Steering onto the exit ramps of public Judaism and of medicine. Both have a fair amount of traffic. Both have created an attachment for me over a very long time in some form. Yet each has become more of a private calling than a public expression. There is a superb lecture on character as a prerequisite for leadership positions in Judaism.
Rabbi Reiss cites sources that require effective Rabbis and other communal leaders to have both personal character and the willingness to irritate their constituency for the right cause. I have found no shortage of people willing to make decisions that generate leadership induced attrition. And at times people who do this conduct themselves in a way that is beyond reproach, but too often not. And too often what is promoted as the right but unpopular cause is both faulty and unpopular. There are limits to what people will accept, giving many a wannbe Jewish leader the Pyrrhic victory of a noble purpose but no talent to implement his vision.
Medicine takes a parallel approach. No shortage of distinguished accomplished charismatic medical school alumni who engage in dastardly conduct. Attrition may be a little harder in this forum where people depend on this type of activity for their livelihood but underparticipation seems rampant. Clinicians have very little incentive to fully engage themselves in the pageant of medicine, opting instead their own niche, whether that be their individual practice or their lab. Medical societies lose their purpose. The American College of Physicians moves toward noctor parity as a surrogate for their own physician participation. People still see patients and run their practices, but they are on the exit ramp just the same.