When the HMO Makes You Question Everything: One Doctor's Path From Burnout to Canada
What happens when a doctor who's loved medicine since she was seven years old starts dreading her own patient notes? That's the question at the heart of my conversation with Dr. Sarah Mauthe on this episode of The Interesting MD Podcast, and it's one that I think a lot of physicians in the United States are quietly asking themselves right now.
I'm Dr. Rob Beck, and in 2020 I left the United States after nearly a decade of practice to start over in Canada. That move changed how I think about medicine, money, and what a physician's life can actually look like. This week's episode continues my three-part series with Sarah, and if you haven't listened yet, I want to walk you through why her story matters — especially if you're a physician wondering whether the job you trained your whole life for is still the job you want.
The HMO Problem: When "Helping People" Gets Complicated
Sarah's story starts somewhere a lot of physicians will recognize. She signed a non-defamation agreement with her HMO before leaving her position — which, as I told her on the show, is never a good sign. She couldn't go into specifics, but she didn't need to. She described clinical scenarios that made her go home and question what she was doing, situations that stacked up — two or three of them — until she sat down and said, "I can't do this anymore."
What struck me most was how this bled into her personal life. She said she was "kind of willing to self-destruct to a certain extent," but it was watching the effect her unhappiness had on her husband that became the real turning point. That's a detail I think gets lost in a lot of burnout conversations — it's not just about the physician. It ripples out.
We also talked through how HMOs actually function, because I think a lot of listeners outside of healthcare don't fully understand the mechanics. HMOs receive a set amount of money per member per month, and that pool of money is what pays for care. Sarah described how certain "yearly wellness visits" were really just data mining — asking leading questions designed to add diagnoses to a patient's chart, which then drives up reimbursement. She said she'd look at a patient's problem list before a first visit and basically disregard half of it, because she didn't trust that those diagnoses were clinically valid.
I shared my own experience with this from working with Medicare Advantage patients — the pressure to code patients as sick as possible, sometimes turning a simple urinary tract infection into a chart full of heart failure, acute kidney injury, and sepsis just to drive up a risk score. It's not unique to one insurer. It's baked into the system.
"What Would 12-Year-Old Me Say?"
Here's the part of Sarah's story that I think is the most important, and honestly the most moving. She told me that when she was 12 years old, she took a job packing ice for a man who owned a bookstore — specifically so he'd give her free medical textbooks. When she was seven, and someone asked what she wanted to do with her life, her answer was simple: "I want to be a doctor."
She loved medical school when her classmates were miserable. She said it plainly: "I love this. This is great." That kind of love for medicine is rare, and it's exactly why her burnout hit so hard. She told me she started researching other paths — utilization review for insurance companies, legal consulting for malpractice cases — and kept hitting the same wall: "Wait, this wasn't the point of all of this. I didn't go through all of this schooling to go do legal testimony for medical malpractice lawsuits."
She even explored other clinical paths, getting her ABOM certification in obesity medicine and looking into menopause and lifestyle medicine. But eventually she realized those were just other ways of avoiding the real question: when am I the happiest? Her answer was the hospital. The real question wasn't whether she loved medicine — it was whether she could be happy practicing it where she was. The answer was no. And that was it.
Running Toward Something, Not Just Away From It
One thing I try to be intentional about on this show is the difference between running away from a broken system and running toward something better. A lot of American physicians I talk to are trying to escape politics, corporate medicine, burnout — and I understand that completely, because I was one of them too.
But Sarah said something that stuck with me: it felt a little like running away rather than running toward something, because she didn't fully know what she was running toward until she actually got to Canada. Now, looking back, her reaction is "why didn't I do this five, ten years ago?"
She also pointed out something important for American physicians considering this move — she had it easier in some ways because she's Canadian and had some early exposure to the system. But she didn't want that to discourage her American colleagues, because the unfamiliarity of a new system can feel overwhelming even when the current system isn't working for you. There's comfort in knowing how something operates, even when what it operates is making you miserable.
She also raised a fair point about the stakes being different for American physicians — they can change their minds and go back. For her, coming to Canada meant surrendering her green card, a final decision. That's worth sitting with if you're weighing this move yourself.
The Takeaway
Sarah's story isn't really about Canada. It's about the moment a physician realizes the job in front of them doesn't match the person who took an ice-packing job at twelve just to get her hands on medical textbooks. If you're a physician in the United States feeling that same disconnect — if you've caught yourself researching utilization review jobs or legal consulting gigs just to escape clinical medicine — I'd ask you the same question I asked Sarah: what would your twelve-year-old self say?
If any part of this resonates with you, I'd genuinely like to hear from you. Reach out to me at rob@interestingmd.com, or send me a message through the socials. There are more physicians reaching out and talking with me about this every week, and I'm happy to share what I've learned.
Stay tuned for part three of this series next week, where Sarah and I talk about the actual move and what life in Canada looks like on the other side of the decision.