A Doctor’s Reflection on a Life of Service

By: Brian Hoeflinger, MD

June 1, 2025 | #49

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Disclaimer: Opinions are my own. Not medical advice.

Medical Trivia of the Week

During medical residency in the U.S., what is the maximum number of work hours allowed per week by ACGME regulations? (the correct answer is at the end of this email)

A) 80 hours
B) 90 hours
C) 70 hours
D) 100 hours

My Career as a Physician

From the early years of medical school, I was taught that the patient always comes first. There was no talk or priority placed on taking care of yourself. It was never even mentioned. You are programmed to keep pushing forward for the greater sake of the patient, even to the detriment of your own health. It’s not that you’re directly told to ignore your own needs. The subject of you simply isn’t part of the conversation.

You needed to look strong at all times because any sign of weakness was frowned upon. If not spoken, the undertone was always clear: You are there to serve (and learn, of course). Even when sick, you still went to work and took good care of your patients.

That was the culture I was brought up in while becoming a doctor. And I can’t say it was all bad. It gave me a sense of purpose and pride to push through my own problems to help others with theirs. You become this almost infallible machine that never stops working. Looking back, it kept me out of trouble. I was learning. I was happy being busy. Because my fellow students and I were all in the same boat, we fed off each other’s energy and commitment. Yes, things could get competitive, we’d try to outdo one another to “look good” in front of our superiors, but in the end, we were just trying to survive together.

Medical school shaped me into someone who could handle what was ahead: residency. Obviously, it was a time of great learning, but more than that, we were being molded into a different kind of person. One who worked hard, didn’t complain, and got the job done at all costs. Those were the unspoken rules.

Residency and the Culture of Endurance

When I moved onto residency, the long hours and intense work continued. But now, two things had changed: I was a well-trained machine who didn’t complain, and there was a strong sense of camaraderie that kept me going. We, residents and attendings alike, worked toward a singular goal: helping patients. Patients with life-threatening conditions. Children and adults with brain tumors, head injuries, depressed skull fractures, bleeding in the brain, spine fractures, spine tumors, ruptured brain aneurysms. Life and death situations. Every single day.

We all had our roles. A weakness in one person negatively affected the whole. So, we pushed through for the greater good of the team. Looking back, we did it as much for each other as we did for the patients. It was survival training, and it worked, or so it seemed. I was becoming a neurosurgeon. I had to learn to work long hours in highly stressful situations while maintaining a calm and rational demeanor.

Nothing Changed, Until Now

When I left residency and started my own practice, nothing changed. My lifestyle remained exactly the same. It was all I knew. It was ingrained in me. So I kept working insane hours. Rarely took a day off. Even vacations were brief and infrequent. Work always took precedence over everything. I can’t quite explain why, maybe because I don’t fully understand it myself. It just felt right.

There is always something that has to be number one in your life. You can’t be a neurosurgeon without making it your number one. That was who I was. That was what I was trained to be. But now, I realize I’ve given far more of my time to my patients than to my family or friends. And that does make me sad. But it was the life I chose.

Looking Back with Clarity

These unspoken rules have shaped my entire life. They are always there. If you wanted to succeed, you did what you were told, didn’t complain, and worked hard until the job was done. And above all else, the patient always came first.

Now, as I approach 61 years old, I’m beginning to understand just how flawed parts of that system were, and how dysfunctional it could be. But I also recognize the necessity of that training. It created someone who could stay up all night operating on a brain, making split-second decisions to save a life. I was forged in adversity. Stamina and survival overtook nature and nurturing.

And now, only now, am I realizing how deeply that life has affected me, and my family. My children spent most of their lives waking up without a dad at home. I was already at work. And many nights, they went to bed before I returned.

My wife Cindy, a physician herself, essentially raised our kids as a single parent. And the stress I endured at work often followed me home and impacted our lives. Somehow, despite all this, we’ve remained close and strong as a family. But it still doesn’t make it right. And only now, as I slow down, do I truly see that.

Wisdom does come with age. Often, you have to live through something to understand how it shaped you, or how you might have done it differently. This isn’t regret. It’s realization. I wasn’t aware of it at the time. Maybe I accepted it as normal. Only now do I see how not normal my life was. And how much I missed.

I’m not arrogant enough to think my experience is unique. But I’m honest enough to admit, it wasn’t right. I only hope the path I chose made a meaningful difference in the lives of others. That’s all anyone can really hope for when it’s all said and done.

Impactful Quote of the Week

"To care for others, you must first care for yourself. Self-neglect is not a badge of honor."

- Dr. Lissa Rankin

All my best,

Brian Hoeflinger

P.S. - if you enjoyed this newsletter, you may enjoy my book that details my life as neurosurgeon and the loss of my oldest son, Brian (see below a synopsis).

My Book

Life and Death . . . Two words with such opposite meaning and which inflict such contradictory emotions and yet are so closely intertwined in our lives. As parents, we bring meaning and life into this world through our children. Our lives become defined as a result. We learn the joy, hardship, and responsibility of shaping an innocent life. But a day will come when that life will be taken. For some, death will come too soon. This is the story of my son, Brian Nicholas Hoeflinger, who died unexpectedly at age 18.

https://doctorhoeflinger.com/products/the-night-he-died-the-harsh-reality-of-teenage-drinking