Medicine as your Second Life: What happens when the game ends?

Medicine is what we do. In retirement it is or will become what we did. How will you handle the transition to a non-physician identity?


In 2003, Linden Lab, a company in San Francisco, released a multiplayer online game called Second Life. At its peak in 2013, it had 1,000,000 active players and as of 2017 had 800,000-900,000 active players. In January of 2008, players spent over 28 million hours actively engaged in game play, and around the same time, an average of 38,000 people were logged in on an average day.

A host of issues sprang up related to content, but many related to users spending more time involved in their virtual lives than they did engaged in their actual ones. The attraction of the game was that it allowed one to create a life they chose, a life they wish they had, for want of a better phrase.

Those who play the Second Life game create their own characters, known as avatars. In a wry twist, players are known as “residents” and, when engaged in play, one is said to be “in-world.”

See where I’m going with this?

Practicing medicine: Your Second Life

In 2021, there were nearly 145,000 residents actively training in the U.S. In 2020, there were more than 1 million actively practicing physicians. Medical school enrollment approached 95,000. That’s a lot of players. And in one way or another, they are all “in-world,” usually for more hours or days than they are not.

Medicine is our Second Life. Doctor [surname here] is our avatar. The number of hours we spend actively engaged in playing the game is staggering. But what happens when we unplug, have our plug pulled, or our career hard drive crashes due to an accident or a disability?

The idea of our professional personas as avatars is particularly intriguing. How many of us can separate our avatar from our actual self? How many of us simply remain our avatar even when we’re not in-world? How many of us simply can’t log off?

Late career and retirement raise all of these questions. When you’ve spent most of your waking life (as well as a lot of your sleeping one) being your avatar, who are you when the screen goes dark? What happens when your “credentials” no longer allow you to Sign In?

The challenges of leaving medicine

I’ve known colleagues who didn’t seem to have a persona outside of their professional one. They were Dr. X 24 hours a day, every day, every month, every year. They took journals with them to read on family vacations and called in from the exotic destinations where they had “escaped” to.

As the insidious reach of digital medicine and the Orwellian EMR has grown, the line between in-world and the real world has blurred even further. This makes, or will make, “leaving it all behind” all the more difficult.

Some describe retirement as shedding a skin – but when that happens in nature, the shedder still looks pretty much the same. If you have a true dual identity (doctor v. nondoctor), you’ve got a fighting chance.

I’ve had colleagues who haunted the hospital wards until the wee hours of the morning. Visiting patients just to check on them – often awakening the patient to make sure they knew how dedicated they were and how much they cared. They much preferred being in-world over the alternative.

They chose the Second Life over their First. Read the comments of people who became “addicted” to Second Life and see if you don’t spot the similarities.

 But why? Why would you spend twenty hours a day roaming the halls if you didn’t have to? Why would one choose their second life over their first?

The appeal of fulfillment

I think the answer is fulfillment. A hospital is a veritable Black Hole of need. The patients need you, the nurses need you, and the administrators (though they won’t admit it) need you. And when you meet that need, you are rewarded with love in return.

And who doesn’t want the love? It flows pretty freely at 3 a.m. and it feels better than an unhappy spouse or a teething child or a mouthy adolescent. Put on your white coat and you can be an emotional vampire, going room to room after sunset, slaking your thirst for validation. Dedication can be just another word for escape.

There are solutions. You can just keep working, returning again and again to that bottomless font of need and drinking your fill.

You can try to stay plugged in – going to dinner meetings, hanging about the office or the hospital or the doctor’s lounge telling war stories and basking in the experience and the camaraderie. You can loiter around the clubhouse for a long time after you’ve quit the game and they won’t ask you to leave.

Or …

Investing in your First Life

You can start reinvesting now in the value of your First Life. Before the plug comes out, the CPU fries and the screen goes black. Medicine is what we do. In retirement it is or will become what we did. If we allow it to become what we are to the exclusion of all else, then we’ve allowed something truly bad to happen to us.

If you’re young or in mid-career, look around at your senior colleagues and see if any of this makes sense. If you’re in late career or facing impending retirement, take stock of what lies ahead and not what you must leave behind.

