Why Physicians Always Feel Behind (And Why Progress Never Feels Like Enough) | Ep33

Michael Hersh, MD

[00:00:00] 

You hit the milestone, you solve the problem. You get through the hard thing, and almost immediately, your attention moves to what's next? The next goal, the next hurdle. The next thing that's still isn't done. It's the sense that no matter what you do, no matter what you accomplish, it never quite feels like enough.

For most physicians, setting a goal isn't the problem. It's that there's never a pause, no moment to register what just happened or how far you've come. Just forward motion. If that sounds familiar, you are not alone, and that's what we're talking about today.

Well, hey everyone, and welcome back to the Better Physician Life Podcast. Thank you so much for being here today. Before we dive in, I wanna slow things down for a moment because when we start talking about feeling behind or [00:01:00] finally feeling like we've made enough progress. It's very easy to turn that into another goal.

Another thing to chase, another place we're trying to get to, and that's not what this is about. This isn't about motivation or ambition or wanting more, or even setting yet another goal. This is about something a little more subtle than that. It's about how rarely we stop long enough to actually notice what we've already done, how quickly our attention moves forward to the next thing that still isn't finished, instead of back to everything that already is.

And I didn't realize how much this was shaping my experience until I noticed how often I felt behind. Even during stretches when on paper things were going really well, [00:02:00] not necessarily perfect or easy, but moving exactly the way I wanted them to. I was doing the work, showing up, handling all the hard things, and making progress, and still there was this steady sense that I should be further along by now.

That's what I wanna unpack today. Not because there's something wrong with feeling that way, but because for a lot of physicians, that feeling becomes so familiar, we stop questioning it. We assume it's just part of the job, part of being driven, part of caring. But there's more going on there. And once I was able to see it more clearly, it changed how I related to my work, my goals, and my sense of purpose.

Most of us were trained this way. Medicine rewards forward motion, the next exam, the next rotation, the next [00:03:00] responsibility, the next level of competence and qualifications. There's always something ahead of you and very little encouragement to pause and take stock of exactly what we've learned or how far we've come.

There's no time for that. In fact, pausing can almost feel irresponsible like you're taking your foot off the gas when there's still so much to do. So we keep moving. We keep aiming. We keep measuring ourselves against what hasn't happened yet, and over time, that starts to feel normal. Feeling behind becomes the default.

Not because we actually are, but because we're always comparing where we are to where we think we should be or where everyone else is or where we wanna be. That's the part that I struggled to see for a really long time. I didn't realize how rarely I ever turned [00:04:00] around. I was always facing forward. What's next?

What still needs attention? What hasn't been finished yet, and because of that, my progress never really registered. Things were getting done sometimes at an epic pace, but they didn't really land. I barely noticed them and moved straight from one hard thing to the next without ever letting myself notice the space in between.

And at some point that started to bother me, not in a big way, not all at once, just enough that I couldn't ignore it anymore. I'd look back over a year and think that was a lot, and then immediately follow it with, yeah, but I still haven't done blank. Whatever blank my brain decided to fill in that day as the next important thing.

And that's when I realized something really important. If I didn't intentionally take the time to turn [00:05:00] around, my brain was never gonna do it for me. So a few years back, I sat down to make this intentional. I created a document for myself. I didn't have a system or a template or someone telling me how to do it.

I also had no plans of ever telling anyone what I was doing, partially because it seemed a little indulgent to be patting myself on the back for a job well done, and partially because I didn't think some of the accomplishments were really big enough to celebrate. I definitely had no plans of sharing it with ever anyone.

I just wanted a place to write things down, things I worked through, decisions I made. Hard moments wins, losses. Stuff that mattered to me at the time, and over time it started to change how I saw things. When I went back and read it, I could see patterns. I had completely missed [00:06:00] challenges that felt overwhelming at the time that I had already moved through, decisions I had agonized over that were now clearly behind me.

Lessons learned and lessons earned. Progress I would've completely discounted if it hadn't been written down. And what surprised me most was how good it felt. Not motivating, not inspiring, but grounding. It showed me where I actually was instead of where my mind kept insisting I should be. And the more I sat with that, the more I realized this wasn't just a me thing.

