There's no one thing, but sometimes I worry about family life. I see that no job in medicine is 9 to 5, and days are NEVER predictable. It's not PM&R specific. If I'm on inpatient, someone could have chest pain at 5:30PM and need to be transferred out and I know I'll be late for dinner at 6PM planned a week in advance -- or not. Or, I could have an outpatient schedule with my last pt at 4PM but need to spend two hours catching up on paperwork if the clinic is busy and everyone shows up -- or not. I feel there are days when I never see the sun. Overall, PM&R is less malignant than many other specialties and I do enjoy it, but being in health care is a sacrifice. We give up time with family, time to ourselves, and even caring for family and ourselves to care for strangers. Dental appts, doctor appts, haircuts, the bridal shower for our best friend, Christmas, or birthday of an eldery relative get pushed aside for our patients. Sometimes it eats at me, gnaws, embittering my days. Other times, it's not so hard. I suppose with any job, in any field, people always have ups and downs.
I like to think outside of the box, so considering something innovative for a career besides medicine is interesting. I like a lot of different things, but not really good/top-notch at any one thing. I can sing, but I sure wouldn't start singing at weddings or try out for American Idol.
You are feeling your own brain's backlash against you for the sacrifices you have made for the career.
Think of it this way - you could have graduated high school and gotten a job - something relatively brain-numbing and poor-paying, but you wanted something more.
After graduating college, you could have taken a job at some corporation, with a decent income, climb the corporate ladder, live 9-5 with health and dental insurance and 2 weeks vacation per year. But you wanted something more.
You chose medicine, and she's a bi-tch of a mistress. Most of us have a love-hate relationship with our careers and the choices we made. Our spouses don't always understand when we miss that 6 pm dinner for a patient we could have put off, but felt the need to help someone when we could, and sacrafice family for medicine. Our kids don't understand why we can't make every concert, recital or party. Our relatives and friends may resent us for not always being there for them, because they will never understand why we do what we do, and most of them could never do it.
Medicine is one of the highest callings you can do. It is only for the select few with the desire, drive, pasion, intelligence and fortitude to be accepted into it and survive the training. The training is hard, and life after training may not be much easier.
But there is nothing in the world that can compare to either saving a life, or salvaging one. Simply improving someone's quality of life will get you through while the rest of the world tries to beat you down.
PM&R offers the opportunity to imporve QOL and salvage lives, but rarely save them. We may get less respect from our collegues in other specialties, but I guarantee, most Physiatrists get more respect and thanks from their patients that most fields. We get paid well (if we do it right), and we have a good lifestyle, if we so choose (I just started taking off every Friday - 4-day work-weeks from now on...!).
But the trade-off is we deal with many patients that either other fields can't help, or don't want to. We treat the untreatable.
Stay with it, find your passion, see what trips your trigger, choose whatever cliche you want. Something drew you into this field. Find it again.