I miss a lot of things about practicing – the mostly wonderful people I worked with, the teamwork, the pure satisfaction of doing good for others and the sense I spent my professional life improving the world. But I never look back or pine for the past.

I never wish I was operating again. I look at the phone every night before bed, ecstatic that it is not going to ring; overjoyed that no one is going to need me.

We all began this journey with a First Life – a real one. As we approach our professional endpoint and the sudden evaporation of our avatar into a million little pixels, the secret to future happiness and success lies in making sure that our First Life is still there. And that is something we can work on preserving throughout our careers.

I’ve been out for two-and-a half years as of this writing. Whenever someone asks, “Say, aren’t you the heart surgeon?” my now-practiced reply is, “I was the heart surgeon. But that was another life.”

After a long career of helping others, that’s what we all deserve – another life.

Next time: Disability and Unplanned Retirement: Do You Have a “Go-Bag” Packed?”

Related reading:

Retiring from medicine: The best of times or the worst of times?

This hobby helps me cope with my grueling medical training


  1. Dipak D Nadkarni

    Thank you for the article.
    I have spent over thirty years in medicine as a Family Physician and retired as a senior Naval officer last year.
    I dipped my toe in the civilian setting but it was different.
    Good people for sure but the comraderie was not there.
    So I have now opted for my next career in the political realm.
    I am currently running for the Florida House in Tallahassee, FL.
    It is new and I find excitement in my new found compassion.
    At nearly the age of 62 I am not sure if I will continue in medicine in the future.
    I will let you know how it goes by the end of this year.
    It is District 59 which includes parts of Clearwater, Largo, and Seminole.


    Dipak D. Nadkarni, DO
    CAPT(ret) MC USN

  2. Patrick Aufiero MD

    After 30 plus years of ID, I decided time to retire, I am solo,
    so no one to pass practice onto, no one to take over, no group or hospital willing to buy practice, as most new MD’s want to work
    only for paycheck, and not start their own practice. Too much headache
    The other groups want the patients though, at no cost to them
    so i have referred all the ID patients to other groups
    I will miss the interactions, friendships, colleagues
    Patient was always first, now with the business of medicine
    Patient is way down the list
    Profit is motive, not patient care
    very sad indeed
    Private practice is thing of the past

  3. David cooper

    I’m an orthopedic surgeon retired from surgical practice after about 40 years. What am I most proud of? That I never lost a patient after surgery to infection or blood clot, or some other acute event. But an office practice is still fun and a lot less stressful and a lot less malpractice insurance.

  4. Robert Fedor DO

    I retired by nonrenewable of my medical license 2/2222. Fortunately I still have family and friends to fill the void.
    What finally drove me out of medical practice were the anti-vaxers.
    I wrote an essay that explains it all. I will release it soon.

  5. Abraham M Jeger, PhD

    Brilliant, creative, and super humane! I’m in the process of planning my second retirement….both as educators, and not as all-consuming as a medical practice. Fortunately, who I am was never substantially defined by what I did for a living!

    1. Suzanne Sumida MD

      Thank you for your insight. Your articles are helping me process a painful reality. As I approach retirement I struggle with who I will be if I’m not the “doctor”. Too much of my identity has become wrapped up in my Second Life. Hard to let go but I am preparing my parachute and weaning myself from my avatar!

  6. Thomas Holthus

    I enjoyed your insight in this & your other article. I retired April 2020 after 33 years in Family Medicine in Virginia (plus other years in Army) where did it all (except OB in Army reserves & going solo in 2000). I didn’t really have any outside likeminded mentoring physician contacts so it’s helpful to read insightful articles like yours since a large part of retirement can be ‘what to do next?’ And loss of the purpose that gave us a drive each day. So that’s why I call it ‘re-purposing’ as I look….

  7. Thomas A. Bragg, D.O.

    I have been a physician now for 44 years and have recently kind of retired and now work only 3 days per week. It gives me ample time to do some other things besides work all of the time (used to work at least 80-90 hr per week). Might still be doing that but I spent most of my career in solo practice and that has died.

Leave a comment Please see our comment policy