This is how a lot of physicians move through our careers. We're trained to keep our eyes forward, to anticipate the next problem, the next demand, the next thing that could go wrong. That skill keeps patients safe. It makes us good at what we do, but it also comes at a cost because when you [00:07:00] spend years scanning ahead, you stop trusting what's already behind you.

You discount it. You minimize it. You assume it doesn't really count anymore because it's already done. So even when you're doing meaningful work, even when you're growing, even when you're handling things you couldn't have handled 5 or 10 years ago, it still feels like you're chasing something that's just out of reach.

And that's where the feeling of being behind starts to take root. Not because you are actually behind, but because you're measuring yourself against what hasn't happened yet, and when that's the only reference point you use, nothing ever feels like enough. What changed for me wasn't lowering the bar. It wasn't stopping and it wasn't pretending things were easier than they were.

It was giving myself a second reference point. [00:08:00] Forward is useful. It keeps us moving, but backward matters too. It shows you what you've already carried, what you've already learned, and what you no longer have to prove. Once I started intentionally looking back, the present felt different. I wasn't bracing all the time.

I wasn't constantly telling myself I should be further along. I could just deal with what was actually in front of me. I didn't second guess myself as much, and I trusted my own decisions more. I had evidence that I could actually figure things out, even if I didn't fully understand them yet. I wasn't constantly trying to convince myself that I was okay where I was because I could actually see it.

And this is why that feeling of never enough shows up so often, especially for mid-career doctors. It's [00:09:00] not because we're failing and it's not because we've lost our drive. It's because we're doing harder things now with higher stakes and less feedback. Early on, progress is obvious. You pass the test, you move to the next level.

Someone tells you you're doing well and meeting the requirements, and later the work gets more subtle, more complex, more dependent on our own judgment. There aren't as many clear markers anymore. So if you're only looking forward, it's easy to miss how far you've come. So you start to feel behind even when you're not.

And you assume that discomfort means you should be further along instead of recognizing that the work itself has changed. And when that goes unnamed, it turns into that low grade pressure that [00:10:00] never really shuts off. Always scanning, always measuring, always feeling like you should be doing more. Looking back, doesn't erase that pressure entirely.

It does change how you relate to it. It gives you context. It gives you a baseline. It reminds you that the person doing the work today isn't starting from scratch. You get credit for the work you've already done. You've been here before. You've figured things out before and you can do it again. A lot of people ask me about that document that I mentioned, how I do it, what it looks like, whether there's a right way, and the truth is there isn't.

Mine isn't fancy. It's just something I can pull up from my phone or my computer and I split it up by months and I write down things [00:11:00] I don't wanna forget. Connections I've made. Podcasts I've recorded. Family vacations, both the planning and the taking. Times I showed up for my family. Times I showed up for my patients. Times I showed up for my colleagues. Battles I've fought, battles I've lost and lessons learned. Sometimes it's a sentence, sometimes it's a paragraph, sometimes it's just a date and a few words. The point isn't to capture everything, it's to give your brain a place to see reality instead of constantly rewriting the story forward.

It's just one small way I stopped letting progress disappear. For a lot of physicians, the hardest place to stay oriented isn't the middle of the day. It's right before it starts or right after it ends. That moment [00:12:00] in the car, the drive home, the drive in, that's where our minds tend to run ahead or replay everything that's already happened, and that's where progress disappears the fastest.

So that's why I created the five minute commute reset for physicians. It's not to fix your job or to convince you to feel better about medicine. Just to interrupt that constant forward motion long enough to reset before you walk into work or through the door at home. It's a short five minute guided audio and a simple worksheet, just a small intentional pause built into a part of your day that already exists, and you can download it for free at betterphysicianlife.com/commutereset, and I'll link it in the show notes. 

So let's come back to where we started that feeling of being behind [00:13:00] that sense that nothing ever quite feels like enough. It doesn't mean you're failing and it doesn't mean you're ungrateful. It definitely doesn't mean you're on the wrong path.

Most of the time, it just means you've been looking forward for so long that you've lost sight of how far you've already come. You don't need to stop moving forward, but you do need to turn around once in a while because progress you never acknowledge doesn't actually help you move forward. 

Thank you so much for listening, and I'll see you next time on the Better Physician Life Podcast.