You try something outside your usual routine, maybe it's a leadership role, maybe it's a new practice model, or a side project. Maybe it's finally starting the thing you've been talking about for the last two years. At first, there's a ton of energy. You block the time, you take a meeting, you sketch out the plan.

You start to see a path. And then, the early results, well, let's just say they're underwhelming. The meeting doesn't go anywhere. The proposal gets a polite, "We'll circle back." The numbers just don't work yet. The person you hoped would be interested is not interested, and your schedule fills back in. The project starts to slide to the edge of the week, and the momentum starts to shift.

And because you're a physician, the conclusion shows up pretty quickly. Maybe this was not realistic. Maybe I'm not built for this. Maybe I should just stay in my lane. And that is the hardest part. Not the setback itself. It's what we make that setback mean.

Hey, everyone, and welcome back to another episode of the Better Physician Life podcast. Thank you so much for being here today. So this is gonna be the final episode in our summer series on books that have shaped how I think about physician life and work. And if you haven't listened to the last four episodes, don't forget to circle back to hear about those other phenomenal books.

The book I want to talk about this week is Think and Grow Rich by Napoleon Hill. Now, that title can sound a bit dated, and I will admit parts of the book feel very much like the era it came from. It was not the easiest of reads. But there is one story in that book that has really stuck with me, and it is the story of R.U. Darby and Three Feet From Gold. 

The story goes like this: Darby and his uncle went looking for gold during the gold rush, and they found some. Not enough to be done, but enough to believe they were onto something. So, they kept going. They raised money. They bought equipment. They dug deeper. And then, the vein, it disappeared.

They kept working for a while, but nothing happened, and eventually they gave up. They sold the equipment to a junk dealer and walked away. The junk dealer brought in a mining engineer who looked at the site and realized what had happened. The gold vein had not ended, it had just shifted.

He dug a few feet in a different direction and found gold. A lot of it. Darby had stopped three feet from it. Now, the usual point of the story is simple: don't quit too soon. And there is some truth in that. But I want to be really careful with that because most physicians do not need a speech about persistence.

We are experts at it. We persisted through college, medical school, residency, boards, call, and years of delayed gratification. We know how to keep going. That is not usually the problem. The more interesting question is what happens when we are trying to build something where the path is not clearly marked.

Medicine gives us a fairly structured track early on. Study, take the test, apply, match, train, pass boards, get the attending job. It's not easy, but the next step is always visible. Very clear. But later on in our careers, the questions get much less structured. Should I pursue leadership? Should I change jobs? Should I negotiate my schedule? Should I build something outside the exam room? 

There is no match algorithm for that, no program director telling you the next right move, no clean metric that says you are on track. And when the early feedback is messy, most of us do the same thing. We turn a poor first result into a permanent verdict.

The idea was bad. I'm not qualified. This isn't worth it. And sometimes that is true. Sometimes stopping is the right decision. But the Darby story pushes back on that. Sometimes the goal is not wrong. Sometimes we're just reading the situation wrong. Sometimes an early obstacle is not the final answer.

It's just information. A physician applies for a medical director role and doesn't get it. The first conclusion might be, "They don't see me that way." Maybe, or maybe the right people didn't know their name yet, or maybe they didn't have enough committee experience. Or maybe they couldn't speak administrator as fluently as they speak medicine.

A physician tries to negotiate a four-day workweek and gets told, "Well, that will be hard with access." The first conclusion might be there is no flexibility here. Maybe. Or maybe they hadn't made the right case yet. Maybe they hadn't run the numbers. Maybe they hadn't figured out how to structure four days in a way that actually protects access and their time.

A physician starts a consulting project, and the first conversation goes nowhere. The first conclusion might be, "Nobody wants this." Maybe. Or maybe the offer was too vague. Maybe the audience was wrong. Maybe they were talking about the clinical problem when the person across the table only cared about the business problem.

That is not motivational. That's practical. Darby did not fail because he lacked a work ethic. He failed because he did not understand the terrain. He needed someone who could read the fault line. In clinical medicine, we accept this without thinking twice. If a patient is not improving, we do not conclude the entire plan is wrong.

We reassess. Is it the wrong dose? The wrong diagnosis? Do I need to consult with a specialist? Do I just need to give this more time? We are comfortable with that process in the exam room. But in our own careers, we tend to jump from a poor early result to a personal verdict. That did not work, so maybe I should just stop.

