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Why I Left Medicine... Forever

2021-11-30 · Long video (solo, talking head or whiteboard) · Ali, Lewis Howes, Grace Lordan · recording, 43:17 · watch on YouTube

Topic: Medicine and his doctor years (also: Goals, purpose and life design, Money and investing) · mode: Reflection and life update · tags: He changed his mind, His own numbers, Lesson from a book, His own products discussed, Family

Ali explains why he is leaving medicine for good: weighing the five things people work for (money, fun, helping people, purpose and meaning, social status), he finds none keeps him a doctor, gets past his risk aversion and fear of losing the doctor badge after a part-time trial and Lewis Howes's challenge, argues he saves more lives giving 10% of a YouTube income, and answers viewers' questions.

What is said

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

00:00:00 — Ali is leaving medicine for good: what the video will cover

  • ★★★ Ali announces that, after agonising about it for many months, he is leaving medicine for good. — 00:00:00

00:01:19 — Why we work: the five reasons, then money and fun

  • ★★ Ali says people broadly work for five things: money, fun, helping people, purpose and meaning, and social status, the unsexy one we rarely admit to. — 00:01:19
  • ★ Ali calls Vicki Robin's book Your Money or Your Life very good and says people should read it. — 00:01:19
  • ★★ Vicki Robin (quoted): Vicki Robin argues in Your Money or Your Life that money is the only thing work gives us: fun, purpose, meaning and fulfilment can all be had by volunteering. — 00:02:09
  • ★★ Money is no reason for Ali to stay a doctor: UK doctors are not paid much, and he can make astronomically more from YouTube than he could as a doctor. — 00:02:47
  • ★★ Ali genuinely enjoyed working as a doctor (the banter with colleagues, talking to patients, the science, taking blood) but not the full-time hours, the struggle to take time off or a junior doctor's lack of autonomy. — 00:04:11
  • ★★★ After deciding in March 2021 to go back into medicine part-time, Ali did a few shifts, but every day in hospital he felt it was nowhere near as much fun as his work in the studio, with the team, on YouTube, reading and writing. — 00:04:40
  • ★★ Ali says his video on leaving medicine is not meant to convince anyone else to leave: a doctor who would keep working even after winning the lottery is in a fantastic position. — 00:05:09

00:05:38 — Helping people: personal joy versus actual impact, and the replaceable junior doctor

  • ★★★ Ali separates the personal joy of helping from the help actually given: a banker earning $10,000 an hour helps far more by working extra hours and donating the money than by ladling soup at a soup kitchen, though that feels less good. — 00:06:09
  • ★★ Ali's friend Lucia, who runs a public health charity working to eliminate lead poisoning in the developing world, has quit clinical medicine because helping patients one at a time has less impact. — 00:06:50
  • ★ Ali says lead poisoning contributes 1% of the global burden of disease. — 00:07:20
  • ★★ Ali says studies estimate how many lives a doctor saves over a career: about seven by some estimates, about 28 or 30 by others. — 00:07:49
  • ★★ Ali says such estimates ignore that someone else would take his place: the UK's NHS has enough doctors in the specialties he would choose, such as emergency medicine. — 00:08:23 · NHS
  • ★★ In a developed-world health system, Ali says, it is the system that saves lives rather than an individual doctor's prowess; only a rare world expert or a uniquely skilled surgeon makes a difference as an individual. — 00:08:53
  • ★★★ As a junior doctor two years out of medical school Ali felt he had no real individual impact; what kept him in medicine was the personal joy of helping, which in his fairly utilitarian view did not justify staying. — 00:09:22

00:09:51 — Purpose and meaning: the gravestone technique, the ideal ordinary week and teaching

  • ★★★ With the gravestone technique Ali found he would want "good father, good husband and good teacher" on his gravestone: he cares more about being a decent teacher than about saving lives as a doctor, and encourages viewers to ask themselves the same question. — 00:11:04
  • ★★★ Doing the ideal ordinary week exercise, blocking out his dream week years ahead in Google Calendar, Ali filled it with reading, writing, teaching, videos and friends, and found that working as a doctor did not fit at all. — 00:11:33
  • ★★★ Ali gets meaning from teaching rather than from saving lives: his YouTube academy, his videos and his book are teaching at scale, and he would like to teach medical physiology at a university, which needs no clinical practice. — 00:12:02 · Part-Time YouTuber Academy

00:12:58 — Social status and the badge of being a doctor

  • ★★ A big part of Ali's hesitation about leaving medicine was not wanting to lose the badge of honour and prestige that being a doctor gives. — 00:12:58

