Why I'm Pivoting
I’ve been wrestling with burnout since I started practicing medicine. I assumed, and a few times was directly told, I was the problem: efficiency, boundaries, documentation speed. Maybe I needed thicker skin.
Trouble is, I can only control what happens in the room with each patient. That’s it. Not who shows up. Not how long I have with them. Not whether I’m cleaning up someone else’s mess. Just: what happens when the door closes and it’s the two of us figuring something out.
It’s not a skill problem. It’s a structural one. Healthcare operates at three layers: patient, workflow, and organization. I’m trained and authorized for the first. I tinker with the second to keep my head above water. But the third is where I want to shift my focus.
Who Absorbs the Friction?
I work in primary care. My job, on paper, is to see patients and manage their ongoing health needs. My job in practice is to be the universal solvent for everything the healthcare system failed to do correctly the first time.
Patient hasn’t been seen in over a year and has multiple chronic conditions that need management, but their primary doesn’t have time to see them for 3 months? That’s a 20-minute appointment slot for a 45-minute conversation, plus another 10 minutes of chart prep. Patient is on twelve medications prescribed by six different specialists who aren’t talking to each other? I get to untangle that. Patient needs a prior authorization for a medication they’ve been on for years because insurance changed their formulary? I’m the one who writes the appeal letter.
Healthcare generates friction. Someone has to absorb it. In primary care, that someone is the clinician in the room.
And I can’t fix it. I can see it. I can document it. I can tell you exactly what’s broken and why. But I can’t fix it because the intervention required is organizational, and I don’t have organizational authority. I’m a physician assistant. I work for a clinic that works for a health system that fits in an industry famously entangled in bureaucracy and politics and profit. My sphere of control ends at the exam room door.
The Workarounds That Became Doctrine
Here’s what actually happens in my workday, all made possible by the workflow layer of healthcare:
The 20-minute appointment that should be 40 minutes. Complex patients with multiple chronic conditions, medication reconciliation needed, care gaps to address, get roughly the same slot as someone coming in for a cold. The schedule doesn’t differentiate, and there’s far more complexity than sniffles. So I either run late, devalue my time because I’ll end up working late, and make everyone else wait, or I do substandard work. I’ve gotten very good at triage: what absolutely must be addressed today, what can wait, what I can delegate to a message later. It’s a workaround for a scheduling system, and clinician availability, that doesn’t match reality.
A lack of continuity. I’m constantly picking up patients who are seeing me because their doctor is booked out three months and they need something addressed now. Sometimes this is because the patient demands to be seen and I have an open appointment, so why not maximize utilization. But more often than not, someone I’ll never meet from a call center I’ll never see just offers the next available appointment because they don’t understand the complexities they’re dumping on me, nor the value of continuity of care. Then I get to repeat the process with my patients when they get scheduled to other clinicians for follow up because I’m unavailable. This is inefficient and alienating.
The bureaucratic industrial complex. I spend hours navigating insurance requirements and fighting prior authorization denials. I write sick notes for adults who shouldn’t need my permission to stay home from work. I create charting shortcuts to satisfy byzantine billing requirements. When my patient needs a specialist, I verify they’re in-network, confirm whether preauthorization is required, check if they’re accepting new patients, then watch them get triaged out to 12 months. I see patients who need 5 minutes of medical care and 15 minutes of HR paperwork. This is not clinical work. This is friction someone added to save money, and I’m the one who absorbs it.
Feedback falling on deaf ears. I have so many supervisors who want to hear if I’m ever having a problem. But it’d better be about how to improve an individual support person’s workflow, and I’d better have screenshots, and be ready to talk them through how to fix it myself. If the concern is in any way systemic, the response is always some version of: maybe you’re just not suited to primary care. We never talk about the fact that we’re understaffed, overbooked, and operating in a system that doesn’t allow for longitudinal care. Open door policies and meetings exist to create the appearance of addressing the problem without actually giving anyone the authority to change anything structural.
The Clinical Informatics Detour
I’m drawn to how information moves through healthcare systems. I can see where workflows break down. I have strong opinions about EHR design, documentation burden, and how data could improve care instead of merely satisfying billing requirements. I even earned my Epic Builder certification so I could work directly on our EHR. When that didn’t feel sufficient, I assumed I needed more formal training. More credentials. Maybe a master’s degree.
