Why I Quit Medicine and Became a Consultant

Why Zach Highley Left Internal Medicine

Zach Highley explains why he left internal medicine after one year of residency and chose management consulting. His decision reflected a mismatch between clinical medicine and his interests, as well as the belief that consulting could help him explore business and healthcare while keeping future career options open.

Career Decision Framework

He compared career paths using three criteria:

• Financial outlook: How quickly each option could provide income and its longer-term earning potential.
• Curiosity and learning: Whether the work would hold his interest and expose him to new fields.
• Life outside work: The time and flexibility available beyond the job.

Consulting ranked especially well for learning and optionality. He expected it to expose him to healthcare technology, pharmaceuticals, private equity, hospital systems, and other industries—useful breadth while he was still unsure what to pursue long term.

Career Paths He Considered

• Venture capital: Invest in early-stage companies using funds entrusted by investors. Returns depend on selecting successful businesses. He described the model as involving management fees and a share of investment profits.
• Consulting: Help organizations solve a wide range of problems—for example, helping a hospital reduce the time patients wait to see a doctor.
• Startups: Take on varied responsibilities in a small company, with greater risk but potentially significant upside. Examples included developing a glaucoma drug or a brain implant to treat seizures.
• Established companies: Work within a larger organization’s core product or service and build deeper specialization.
• Entrepreneurship and independent work: Gain autonomy, while potentially making it harder to transition later into a large company.

Business and Career Insights

• Consulting as a learning platform: He chose consulting partly for the opportunity to work across companies, sectors, and business problems while preserving more future options than a narrow specialization might.
• Indirect impact in healthcare: He came to see that business, investment, and consulting roles can contribute to patient outcomes without direct clinical care. Examples he cited included helping develop vaccines, reducing hospital stays and medical errors, and funding research and clinical trials.
• Follow incentives: He advises examining the incentives behind career guidance and institutional messaging. He felt medical training institutions emphasized residency without clearly explaining nonclinical options.
• Talk to practitioners: Informational conversations helped him learn what jobs actually involve, what qualifications they require, and how people found their way into them. One contact introduced him to others, expanding his network and exposure to possible paths.
• Test assumptions rather than follow convention: He cautions against choosing a career simply because it is the standard route, and against letting past investment in a path dictate future decisions—the “sunk cost” trap.
• Optimize for fit and contribution: His working principle is to find work that genuinely interests him, develop unusual strength in it, and create value for others.

Experience and Current Status

Highley moved to New York after receiving an offer from what he described as the best firm in the city. At the time of recording, he had been in the job and city for about one month. He found the work interesting and educational, but the combination of a demanding job and a busy city felt overwhelming.

He estimated working 12–15 hours per day, Monday through Friday, with weekends off. He planned to reassess how the arrangement felt over the next 3–5 months. He said he had spent about a year exploring alternatives before landing the consulting role.

His decision also reflected his financial circumstances. He said his family had paid for his education, he had no education debt, and income from YouTube, his book, and other work gave him additional flexibility. He stressed that this made his situation unusually fortunate.

Metrics and Figures Mentioned

These figures are as stated or recalled in the video; some were presented as rough estimates rather than verified statistics:

• About 900 conversations and roughly 1,000 new LinkedIn conversations are mentioned, though the subtitle wording is unclear and may be imprecise.
• He recalled that around 70–80% of Stanford medical/business students and 30–40% at Wharton do not go into residency. He explicitly said he could not recall the figures precisely.
• He described staying in medicine as potentially requiring another 6–8 years of training before reaching higher earnings.
• He discussed the possibility of income increasing substantially over 6–10 years in some nonclinical careers, without giving specific salary figures.
• In describing venture capital, he referred to aiming to outperform a typical market return of roughly 8–10%.

Practical Recommendations

1. Speak with people already doing the jobs you are considering. Ask about their day-to-day work, motivations, and career paths.
2. Compare options across money, genuine interest, and lifestyle—not just prestige or the expectations of others.
3. Investigate less-visible career routes, especially when an institution or profession presents one path as the default.
4. Consider whether a role builds transferable skills and preserves future choices.
5. Try plausible alternatives and reassess based on experience rather than committing indefinitely based on assumptions.
6. Treat “I should do this” as a prompt to examine whose expectations are driving the decision.

Presenter and Sources Mentioned

Zach Highley is the presenter. He names Steve Jobs, Naval Ravikant, and Paul Graham as people whose ideas influenced his thinking about curiosity and finding work that feels intrinsically engaging.