In this article (part one of a two-article piece), I, Erin Nissen Castelloe, a woman who has worked almost twenty years as a doctor, first in the practice of Family Medicine and later as a Pharmaceutical Medicine consultant, ponder the next phase of my career. In an attempt to understand myself and my experiences in medicine -and to connect with others who may share my belief that medicine (and those who practice it) must evolve in order to empower and serve -I share my personal story: the influences and idealism that led me to medicine; the best career advice I ever received (from a patient, not a doctor); my past and present frustrations with clinical medicine; my struggles to balance my personal and professional aspirations; my growing dissatisfaction with a career in Pharmaceutical Medicine; and, ultimately, my attempts to collect, sow, and cultivate ideas that may -nurtured with tinctures of time and collaboration -become strong, new branches on the magnificent tree of medicine. Conflict of interest: Erin Nissen Castelloe works as a paid pharmaceutical medicine consultant to several drug-development companies; she does not own or accept stock (or stock options) from any drugdevelopment company for which she works. Erin Nissen Castelloe also works in health education and pro bono patient advocacy.

In this article (part two of a two-article piece), I, Erin Nissen Castelloe, meditate on long-standing frustrations originating from my personal experiences in clinical medicine. My exit from clinical medicine can most succinctly be attributed to burnout, burnout triggered by inadequate time to address my patients' needs and complete the tasks mandated by the healthcare delivery system in which I worked. Self-and system-imposed pressures to meet my professional obligations led to chronic overwork, reduced personal time, sleep deprivation, exhaustion, and ultimately, recognition that my work situation was unsustainable. For more than ten years, I have questioned my decision to leave clinical medicine, hashing and rehashing the circumstances leading up to it. I am ready to let go of the questions that have haunted me, but I want to do so deliberately, considering them carefully before I release them. Therefore, with high hopesto understand my past, accept it, and move boldly into my future in medicine -I searched the literature, focusing on burnout in physicians and physicians-in-training; the role of time pressures in burnout; and the value of physicians spending adequate and high-quality time with patients. Conflict of interest: Erin Nissen Castelloe works as a paid pharmaceutical medicine consultant to several drug-development companies; she does not own or accept stock (or stock options) from any drug-development company for which she works.Acknowledgements: With humble thanks to the family, friends, and colleagues who reviewed drafts of this manuscript and the ideas therein.

To organize work in such a manner that it becomes meaningless, boring, stultifying, or nerve-racking for the worker would be little short of criminal; it would indicate a greater concern with goods than with people, an evil lack of compassion and a soul-destroying degree of attachment to the most primitive side of this worldly existence. E. F. Schumacher, Small Is Beautiful: Economics as if People Mattered And don’t make the mistake of calling us resilient. To not have been destroyed, to not have given up, to have survived, is no badge of honor. Would you call an attempted murder victim resilient? Tommy Orange, There There (...)