**Introduction**
Upon my arrival in North Carolina several years back, I believed that happiness would easily follow. Having completed my medical training in Nepal, I was eager to contribute as a physician within the U.S. healthcare system, fueled by the enthusiasm of new beginnings. However, I soon understood that happiness is not guaranteed—especially for physicians navigating the complexities of American healthcare while trying to retain their sense of purpose.
The shift from practicing medicine in Nepal to establishing my career here was both a challenging and transformative journey. Back in my homeland, I could communicate fluently with my patients about their pain and grasped their cultural nuances. Here, I had to reconstruct not only my medical practice but also my entire strategy toward patient care and professional satisfaction.
As physicians, we frequently prioritize our patients’ well-being at the expense of our own. Currently, while managing my rheumatology practice, I have realized that enduring happiness is built on four interconnected foundations that I wish to share with fellow physicians in search of balance and significance.
**Faith: Discovering purpose beyond the prescription pad**
Faith—whether spiritual, philosophical, or simply a profound sense of purpose—has been my grounding force throughout my medical journey. My upbringing in Nepal infused my understanding of service with Eastern teachings. The principle of “dharma” from the Bhagavad Gita has been especially pertinent: engaging in righteous action without clinging to outcomes.
This philosophy has reshaped my approach to patient care. Rather than being primarily motivated by financial results or professional accolades, my focus is to dedicate myself entirely to serving each patient. When I encounter a young mother unable to cradle her baby due to rheumatoid arthritis, I’m not merely treating inflammation—I’m partaking in a greater purpose.
Incorporating mindfulness into my daily routine has become vital. Before seeing patients, I take a moment to center myself, reminding myself that each individual merits my full attention and compassion. This shifts clinical tasks from standard medical practice to significant service.
During those initial, often overwhelming days of establishing my practice—grappling with insurance intricacies, staff shortages, and financial instability—I consistently relied on that deeper sense of purpose. Timeless teachings about remaining composed through both success and failure shaped my entrepreneurial approach, enabling me to confront each obstacle with resilience. The administrative tasks—strategic planning, compliance, and financial management—evolved into an extension of my service, a necessary responsibility to ensure my practice thrived as a sustainable force for healing.
**Family: Redefining work-life integration**
As physicians, we frequently grapple with achieving work-life balance. The truth is, medicine is demanding, and achieving a traditional balance might be unfeasible. Instead, I’ve come to concentrate on work-life integration—harmonizing my professional calling with family values.
As a father of two and a husband to a woman on her own healthcare mission, I’ve realized that support from family is essential for a sustainable medical practice. My wife aspires to serve the Indo-Nepalese community by supporting new mothers. Witnessing her enthusiasm has taught me that thriving families in medicine often feature both partners pursuing meaningful work while backing each other’s endeavors.
Managing a medical practice while nurturing young children has enlightened me that “family” encompasses more than just blood relations. My patients have become an extended family—especially older patients who remind me of my reasons for entering medicine. My clinic team has also become family, as we collaborate with shared values and objectives. Family signifies any community of belonging that underscores the significance of your work beyond yourself and that you’re not isolated in the challenges of medical practice.
**Meaningful work: From employment to entrepreneurship**
The journey from being an employed physician to leading my own practice—Empowered Arthritis and Rheumatology Center PLLC—compelled me to reconnect with the deeper purpose of medicine beyond productivity measures and RVU goals. This reaffirmed why I chose rheumatology: the chance to profoundly enhance patients’ quality of life through comprehensive, compassionate care.
Launching my own practice enabled me to adopt a more patient-centered philosophy. I could spend adequate time with patients, engaging with their complete narratives, addressing not only physical symptoms but also their fears and aspirations. The business elements of the practice became acts of stewardship, ensuring this healing avenue remains viable.
I’ve discovered profound meaning in mentoring emerging physicians, particularly those from immigrant backgrounds, imparting strategies for upholding cultural identity while thriving in American healthcare. Guiding them to respect their values while delivering excellent patient care has emerged as another avenue of service. Meaningful work in medicine transcends clinical excellence—it involves establishing systems and relationships that enable you to practice medicine in the way you envisioned when you initially chose this career.
**Friends: The colleagues who sustain us**
Forging meaningful connections with colleagues—both within and beyond our specialty—is essential for our well-being and professional advancement. The early stages of establishing my practice were marked by isolation. Prolonged clinic hours, family commitments, and the demands of business management left scant energy for professional networking. I realized I was achieving clinical success but becoming professionally lonely.
Now, I am purposefully creating a network of physician colleagues who comprehend our unique challenges. Through medical associations and local physician groups, I’ve encountered practitioners who share similar values regarding patient care and professional integrity.