Why doctors and probably everyone else need work that belongs to them

Seeing patients all day was never my favorite way to use my skills.

Even writing that sentence feels strangely uncomfortable. Physicians aren’t supposed to say things like that. We spend more than a decade training to take care of patients. We sacrifice our twenties, accumulate debt, miss weddings, work nights, weekends, and holidays, and build an enormous amount of our identity around becoming a doctor.

So, once you finally become one, shouldn’t patient care be the thing that gives you the greatest sense of meaning and fulfillment?

Maybe.

But what if it isn’t?

And what if there is nothing particularly wrong with that?

One of Medicine’s Quiet Expectations

I enjoy psychiatry. I care deeply about doing good clinical work. I want the people I treat to get better.

But if you asked me what activities make me lose track of time, they usually aren’t the routine parts of clinical medicine. They are reading. Writing. Teaching. Going down an intellectual rabbit hole because I came across an idea I don’t understand. Reading an old psychiatry paper and wondering why we stopped thinking about the problem that way. Taking something complicated and figuring out how to explain it so another person can actually use it.

Those have always been some of the most meaningful parts of my life.

And for years, I almost felt guilty about that.

There is an unspoken belief in medicine that the ideal physician should receive nearly unlimited emotional and intellectual nourishment from direct patient care. Anything else can sound selfish.

You want to write? Fine, if you see your patients first.

You want to teach? Great, if it doesn’t interfere with productivity.

You want to research an obscure idea, create educational content, study philosophy, build something, or spend three hours thinking about a question nobody assigned you?

That’s a hobby. Get back to work.

Then I Heard Someone Say It Out Loud

Recently, psychiatrist Nassir Ghaemi described an idea during his commencement address to the 2026 Yale psychiatry residency class that immediately resonated with me.

He called it having a “night job.”

Your day job is the work you are paid to do. Your night job is the work that satisfies something deeper.

As Ghaemi put it: “Many people are dissatisfied because their day job doesn’t satisfy them emotionally or intellectually.”

That doesn’t necessarily mean your day job is bad. It means we may be asking far too much of it.

We expect a single profession to provide income, identity, purpose, intellectual stimulation, emotional fulfillment, social connection, prestige, and happiness. That is an enormous burden to place on a job. And when it inevitably fails to provide all those things, we conclude that something must be wrong.

Maybe we chose the wrong specialty. Maybe we are burned out. Maybe medicine has changed. Maybe we aren’t as dedicated as everyone else.

Sometimes those explanations are true.

But sometimes your job is simply your job. It can be important. You can be good at it. You can care deeply about doing it well.

And it still doesn’t have to satisfy every part of you.

The Night Job

The term “night job” is a little misleading, because this isn’t about staying up until midnight working on another project. It isn’t another version of hustle culture. The goal isn’t to finish a twelve-hour clinical day and then punish yourself with four more hours of productivity.

The night job is the parallel pursuit that belongs to you.

For me, that has meant writing, teaching, and creating — studying psychology, philosophy, neuroscience, and human behavior far outside the narrow boundaries of daily clinical practice. Trying to understand not simply what the treatment guidelines tell us to prescribe, but why people suffer, why treatments work, why they fail, and what we may be getting wrong.

And then taking those ideas and sharing them.

That’s a large part of why I created Shrinks in Sneakers. I wanted to talk about psychiatry the way clinicians experience it. I wanted to explain treatments without pretending the evidence is cleaner than it really is. I wanted to challenge conventional wisdom when the conventional wisdom didn’t make sense. And I wanted ordinary people to have access to high-quality psychiatric education without needing a medical degree to understand it.

Nobody assigned me that job. For most of it, nobody paid me.

I did it because I couldn’t imagine not doing it.

That’s the difference.

Your Greatest Work May Not Be the Work Someone Hired You to Do

This is the part I think young physicians need to hear.

Your career does not have to fit neatly inside your employment contract.

Medicine has become very good at defining our value through measurable units. Patients seen. Notes completed. RVUs generated. Charts closed. Quality metrics achieved. Those things may be necessary to operate a healthcare system.

But they are terrible measurements of a human life.

Some of the most important work you ever do may have no billing code. It may be the paper you write because an observation bothered you. The lecture you build because nobody ever taught the topic correctly. The student you mentor. The podcast nobody listens to for the first year. The book sitting half-finished on your computer. The research questions your institution doesn’t care about. Or simply the subject you study because understanding it makes you feel alive.

Your employer may never reward you for it. The world might not reward you for it either.

Do it anyway.

But there is a catch

There is one major problem with the night job.

Energy.

After a full clinical day, there isn’t always much left. This is where I think the idea needs an important modification:

Protect your best energy for at least some of the work that matters most to you.

Don’t automatically give your employer every productive hour you have and reserve whatever exhausted fragments remain for the things you supposedly care about most.

Sometimes that means writing before work. Reading for an hour in the morning. Blocking off an afternoon. Saying no to another committee. Doing slightly less of something that doesn’t matter so you can do more of something that does.

Ghaemi described doing something similar — stopping at a café before reaching the hospital so he could write while his mind was still fresh. That makes far more sense to me than glorifying exhaustion.

The night job shouldn’t shrink your life.

It should make your life bigger.

You Are Allowed to Be More Than Your Profession

Medicine has a strange way of consuming identity. First, you are a premed. Then a medical student. Then a resident. Then an attending. Eventually somebody asks who you are, and without realizing it, you answer with your specialty.

“I’m a psychiatrist.”

True. But incomplete.

I’m also someone who writes. Someone who teaches. Someone who creates. Someone who is endlessly curious about why human beings do the things they do. Being a psychiatrist gives me an extraordinary vantage point from which to explore those questions.

It doesn’t need to be the boundary around them.

Take your work seriously. Treat people well. Become excellent at whatever profession you choose. But you do not have to surrender the rest of yourself to your job.

Find the thing you would keep doing even if nobody put it on your performance review. Find the subject you read about when nobody assigned the chapter. Find the work that makes two hours feel like twenty minutes.

Then build some space for it.

Call it your night job. Call it a side project. Call it your life’s work. The name isn’t important.

What matters is recognizing that the work that pays for your life and the work that gives your life meaning do not have to be the same thing.

And maybe we would all be a little happier if we stopped pretending they did.

Psychiatry Unfiltered