But I realized: clinical informatics is a bandaid. Most roles remain clinically tethered and advisory. Influence without authority. Additional responsibility without organizational power.
It optimizes within existing constraints. I’m interested in questioning the constraints themselves.
Data science is about inference, experimentation, and decision-level insight. It allows you to test whether the scheduling model is flawed, quantify the cost of fragmentation, measure the downstream impact of poor continuity. It doesn’t just optimize the workflow, it evaluates whether the organization is designed correctly.
I want to work at that level.
The Real Constraint
The problems I care about are organizational. My authority is individual. That mismatch is the root of my burnout. I can recommend. I cannot redesign. I can document. I cannot restructure.
As a clinician, my authority is the wrong shape for the problems I see. I can’t set policy, adjust staffing, or redesign incentives.
I don’t need more authority. I need different authority. The kind that lets me work on system-level problems without absorbing patient-level distress. The kind where being tired at the end of the day means I thought hard about a complex problem, not that I absorbed eight hours of human suffering I couldn’t adequately address.
I’m tired of being the person who sees the problem clearly but can’t solve it.
I don’t think I want to leave medicine completely. Those moments when a patient walks out of the room, on time, but still smiles and says you’ve changed their life… Most people will never get to experience that feeling after one 20-minute conversation.
That said, it should be supplementary, not primary. I don’t want my professional identity tied to a role where my impact is limited to one patient at a time, at the expense of my mental health. Working per diem will allow me to maintain clinical skills, stay connected to the reality of patient care, and provide financial support while I figure out if this will actually work.
I want to work on systems. I want to design interventions that could actually change how care is delivered, not just how individual clinicians cope with broken delivery. I want to do the kind of analysis that informs organizational decisions, not the kind that gets filed under “nice to know” and ignored.
Why Data Science
Leverage. In clinical medicine, I help one patient at a time. Data science changes the scale. A single well-executed analysis can shape decisions that affect thousands of patients, multiple clinics, or an entire system. Instead of repeatedly compensating for the same design flaws at the bedside, I can help alter the conditions that produce them.
Authority matched to expertise. If I can demonstrate that a particular workflow generates measurable friction, quantify its downstream cost, and propose a testable alternative—that’s the kind of work organizations act on. Not because I’m advocating more loudly, but because I’m providing decision-makers with information they need and cannot generate on their own. Data creates authority that opinion alone never will.
Sustainability. Clinical work is emotionally intensive by necessity. Data work is cognitively intensive. I want to be tired because I’ve wrestled with a hard problem, not because I’ve absorbed preventable distress all day. Data science allows for deep, uninterrupted engagement with complex systems—work measured in projects and outcomes rather than appointment slots.
The Plan
I’ve designed a self-prep course for the next few months. Statistics, Python, SQL. The foundational skills I need to be competent going in. Then I’ll spend six months working through a more formalized online analytics course. This gives me structured learning and something concrete to point to when I’m applying to programs.
The goal is an online masters in data science from a top university. Rigorous without requiring me to quit my clinical job immediately, respected enough to get me a conversation where I can illustrate credibility. That’s the credential that opens doors.
While I’m doing all this learning, I’ll also be building a portfolio. Healthcare analytics projects. Data visualization. Maybe some work on predictive modeling. Things that demonstrate I can do the work, not just talk about it.
And I’ll dial back my clinical hours. I’ll work per diem to stay clinically sharp and remember what it’s like to be in the room. But not enough that I’m back to absorbing system friction full-time.
The Broader Pattern
This isn’t just about me. This is a pattern I see constantly: skilled clinicians who can diagnose system failures but can’t fix them because the intervention required is outside their authority.
Healthcare asks clinicians to absorb system failure and calls it resilience. So they stay and become increasingly cynical, or they leave.
The response from healthcare administrators is usually some version of: “We value your feedback. Here’s a wellness seminar.” Which is not the same as: “Here’s organizational authority to redesign workflows.”
The problem isn’t that clinicians don’t know how to cope. The problem is that coping isn’t the same as solving. And if the only tool you have is individual resilience, you’re going to interpret every system failure as a personal failure.
What I’m Still Figuring Out
Am I running toward something or away from something? Both. I’m moving away from absorbing system friction I can’t fix, and toward work that lets me address root causes instead of symptoms.
Either way, I’m not leaving medicine because I stopped caring about patients. I’m stepping out of the exam room because it’s too small for the problems I want to solve.