The Medical Startup

I was listening to The Tim Ferriss Show (his podcast), Episode #295, where he goes into “The 4-Hour Work Week Revisited.” If you’ve read any of his books, or even if you’ve just heard of “The 4-Hour Work Week,” I highly recommend listening to it. He has some thoughtful insights from the unprecedented response to his most famous book on working well, productivity and “lifestyle design”, and answers some of the most commonly asked questions he’s received since first publishing it over ten years ago.

Approximately midway through the episode, Tim discusses what he believes is the most important and overlooked chapter, “Filling the Void.” In a nutshell, the chapter is about what the reader could do after finding their success on their terms; automation, fantastic cashflow, a great team, flexibility, low stress; as detailed in the book. However, Tim has found that people too often mistake the chapter as being a treatise on the benefits of lifelong idleness after achieving “success” in this manner. Furthermore, he believes people who misread this chapter may misunderstand how to relax well.

“It’s about contribution; getting yourself out of a ‘me, me, me!’ focus, so that you’re hopefully putting a positive dent in the world, in a way that extends outside of yourself and your immediate family, and hopefully has some persistence over time,” says Tim. “And taking the tools you’ve developed in a business capacity, and applying them to impact in some fashion. I expect many people skipped (the chapter) because they don’t expect to succeed…. But (perhaps) what started out as a party or a celebration ends up being really lonely, they feel isolated and don’t know how to address that…. and by thinking about filling the void, about starting to incorporate those pieces into your life, BEFORE you end up in a challenging psychological position where you end up being reactive, … since you haven’t filled the void with anything non-business related, you’re going to continue to work for work’s sake. This is really common for people who succeed in any capacity. .. It’s really rare you see someone who’s been in sixth gear for a very long time, who then retires and is really good at chilling out. Learning to relax and enjoy other aspects of life, and engage with people around you- friends, community or built community- those are skills you need to practice and develop, just as you need to develop and practice the skill of split testing (ie. A-B testing) to anything else. It’s not a default ability you have as soon as you stop.”

“They can be really existential (issues) for someone. If the business has been your identity for a long time, and all of a sudden you want to replace that, if you don’t have a compelling replacement, you’ll just continue working because you don’t want to have to sacrifice that identity.”

(If you don’t have a business, feel free to replace it with “work” in the quotes above to apply to your situation.)

I think this is why people have trouble taking a break; even if you haven’t felt that you’ve reached your ideal of “success” yet; even if you’ve failed or had a hard time and wanted to distance yourself from your work for a time; in order to recuperate. If your identity’s so wrapped up in your work (and don’t worry, you’re not odd- it’s very common in medicine and startup land), you’ll feel that strange sense of time stretching out, empty and unfilled, and you’ll perhaps feel guilty for having that free time, and try to keep “busy” by filling it up with quick dopamine rushes, which may be simply starting a bunch of new projects with too much zest (who doesn’t love enthusiasm?), or at their extreme, can include overspending, binge eating, even drugs and so forth.

Or maybe you don’t experience any of that, but you think that to fill that void, you have to go back to work ASAP. And if that work environment was toxic for you, or you had issues to work through that you didn’t get addressed while having time off, those issues can quickly reappear, or be amplified, creating an even worse situation for yourself.

And the worst is that you may feel you’ve trapped yourself.

But there’s always a good way out.

You can be proactive about this.

As Tim suggests, no matter where you’re at in life, you can start today by asking yourself if you’re enjoying enough time with your friends/loved ones; if you’re doing something meaningful to you that is part of your identity, like a hobby that isn’t directly related to your work; or you can start something new, a new activity or hobby that helps build your identity beyond your medical life or startup life. You need to know that you’re valued beyond the workplace. And if you do find that you want to go back to work, that’s okay, but you could consider an option of trying a different work environment; working fewer hours/part time; or changing your work style in some other way. (A burnt-out, bullied doctor shouldn’t necessarily jump straight back into the exact same workplace; locuming a couple of days in a different workplace, or volunteering your compassion, integrity and other qualities into a tutoring job for homeless children, let’s say, could help you recuperate and feel fulfilled beyond your initial job description.)

It takes time to decelerate; even a car doesn’t do it gracefully when the brakes are slammed on! Patience with yourself will go far.

Feel free to comment below with your thoughts!