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Why I Left Medicine (And Why I'm Going Back)

2021-03-14 · Long video (solo, talking head or whiteboard) · Ali · recording, 23:21 · watch on YouTube

Topic: Medicine and his doctor years · mode: Personal story · tags: Family, Lesson from a book

Ali explains that he left medicine in August 2020 at the natural career gap after the UK's two foundation years, unsure of a specialty or of medicine itself, and why he is now going back part-time in emergency medicine: to test whether part-time medicine is what he wants, for in-person work with patients and colleagues, and to do things rather than only read about them.

What is said

The parts of the video and what is said in each (★ — how much it matters to the video).

00:00:00 — Introduction: why he left medicine and why he is going back

00:00:29 — Logistical context: Cambridge, the foundation years, the natural career gap and the year-ahead decision

  • ★★ Ali was a medical student at Cambridge University from 2012 to 2018, started his YouTube channel in 2017 in his final year, and worked as a foundation year doctor in East Anglia from 2018 to August 2020. — 00:00:29 · University of Cambridge, Foundation Programme
  • ★★ UK foundation year doctors have no specialty yet: they rotate through many specialties to work out what they want to do; the closest American equivalent is an intern. — 00:00:29 · Foundation Programme, United States
  • ★★ Ali calls the choice of medical specialty a ridiculously important decision: it dictates who you spend your time with, what you do, maybe even whom you marry. — 00:01:16
  • ★★ In the UK, Ali says, many doctors take a break after the two foundation years, a year out or sometimes two or three, to explore other interests. — 00:01:46 · Foundation Programme
  • ★★ When Ali decided in August 2019 to take time out of medicine from August 2020, he liked the idea of travelling, of emergency medicine work in Australia, or of moving to America. — 00:02:15 · United States
  • ★★★ To Instagram comments asking how he can feel okay leaving medicine in a pandemic, Ali says he decided long before the pandemic, as UK doctors apply for training a year ahead; he and most of his friends chose not to go straight into training. — 00:03:13 · Instagram
  • ★★ Ali describes leaving after the foundation years as a natural career gap: unsure which specialty to choose, you step back and assess, rather than quitting medicine. — 00:04:02

00:04:26 — Reasons for leaving: choosing medicine at 16, what brought him joy, no specialty that fit, emergency medicine untried

  • ★★★ Ali left medicine because he was really unsure which specialty he wanted and not even sure he wanted to stay in medicine at all. — 00:04:26
  • ★★ Ali decided on medical school at about 16 when choosing his A-levels, had it in mind from 13 or 14, and started volunteering with St John Ambulance to build a competitive application. — 00:04:26
  • ★★★ When his mother asks why he does not see medicine through, Ali answers that it is unreasonable to expect a decision made at 14 to 16, about 12 years ago, to bind him. — 00:04:55 · Ali Abdaal's mother
  • ★★ Ali's mother and several relatives are doctors; for an Asian student with good grades medicine was standard, and as a teenager he knew of few careers beyond doctor, vet, lawyer and engineer. — 00:05:24 · Ali Abdaal's mother
  • ★★ Ali calls going to medical school one of the best things ever and regrets none of it, but prefers the American system, where you choose a postgraduate path after college with more life experience. — 00:06:03 · United States
  • ★★★ Ali does not want to be welded to a career decision he made at 16, or let it shape the rest of his life unless he decides it is actively what he wants. — 00:06:32
  • ★★ In medical school what brought Ali fulfilment, joy and meaning was teaching, which he still really enjoys, rather than medicine itself. — 00:06:32
  • ★★ Ali's other joy in medical school was building businesses, coding, web design and a question bank; as a doctor he looked forward to coming home to work on his YouTube channel and businesses. — 00:07:02
  • ★★ Ali cites a quote that what you think about in the shower should be what you do with your life; his own shower thoughts are never about medicine. — 00:07:02
  • ★★ Ali did not want to look back in 30 years regretting sticking to his decision to study medicine; while young, with his businesses and channel going well, it made sense to step back and ask what he wants. — 00:07:49
  • ★★ After eight months on obstetrics and gynaecology, extended by the pandemic, Ali fell out of love with it; with experience in cardiology, elderly care, general surgery, psychiatry and O&G he could not see himself in any of them. — 00:08:35 · Obstetrics and gynaecology
  • ★★ Apart from obstetrics and gynaecology, the specialty Ali enjoyed most in medical school was emergency medicine. — 00:08:35 · Obstetrics and gynaecology
  • ★★ Emergency medicine tops Ali's list of specialties, but he has no experience of it, and he calls committing to a seven-year training programme in it without that experience completely stupid. — 00:09:24
  • ★★ Ali meant to travel to Australia to do some emergency medicine and started making inquiries about getting a job there. — 00:09:24
  • ★★★ Ali also wanted to travel and explore while he had no responsibilities and, thanks to his channel, no money worries; in August 2020 he left with no intention of returning until he knew what he wanted. — 00:10:03

00:10:26 — Reasons for returning: testing part-time medicine, marginal impact and guilt, in-person work, doing rather than reading

