Some Work Gives You Energy. Some Work Makes You Browse Remote Cabins on Zillow.

This may not be only for doctors, but I suspect many of them will recognize themselves in it. Some work energizes us. Some work is hard, but satisfying. And some work is nervous system sandpaper.

It may not look dramatic from the outside. It may be ordinary, necessary, even small. The inbox. The scheduling changes. The “quick questions.” The daily triage. The tiny decisions that never stop arriving.

You may be good at it. You may be trusted with it. You may even be the person everyone relies on to keep it moving. And still, it can wear you down. That doesn't mean you're failing. It may mean the work no longer fits how you are built.

I've been thinking about this a lot lately because I'm in the middle of making changes in my own work. Not because I dislike work. Not because I'm no longer capable. Not because I have stopped caring.

Quite the opposite.

As as begin to prepare for semi-retirement, I'm noticing more clearly which kinds of work use my brain in a way that feels steady, focused, and satisfying and which kinds leave me feeling scattered, braced, and depleted. (Semi-retirement means I'll still be working but on a project basis. I'm not vanishing!)

I love systems work. I love workflows, intake logic, automations, EHR buildouts, and the kind of problem-solving that lets me sit quietly with a process and make it cleaner. That work energizes me.

What drains me isn't complexity. It's interruption. It's too much triage. It's the invisible emotional labor of holding too many people, details, decisions, and loose ends in motion at the same time.

That's nervous system sandpaper.

And many medical practices are full of it. Doctors know this better than almost anyone. I've observed that some physicians didn't burn out because they stopped caring about patients. They burned out because the work became crowded with things that repeatedly pull them away from the part of medicine they're actually built to do.

Messages. Refills. Portal questions. Prior authorizations. Scheduling confusion. Documentation. Follow-up loops. Forms. Lab tracking. Staff questions. Patient expectations. Inbox archaeology.

Some of this work matters. Some of it's unavoidable. But when too much of it lands on the wrong person, in the wrong format, at the wrong time, with no clear system around it, it becomes abrasive. Not all at once. Not dramatically. But steadily.

It sands down patience.

It sands down creativity.

It sands down the ability to think clearly.

It sands down the part of you that used to feel capable.

The question is not, “How do I become the kind of person who can tolerate unlimited friction?” The better question is: What am I doing every day that repeatedly scrapes against how I’m built? That question matters because we often mistake capacity problems for character problems.

We tell ourselves we should be more disciplined. More efficient. More resilient. More grateful. Better at multitasking. Less bothered by interruptions. Less annoyed by this and that. Less tired after work that “shouldn’t be that hard.” But sometimes the issue is not attitude. Sometimes the issue is fit.

You can be excellent at work that is still wrong for your nervous system.

You can be competent at tasks that still cost too much.

You can be the obvious person to handle something and still need to ask whether it should belong to you at all.

That is especially hard for capable people. Capable people become the default container for broken systems. If you can solve it, it comes to you. If you can tolerate it, it stays with you. If you can keep the wheels on, no one notices that you are using your own energy as the duct tape. Until one day, you notice.

You notice the dread before opening the inbox.

You notice how quickly your brain feels crowded.

You notice that small tasks feel strangely heavy.

You notice that you are not less skilled, less caring, or less intelligent. You're overloaded.

That noticing isn't weakness. It's data. So what do you do with it?

Start by naming the sandpaper.

Is it the inbox?

The refill process?

New patient screening?

Follow-up scheduling?

Lab review?

The intake packet?

The “where does this go next?” decisions your team asks all day?

The work may be necessary, but that doesn't mean it has to remain messy. Once you name the friction, you can stop treating it like a personal failure and start treating it like a workflow problem.

Some things can be delegated.

Some things can be automated.

Some things can be batched.

Some things need clearer rules.

Some things need better forms, better templates, better routing, or better boundaries.

Some things simply need to stop landing on the person whose brain is already carrying too much.

This isn't about making work effortless. Meaningful work is often hard. Clinical work is hard. Business ownership is hard. Leadership is hard. But hard work and abrasive work aren't the same thing. Hard work can leave you tired and satisfied. Abrasive work leaves you raw. That distinction matters.

When work fits how you are built, you may still need focus, time, and recovery. But there's a steadiness to it. You can feel yourself using the right part of your brain. You can stay with the problem long enough to solve it. You can trust yourself.

When work doesn't fit, every interruption feels louder. Every decision feels heavier. Every open loop takes up space. You may still get it done, but the cost keeps rising.

For physicians, practice owners, and anyone carrying too many operational loose ends, this is worth asking:

• Where does my work give me energy?

• Where does it drain me?

• What am I tolerating only because I am good at tolerating things?

• What would become easier if the system were cleaner?

The goal isn't to eliminate every unpleasant task. That's not real life, and it's definitely not real medicine. The goal is to reduce unnecessary abrasion. Choose work that fits how you're built when you can. And when you can't, build systems that protect you from the sandpaper.