practice. And as these things are complete, the novelty and the ascension has worn off and the horizon for the remaining years becomes more visible.

Time becomes more palpable. In your 30s, your career feels wide open. In your 40s, you can actually start to project out the latter third of your career in your mind. You also tend to have some more bandwidth as some of the demands of training in early practice have dissipated. And with that increased bandwidth you can reflect on where you are, where you’ve come, and where you’re going.

When you’re in your 40s, your peers start to demonstrate their career trajectory. You’ll see concrete examples of what other people are capable of and you start to think about the different versions of yourself that were possible. This sharpens the question of why you didn’t pursue some of those same paths. Could you have done that too? Should you have taken that risk, that step?

Turning 40 is also a meaningful milestone for anyone, physician or not. It’s a concrete reminder that time is finite, that you’re getting older. Around this time you may have had a significant event happen to a family member or someone you’re close to - perhaps the loss of a parent, or an unexpected illness befalls someone close to you, or the ending of a close relationship. All of these things make you pause and introspect - and how you spend the majority of your time - your career - will definitely fall under the microscope.

Yet, your 40s are still a time period in which you have agency to design a significant portion of your remaining career. You still have a decent amount of runway and this potential regret arrives at a time when it can still be acted on. In a positive way, it serves as an early warning sign rather than a final verdict.

WHY THIS REGRET CAN STAY HIDDEN

This regret, however, can stay silently below the surface, and this repression makes its effects worse. Firstly, regret can appear to some as ingratitude. It’s reflexive for some to think, “why does this physician who has so many good things going for him feel any sort of regret whatsoever? Who’s this person to complain; what right do they have?” So physicians tend to stay quiet to avoid seeming unappreciative.

Additionally, this sentiment is hardly ever voiced by other physicians, and when you don’t see anyone else around you talking about this, and your peers appear either content - or have a sense of resigned acceptance - then the silence becomes self-reinforcing. Each physician might assume that they’re the only one that feels this way, and think ‘other doctors seem fine’. They’re not. This is one of the most common experiences in mid-career, and one of the ones least vocalized. The silence around it is not evidence of absence.

We’re also trained to endure situations and not to necessarily push back against them or question them. Medicine requires a degree of sacrifice and stoicism, and questioning the arc of your career can feel like a weakness, a chink in the armor that you don’t want to expose.

Finally, there isn’t a specific language for this feeling. And without that precise language and definition, it becomes more of a vague sense of unease and restlessness that you experience at 2 p.m. in the clinic. And if it’s not concrete and nameable, it’s hard to fix it. Part of what this essay series hopes to do is to actually name that feeling - because unnamed things are hard to address, and this one deserves to be acted on.

The positive aspect of this is that regret experienced early enough becomes data. It becomes information, a compass. It points you in the direction of where you should go and what the next layer of your career should include.

Regret surfaces your values because you only regret things that you legitimately care about.

It nudges you to unearth your values and bring out those pieces of you that you’ve left unexpressed.

Also, regret about the future is still editable. The better question to ask yourself is not, what do I regret about the choices I made in the past, but rather, what will I regret at age 65 if I don’t make the changes that I’m thinking about now? That second regret hasn’t occurred yet and is within your control. Again, the 40s are a decent starting line and there is still a large enough time horizon for a physician to create something significant. So this regret, if acted upon early, serves as a launching pad for bigger things to come for the physician’s career.

WHAT TO DO WITH THIS SIGNAL

The response to this regret is not reinvention. It’s a series of small, deliberate steps in which you begin expressing what has up to this point gone unexpressed.

The first thing is an honest acknowledgement that an element of this regret exists, and to name it for what it is. This brings it out in the open and removes some of its power and control over your trajectory.

The second is to understand that regret serves as a map and a compass that will guide you. Ask yourself what specifically has gone unexpressed in your professional life up to this point in time: is it the part of you that could be the builder, the part that could be the innovator, the writer, the investor, the leader … these answers will guide you towards where to begin.

Next, take this signal and let it nudge you towards one small step. Start with one small bounded experiment or action that begins expressing the unexpressed part of you. Maybe this is exploring AI leadership, maybe it’s interviewing 3 people, maybe it’s joining a cross-institutional collaborative project. Maybe it’s mapping opportunities or assets. Finally, appreciate that this signal indicates that the next 10, 20, or 30 years do not have to be a static continuation of the path that you’re currently on. Those years are unwritten - a design space, with you as the physician architect.

Keep in mind that most physicians spend their 40s suppressing this feeling, but the ones who truly listen to it design a different next 20 years.

The physicians I’ve observed who are least burdened by this regret in their 50s and 60s tend to have one thing in common: at some point in their 40s, they made a deliberate choice to design their career rather than inherit it. They don’t mistake stability for design. And they realize that they don’t have to blow up their career with a big leap - a small, deliberate, judicious experiment is enough to start. In the next essay, I want to give that choice a name - and show you what it looks like in practice.

If this names something you’ve felt before but haven’t vocalized out loud, I’d love to hear from you. You’re not the only one. Comment and tell me what part resonated.

- Scott F. Cameron, MD. Radiologist. AI implementation leader. Angel investor. MRS Past President. Career architect.