00:14:22 — Risk aversion, and Lewis Howes's challenge on The School of Greatness

  • ★★ Out of risk aversion Ali assumed he should stay a doctor as a backup in case YouTube died, since very few YouTubers big today were big ten years ago. — 00:14:22
  • ★★ Interviewed by Lewis Howes on his podcast The School of Greatness, which Ali calls amazing, Ali found a talk about multiple streams of income turning into a coaching session on whether to stay in medicine. — 00:14:51
  • ★★ Lewis Howes challenges Ali: with all the energy, thought and skill he has developed, would he really be unable to launch a new revenue stream if his others ran dry? — 00:15:48
  • ★★★ After Lewis Howes's challenge Ali saw that the skills he built online over five to ten years, making websites since 13, would let him earn more if needed, so keeping medicine as a fallback salary was irrational. — 00:16:12

00:16:41 — Fear of hate and of losing the doctor badge; going part-time and why it did not work

  • ★★ Ali feared hate online for leaving medicine in the middle of a pandemic, since to some of the public medicine is a sacred, hallowed profession. — 00:16:41
  • ★★★ Ali built his brand on being a medical student and then a doctor with a business and channel on the side; that probably made his channel grow early and arguably still does, so he feared the channel and business would die without it. (hedged) — 00:17:10
  • ★★ Ali's answer to these fears in March 2021 was to be a doctor part-time, one or two days a week, so he could still call himself a doctor in good conscience. — 00:17:55
  • ★★ Lewis Howes tells Ali he does patients a disservice by giving 10% of his time and energy to medicine when others want to do it full time and obsess over it. — 00:19:09
  • ★★ Ali does not fully agree with Lewis Howes: for a junior doctor in an emergency department, shift work means it hardly matters whether one works one day a week or four. — 00:20:02
  • ★★ Ali does see Lewis Howes's point that practising medicine for reasons other than passion is in a way a disservice to patients. — 00:20:31
  • ★★ Ali thinks many doctors keep working in medicine because they need the money, and most he knows would quit if they won the lottery or had a successful YouTube channel. — 00:20:31
  • ★★★ Staying a part-time doctor so people online would not hate him is not a good enough reason, Ali says, to keep doing something he is not passionate about, when what he cares about is teaching. — 00:20:31

00:21:13 — Helping people, the long version: a teacher's impact and viewers' messages

  • ★★ Being nice to patients is a form of impact, but Ali is not the most empathetic doctor and another doctor would take his place and hold the patient's hand; staying for that would be to make himself feel good. — 00:22:12
  • ★★★ The impact Ali cares about is a teacher's, inspiring people onto a path, rather than saving individual lives; being seen as a good teacher and an inspiration is what brings him joy. — 00:22:46
  • ★★ As a doctor Ali got about two thank-you messages from patients, but he has had thousands from viewers: study tips that got them through school, a viewer saved from the brink of suicide, YouTube and passive-income tips that paid for IVF. — 00:23:10

00:24:09 — The drowning child, effective altruism and the 10% pledge

  • ★★ Ali retells Peter Singer's drowning-child thought experiment from The Life You Can Save: we would ruin a £5,000 suit, cross a border or climb a wall to save a drowning child, yet hesitate to donate $3,000 that would save a child in Africa from malaria. — 00:24:09
  • ★★★ Ali thinks all lives are roughly equal: if he would pay five grand to save someone in front of him, he should pay five grand to save a child in Africa, rather than value a UK patient's life more. — 00:26:30
  • ★★ Ali describes effective altruism as a community seeking the most cost-effective ways to donate: we are evidence-based in everything else, so we should be evidence-based in how we give. — 00:26:59
  • ★★ Citing the charity evaluator GiveWell, Ali says $3,000 given to Save the Children would not save a life, while $3,000 given to the Against Malaria Foundation would. — 00:26:59
  • ★★★ Ali took the Giving What We Can pledge in 2019 and donates 10% of his income to cost-effective charities every year; his video about it performed terribly. — 00:27:28
  • ★★★ Making a few million a year from YouTube and donating 10% of it, Ali says he saves more statistical lives than he would in an entire career as a doctor; someone else would take his place in medicine, but no one can take his place as a YouTuber. — 00:27:28
  • ★★ Ali invites viewers to take the 10% pledge: giving 10% rarely makes a meaningful difference to happiness unless you are on the cusp of poverty, but it can have an enormous impact on others. — 00:28:27