  • ★★★ In March 2021, eight months after he last set foot in a hospital, Ali has decided to go back into medicine. — 00:10:26
  • ★★★ To work out what to do with his life, Ali imagines what he wants his average week to look like 10, 15 or 25 years from now; he keeps landing on still being a doctor, part-time. — 00:10:55
  • ★★ Over eight years Ali has asked doctor friends whether they would still practise if they won the lottery: half would leave, half would go part-time, and none would stay full-time. — 00:11:20
  • ★★ However much you enjoy something, Ali thinks, doing it five or six days a week is probably not that fun, and three or four days would be much more fun. (hedged) — 00:11:20
  • ★★★ Ali's picture of his life: medicine maybe two days a week, teaching at a local medical school one or two days, and the rest making videos, writing books and his website. — 00:12:02 · aliabdaal.com
  • ★★★ Ali says we are really bad at knowing what we want: he has tried medicine five or six days a week and knows it is not for him, but will not know whether two or three days suits him until he tries. — 00:12:24
  • ★★ Tim Ferriss (quoted): In The 4-Hour Workweek, Tim Ferriss advises not deferring retirement to 65: take a few weeks off on a beach to see if that life brings happiness, and you find it gets boring. — 00:12:53 · Tim Ferriss, The 4-Hour Workweek

  • ★★★ Ali's lesson: when we think we want something, we should test that assumption; he is going back into medicine partly to test whether he enjoys working as a doctor two or three days a week. — 00:13:38

    “When we think we want something, we should test that assumption.”

  • ★★★ A utilitarian in his cost-benefit analyses, Ali feels no guilt about not working in medicine during the pandemic, because his marginal impact as a full-time YouTuber is much higher. — 00:14:22

  • ★★ Ali says he is not special as a doctor: a junior doctor of two years with limited experience, not much separates him from other doctors, which is how medicine is supposed to work. — 00:14:22
  • ★★ Ali compares medicine with McDonald's: a tight, well-tuned system lets almost anyone with a little training deliver a consistent result, and that is what medicine should be too. — 00:15:34
  • ★★ Doctor shortages at his hospitals are not dramatic enough for one extra part-time doctor to make a difference, Ali says, and the system fills gaps with extra shifts and locums. — 00:16:36
  • ★★ Ali cites analyses that on average in the Western world a doctor saves about eight lives over an entire career. — 00:17:06
  • ★★ Going by GiveWell's estimates, Ali says a $3,000 donation to the Against Malaria Foundation saves one life on average, so $24,000 saves eight. — 00:17:34
  • ★★★ Having taken the Giving What We Can pledge to give 10% of his income to charity each year, Ali says he saves more lives earning online and giving than he would as a full-time doctor for life. — 00:17:34
  • ★★ People email Ali that his videos taught them how to study and got them into medical school; he sees more marginal impact in his videos than as a cog in the hospital machine. — 00:18:17
  • ★★★ Ali's second reason to return: he genuinely enjoys being a doctor, talking to patients, helping people, banter with co-workers and the real-life community, which making videos does not give him. — 00:18:50
  • ★★ Without the pandemic Ali would have travelled and done some medicine in Australia or New Zealand; instead for eight months his life has been Zoom calls, videos, World of Warcraft and sleep. — 00:19:30 · Zoom, World of Warcraft
  • ★★★ Ali does not want to be a professional influencer or a full-time YouTuber: it is not the life he imagined for himself. — 00:20:04

  • ★★★ Ali holds that doing something and then talking about it is far more interesting than reading and then talking about it; he has become the reader and wants to be the doer. — 00:20:33

    “Doing something and then talking about it is so much more interesting than reading something and then talking about it.”

00:21:01 — What's happening now: emergency medicine shifts agreed, waiting on the criminal records check

  • ★★★ In mid-January 2021 an emergency medicine consultant at Ali's local hospital agreed to give him extra shifts in the emergency department, despite his lack of experience there. — 00:21:01
  • ★★ Ali cannot return to work as a doctor until his criminal records check clears; six weeks on, it is still being processed. — 00:21:31
  • ★★ Back in medicine Ali wants to work two or three days a week, maybe more at first for experience, to see if he likes it, be with colleagues, get vaccinated and help in the pandemic. — 00:21:58

00:22:40 — Conclusion and sign-off

  • ★★ Ali does not know whether emergency medicine is the specialty for him or whether he will like working part-time as a doctor, and means to test it. (unsure) — 00:22:40

Threads in this video

Where the stories that moved here went next

Mentioned

Central: Emergency medicine

Also: People: Ali Abdaal's mother · Tim Ferriss

Projects: aliabdaal.com

Works: The 4-Hour Workweek · USMLE

Organizations: Against Malaria Foundation · GiveWell · Giving What We Can · Instagram · McDonald's · St John Ambulance · Twitter · University of Cambridge

Concepts: Cardiology · Foundation Programme · Gap year · General surgery · Geriatric medicine · Obstetrics and gynaecology · Psychiatry · Specialty training · Utilitarianism

Places: Australia · East Anglia · New Zealand · United States

Products: World of Warcraft · Zoom

Also centred on Emergency medicine: I'm Moving to America 🇺🇸 - Life Update

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