The push, the pull, and the leap 

By David Kopacz, MD, University of Washington 

I just quit my job of over 11 years at the Seattle Veterans Affairs (VA). I’m letting go of a lot–my job in primary care mental health integration, working with veterans, working with amazing primary care staff and my colleagues, my role as a national Whole Health Education Champion (Whole Health is the holistic model of self-care for veterans and staff), and my appointment as a clinical associate professor at the University of Washington (UW). It’s been a tough decision to leave, but I feel a pull to be closer to my aging parents to support them in their next phase of life. I also feel a push away from being a federal employee under the current administration. I’m starting a new chapter in my life and I’m not sure what it will hold. 

As I go through this transition, I remember other job transitions over my career–sometimes I’ve left because of a push from changes in the job (such as leaving a multi-specialty practice that had been sold to an aggressive medical management company and then having a two-year non-compete clause); other jobs I’ve left because of a pull to do something new (such as when I closed my private practice and moved to New Zealand to work). Even though I’m familiar with going through the liminal space of transitions, I feel all the intense and complicated emotions of loss and gain, excitement and fear, inner certainty and self-doubt. I often tell residents that every job has its pros and cons and that there’s no “perfect” job, although a job can be perfect for you at a certain point in your career.  

How does one decide to change jobs?  

Sometimes it’s the push of something that no longer sustains you or even goes against your values. Other times it’s an opportunity you can’t refuse. I’ve written about holistic decision-making in my book “Re-humanizing Medicine” that explains how to use all aspects of yourself to see how a decision feels in your body, emotions, mind, heart, creative self-expression, intuition, and spirit. We often think of ourselves as unitary beings, but we’re made up of many different domains of human experience and these can be at odds with each other. In my current decision, the pull of supporting family outweighs career development and academic advancement. These are other dimensions of holistic decision making–the context of family and relationships and the time of life that I’m in with aging parents. For holistic decision making, you can meditate on each of these dimensions to see how you feel about a particular decision, and you can also journal with a page for each of these nine dimensions.  

In going through a job transition, it’s important to review and honor the work that you have done. Looking back, I’ve accomplished a lot in my 11+ years at the VA and UW: I’ve published six books (four with Joseph Rael–Beautiful Painted Arrow); I’ve published many articles, essays, and poems; I’ve created workbooks for a Whole Health Class, a Hero’s Journey Home class (using Joseph Campbell’s hero’s journey as a model for coming home after military service), and a Healer’s Journey text (for psychiatry residents learning psychotherapy); I helped develop a Native Veteran Clinic; I’ve developed and taught more Whole Health courses and lectures that I have facilitated in-person and on-line; and of course, I’ve had extremely rewarding clinical work with hundreds, maybe even thousands, of veterans.  

It’s been a tough few years. In many ways, I feel like I’m still coming out of the pandemic and searching for “normal,” or at least the “new normal.” I’ve been through a lot of change the last five years: the pandemic hit, my father-in-law developed Parkinson’s and died of Covid-19, I was diagnosed with stage IIIa melanoma–the surgery went well, but I have persistent side effects from the adjunctive immunotherapy. At the VA, we’ve had constant workflow changes at least every six months for the past five years. This was accelerated by the Department of Government Efficiency (DOGE). Perhaps there’s a need for a new term for occupational stress for federal employees–FESS: Federal Employee Stress Syndrome. We all have personal, institutional, national, and political variables that affect us and need to be factored into our decisions.  

In my book, “Caring for Self & Others,” I’ve added a tenth human dimension–becoming caring–a leadership dimension where we grow in becoming capable of caring for all. This is regardless of whether you have a formal leadership role. As professional carers, we have a responsibility, not just to the patient in front of us, but to the health of all. This is true public health, true universal health, that the health of all is dependent upon the health of each individual. I think of this as a kind of medical activism—in which we take responsibility and action for the health of all as healthcare professionals. I’m not sure what form this will take for me as I shift to an all-clinical telepsychiatry role in the private sector but watch this space! 

Here are a few things I take away from the experience of quitting a job and finding a new one:

1. Quitting a job to start another entails powerful emotions of loss as well as exciting new opportunities–reflect both on what you’ve accomplished in your career and what new vistas await you!

2. There’s no perfect job–each job has pros and cons, but certain jobs may be more or less supportive for your life stage and family responsibilities.

3. Reconnect with your origin story–why were you drawn to healthcare in the first place? How can you recommit to your values in a new job?

4. Try to embrace the opportunity to re-invent yourself–not just your professional career, but other personal and creative domains as well. Is there something you’ve always wanted to do or learn that your busy current professional job didn’t support? How can you build that into your new life?

5. Are there ways that you can embrace caring for all–working for the public health of all of us through various kinds of medical activism? Writing, advocating, joining professional or topic-focused organizations, running for office–any way that you can expand caring from a patient interaction to recognize our interconnectedness. 

6. You can use holistic decision making to check in with multiple different dimensions and see how you feel in each domain. You can meditate on each aspect of yourself, or you can journal a page (or more) from each perspective:

1. Body
2. Emotions
3. Mind
4. Heart
5. Creative self-expression
6. Intuition
7. Spirit
8. Context
9. Time 

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This piece expresses the views solely of the author. It does not represent the views of any organization, including Johns Hopkins Medicine.