Sometimes, yes, but not always. Sometimes the better question is, what exactly didn't work? Was the plan incomplete? Was I talking to the wrong person? Was I expecting attending-level competence in something I've only been doing for six months? That last one is so common. Physicians are used to being good at things.

Then we step into a new arena and forget what it feels like to be a beginner. Leadership, business, negotiation, consulting, practice ownership. These are skill sets, and skill sets feel clumsy before they feel natural. You feel it when you finally get home after clinic, get through dinner, get the kids to bed, and sit down to work on the thing you've been trying to build.

It's 8:30, maybe nine. You're already tired. You open the laptop and stare at a document that doesn't look much different than it did three weeks ago. The idea that felt so clear on a Saturday morning feels a lot fuzzier on a Tuesday night after a full day of work. So the easy conclusion, you know it, the thought that shows up when you're tired, and you're questioning why you even started this in the first place, just go back to what you already know.

Medicine is stable. The paycheck is real. The role is clear. And medicine will pull you right back in if you let it. But 10:00 PM on a Tuesday night after a full day of clinic is a terrible time to make a permanent decision. One thing worth separating here is exhaustion from evidence. Because physicians often evaluate big decisions when they are tired, late at night, after a full clinic day, after a rough call weekend, after a disappointing meeting.

In that state, everything feels more final than it probably is. This is never gonna work. But that may not be evidence. That may just be fatigue. A bad week on call can make any career question feel impossible. A single no from administration can make a whole idea feel naive. So, before you conclude the vein of gold is completely gone, is this truly not working?

Or is the plan still incomplete? In medicine, we know the first explanation is not always the right one. Careers work the same way. Darby didn't need to swing the pickaxe harder. He needed a better read on the ground. Physicians often respond to stalled progress by working harder, staying later, trying to force the result, and sometimes that actually works.

But sometimes the next move isn't more effort. It's a better question. Who has already done this? What did I miss? What does the next attempt look like if I actually know what I'm doing? Because most physicians don't stop exploring new directions because they lack ability. They stop because the first attempt felt humbling, because the schedule crowded out the experiment, because it's a lot easier to be excellent at something you've been doing for fifteen years than to be a beginner at something you've only been doing for six months.

And there is nothing in medical training that prepares you for being bad at something that's important to you. But there is a cost to letting every early attempt die quickly. Not just a lost opportunity, another year in the same structure, the same inbox, the same compensation model, the same call schedule, the same quiet thought that maybe there's a different way to practice, but no clear space to test it.

That is how a career gets narrower without anyone meaning for it to happen. Not from one big decision, but from a hundred small decisions that each felt completely reasonable at the time. You stop asking, you stop exploring, you let the clinical schedule reclaim the time. You tell yourself it probably wasn't realistic anyway.

And sometimes that conclusion is right, but sometimes the idea didn't need to be abandoned. It just needed a cleaner experiment, better information, a more honest look at what actually went wrong. And that's hard to do alone. It's hard to do in the five minutes between patients. It's hard to do at night when you're already exhausted.

It's hard to do when every option feels like it creates another problem somewhere else, which is exactly why most physicians never really do it. They just let the clinical schedule fill back in, and the idea quietly disappears. And physicians understand this process. We don't change a treatment plan because one data point made us uncomfortable.

We look at the trend, we look at the context, we decide the next reasonable step. A career deserves the same kind of honest reassessment because the real question here is bigger than any single project. It's about how you want to work, what you want the next ten years to actually look like, what you're building beyond just getting through the next clinic day.

And those questions are almost impossible to think through clearly when you're that deep in it. Tired, frustrated, questioning why you started in the first place. You can feel the fatigue, you can count the hours, but you can't always tell whether you're done or just three feet away. What Darby needed wasn't more effort.

He needed someone who could read the ground differently, someone who could look at the same situation and see what he was missing. If that's where you are right now, something you've been trying to build, a first attempt that didn't go the way you hoped, a direction that still feels worth exploring, but you're not quite sure what the next move is, you don't have to figure that out alone.

Those are exactly the kinds of conversations I have with physicians, and you can learn more at betterphysicianlife.com.

Because sometimes stopping is the right call. And sometimes you just need someone who can help you read the ground and figure out whether you're three feet away or whether it's time to dig somewhere else entirely. 

Thank you so much for being here today, and I'll see you next time on the Better Physician Life podcast.