“Something More” – The Spiritual Limits of Perfect Practice
*”Five years and there’s no doubt that I’m burned out. I’ve had enough…”*
The opening lines of Sugarland’s “Something More” could be the internal monologue of countless physicians scrolling through job boards at 2 a.m., finally ready to walk away from the soul-crushing machinery of modern healthcare. The song captures that crystallizing moment when the cost of staying becomes unbearable, when the realization hits that life is finite and we’re spending it in ways that feel meaningless. This restlessness, this sense that there must be something more than the endless cycle of productivity metrics and insurance denials, drives many physicians toward DPC. They stumble on a colleague whose “life has never been better since switching to Direct Primary Care”, read a news article showcasing a new practice whose smile extends from ear to ear, or attend a CME and decide to attend a lecture about Direct Primary Care rather than another soporific, monotonous, and impractical “mindfulness” session….ah, DPC, there’s the solution! And why shouldn’t it? The promise is intoxicating: meaningful patient relationships, practice autonomy, medicine as it was meant to be practiced.
On the return trip, that Sugarland song pops up on Spotify, Apple Music, or whatever streaming app you use, followed closely by U2 and Creed (I know, strange combination).
U2’s “Where the Streets Have No Name” paints a picture of transcendence, of reaching a place beyond artificial boundaries and divisions. For burned-out physicians, DPC can feel like that mystical destination—a place where the barriers that prevent authentic healing simply don’t exist. No more insurance hassles. No more seven-minute visits. No more choosing between what’s right for the patient and what the system demands.
Creed’s “Higher” offers a similar vision—a dreamlike realm where “troubles seem so very far away,” where everything is peaceful and fulfilling. Read the testimonials of DPC physicians, and you’ll hear echoes of this promise: finally practicing “real medicine,” finally feeling like a doctor again, finally finding that elusive professional satisfaction.
The Seductive Escape
These songs speak to something deep in the human psyche—our longing for a place where struggle ends, where all the things that create suffering simply disappear. DPC becomes our “higher place,” our street with no name, our escape from the weight of practicing medicine in a broken system.
There is some truth in this promise. DPC often provides more meaningful patient relationships, greater autonomy, and relief from many of the systemic frustrations that drive physician burnout. But here’s where we must tread carefully into deeper philosophical waters.
The Persistent Restlessness
What happens when physicians make the leap to their promised land and discover that some of that restlessness, that sense of “there must be something more,” persists? Not because DPC isn’t better—it often is—but because the human search for meaning runs deeper than any practice model can satisfy.
Even in the most idyllic DPC practice, physicians still face:
• Patients who suffer despite our best efforts
• The limits of medical knowledge and our own capabilities
• The weight of responsibility for others’ well-being
• Our own mortality and the mortality of those we serve
• The fundamental questions about purpose and meaning that drew us to medicine
• Excessively demanding patients
• A sense of entitlement from a subset of patients
• Noncompliance of patients who expect you to wave a magic wand that eliminates all their ills
Beyond the Perfect Practice
The spiritual trap is believing that changing external circumstances will resolve our internal restlessness. DPC can be a more authentic way to practice medicine, but it doesn’t eliminate the existential challenges inherent in being human healers in a world full of suffering.
The physician who leaves traditional practice seeking that “something more” may find improved work-life balance and greater professional satisfaction. But they may also discover that the deepest sources of angst—the encounter with human limitation, the mystery of suffering, the search for meaning in the face of mortality—travel with them.
The Real Work
Perhaps the “something more” we’re seeking isn’t found in any particular practice model, but in learning to be fully present with whatever arises—including our own ongoing dissatisfaction and longing. The real spiritual work may be finding meaning not in the absence of struggle, but within it.
This doesn’t diminish the value of DPC or other practice innovations. Rather, it places them in proper context: as potentially meaningful steps in a longer spiritual journey, not as final destinations that will resolve our deepest questions about purpose and fulfillment.
The Invitation
DPC can offer a clearer path to engage authentically with both the joys and sorrows of medical practice. But the ultimate “something more” may be the recognition that our restlessness itself is sacred—a sign that we’re asking the right questions about what it means to be healers in an imperfect world.
If you find yourself drawn to DPC—pursue it wholeheartedly. If it offers you a more genuine way to practice medicine, embrace it completely. However, don’t mistake it for the ultimate solution to your deepest desires. That profound work occurs in other realms: in houses of worship where you confront questions that transcend medicine, in quiet moments of prayer or meditation where you remember your true self is greater than your profession, and in communities of faith where your worth isn’t defined by patient outcomes or practice success.
The restlessness that compels us toward “something more” is itself a form of prayer—a recognition that we were created for purposes beyond the material world. Whether you find that in a sanctuary, a synagogue, a mosque, or in the cathedral of nature, tend to your soul with the same dedication and care you bring to your practice.
DPC may give you back your joy in medicine. But only the sacred can give you back your joy in being human.
The invitation isn’t just to practice differently—it’s to live differently, to remember that you are a soul who happens to practice medicine, not the other way around. That recognition, more than any practice model, might just be the “something more” you’ve been searching for.
*With gratitude to Sugarland, U2, and Creed for songs that capture the universal human longing for transcendence, and to the direct primary care movement for creating space for more authentic practice—while acknowledging that the deepest work remains an inside job.*
Perfectly said.