00:29:25 — Answering questions from Twitter

  • ★★ Answering critics who say content creation is less worthy than being a doctor, Ali says, if the messages he gets are to be believed, his videos have a different sort of impact but not a less valuable one. — 00:29:54
  • ★★ Grace Lordan, a professor of behavioural science at the London School of Economics, says leaders of the future need to be able to say "I don't know", "I got it wrong" and "I've changed my mind", deliberately rather than by reflex. — 00:30:26
  • ★★★ Ali thinks changing your mind is a good thing: there is value in quitting and little value in clinging to a decision made some time ago, even one announced to the internet. — 00:30:55
  • ★★ About two years earlier Ali decided to move to America, take the USMLE and become a doctor there; he tried the exams and the preparation, found it a lot of work, and as the channel and business took off he decided it was not worth it. — 00:30:55 · USMLE, United States
  • ★★ Steven Bartlett (quoted): Steven Bartlett's quitting framework, from Happy Sexy Millionaire: if you are thinking of quitting, ask whether it is just hard or it sucks; if hard, is the reward worth it; if it sucks, can you make it not suck and is that worth the effort; if not, quit. — 00:30:55
  • ★★★ Ali likes Steven Bartlett's quitting framework: it is the thought process he used to stop working towards the American medical exams, which were hard and whose payoff was not worth it. — 00:31:46 · United States
  • ★★ Asked whether medicine is safer for the long run if social media dies, Ali says he has a safety net of money in the bank and investments in real estate and crypto that would let him go ten years without earning. — 00:32:48
  • ★★ Ali lists the skills he could fall back on: a job at a startup, marketing, videography, photography, another business or company, or writing books; he is writing a book now. — 00:32:48
  • ★★★ Ali does not feel he wasted his years in medicine: medical school and two years as a doctor were fun and fulfilling, and what matters is the journey, not the destination. — 00:33:55 · journey before destination
  • ★★ Without medical school there would probably be no Ali Abdaal on YouTube: his 2013 company helping people into medical school led to the channel, then to videos on studying, productivity and iPad note-taking. (hedged) — 00:34:25 · 6med
  • ★★ Ali now has a studio and a team of 17 people. — 00:34:25
  • ★★ Ali feels no guilt about not using his medical skills, such as putting in a cannula or prescribing fluids: as a bog-standard junior doctor he thinks he has more impact online. — 00:35:40
  • ★★★ To people who want to switch careers, Ali advises testing your assumptions, writing them down and talking them through with others, because it is easy to fool yourself, as he did until his brother and Lewis Howes pointed out his flawed thinking. — 00:36:09 · Taimur Abdaal
  • ★ Richard Feynman (quoted): Richard Feynman: the first person you must not fool is yourself, because you are the easiest person to fool. — 00:36:09
  • ★★ Ali's business has several years of runway in the bank for the whole team; if needed, he and one video editor, such as Christian or Dan, could go it alone and make content for ten years before the money ran out. — 00:36:38 · Christian
  • ★★ Whenever his business became too reliant on one line of revenue (the YouTube channel, Skillshare or the courses), Ali diversified into other pillars, so he is confident it will survive even if YouTube dies. — 00:37:07
  • ★★ Ali's biggest fear in quitting medicine was becoming just another productivity guy on YouTube and losing his medical-student viewers, but keeping them is not a good enough reason to do something he is not passionate about. — 00:38:11
  • ★★ Ali admits that leaving medicine "for good" is realistically "for now": he keeps his medical licence and full General Medical Council registration and could go back, but for the next season of his life he is going all in on YouTube, business and writing. — 00:38:46
  • ★★ Ali probably will not go back into medicine, because it would take a lot of training and his life as a YouTuber beats a junior doctor's, though he will never say never. (hedged) — 00:39:28

00:40:51 — What is next, and thanks to viewers

  • ★★ Ali no longer feels he needs a five-year plan: he has become more comfortable with uncertainty and answers "what's your plan?" with "I don't know, but I'll figure it out along the way". — 00:40:51
  • ★★ What is next for Ali after medicine: writing a book, growing his YouTube channel, building a second YouTube channel, and doing more on his website, newsletter and social media. — 00:41:15
  • ★★ Ali thanks his viewers: without his YouTube channel he could not follow his dream of teaching and writing instead of being a doctor, which he felt he had to do. — 00:42:01

In the description and comments

  • ★★ In a reply to a viewer, Ali says he normally decides small things by gut but uses a framework for big decisions such as leaving medicine. — creator comment

Threads in this video

Where the stories that moved here went next

Mentioned

Central: Lewis Howes

Also: People: Christian · Grace Lordan · Peter Singer · Richard Feynman · Steven Bartlett · Taimur Abdaal · Vicki Robin

Projects: Part-Time YouTuber Academy

Works: Happy Sexy Millionaire · School of Greatness · The Climb · The Life You Can Save · USMLE · Your Money or Your Life

Organizations: 6med · Against Malaria Foundation · General Medical Council · GiveWell · Giving What We Can · London School of Economics · NHS · Save the Children

Concepts: drowning child · effective altruism · Emergency medicine · gravestone technique · ideal ordinary week · journey before destination · quitting framework

Places: United States

Only in the description or credits: Lucia

Also centred on Lewis Howes: Everything's Changing - Life Update

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