Finding physician fulfillment

Physician Executive, Sept-Oct, 2005 by Kernan Manion

Unlike previous eras in medicine where physicians stayed on one relatively constant career course, physicians today are exploring a host of ways to run their professional lives. Some are seeking changes due to stress. Others are simply searching for something that connects more deeply with their talents and passions.

Consider these two scenarios:

1: A 46-year-old female married physician heads up a small group practice that she started. She enjoys the practice of medicine, but finds herself in an administrative role dealing with the myriad logistics of running a practice. Increasingly, she is dissatisfied. Practice revenue is decreasing and expenses are increasing. Staff is bickering and her physician partners and employees are threatening to leave the practice if their salaries are not increased. She is feeling fatigued and weary and the stress is having an impact on the health of her marriage.

2: A 37-year-old male specialist in ENT enjoys a busy practice within a multispecialty clinic. He faces the usual gamut of stresses--heavy workload and call schedule, insurance and regulatory issues, some difficult patients, some staff conflicts, etc.--but has been managing these in stride. It's not so much worklife distress that prompts him to consider a different job or career direction; rather, he wonders if there's something that's missing, some kind of work other than his career that he would find more fulfilling. He has considered medical missionary work where he feels his special skills are greatly needed and would be greatly appreciated. On the other hand, he has entertained the entrepreneurial thought of starting a free-standing ENT clinic with associated hearing-related diagnostic and treatment services.

Whether you are a physician who is grappling with career transition questions or a physician coach trying to help others, understanding the difference in the plights that these two physicians face is critical.

All job and career modification implies movement. Remember physics and the law of force vectors? "The sum total of forces acting on a body determines its forward movement. The sum total of forces acting against a body determines its resistance to forward movement."

Likewise for a physician's career "movement."

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So, what are these change drivers and resisting forces?

The change force is actually comprised of two distinctly different types of drivers. Those that push one out of, away from, the present situation--these are the pain drivers. And those that attract one to a new state--these are the longing forces.

Pain relief?

Stress in the practice of medicine (and it seems in society in general) is at an all-time high and shows no signs of plateauing.

Physicians face huge workloads, grueling practice and call schedules, rising costs, concerns about litigation, increasing government intrusion, etc. Add to these the challenge of simply running a business--having partners, managing staff, staying and growing in business and, perhaps more importantly, interacting with the real people who are patients.

As stress continues, and as the stress issues are unaddressed and unmanaged, pain ensues.

Pain is perhaps the greatest motivator for change. In the context of a physician's job or career dissatisfaction, you will hear "I can't stand this any longer," and "This isn't working for me."

So, pain pushes us toward change. Pain is the "propeller" of worklife transition. It moves us forward.

Longing

It is a fundamental manifestation of our maturing psyches that we want to do well in all that we pursue. We want to follow our interests, use our skills, live our values and achieve certain goals. These goals may be financial, intellectual and social.

We strive to find means to achieve an expression of skills, interests, values and goals in work that meshes with our personality style. Over time, we've learned not to fit the round cylinder of ourselves into the square hole of work.

If we are outgoing and creatively flexible, we look for an environment that fosters that. If we are more introverted and analytical, we seek a setting that enables us to best be who we are.

Finding yourself in an environment that is not favorable to your personality style is like trying to plant palm trees in Alaska. They just don't do well there. (And you may have noticed, igloos don't do particularly well in Florida either.)

When we find that work fails to enable us to use and develop our skills, capture our interests, live our values or meet our goals, there is a disconnect. We are "out of sorts," and long for something that will bring us fulfillment.

So, we begin to imagine and explore other career possibilities. This change force is "longing."

Longing compels us. It attracts, and pulls us forward. So, there are two dynamics or vectors that drive us toward change: Pain pushes us and longing pulls us. And physicians vary in the proportions of each dynamic.

Increasingly, many are motivated predominantly by pain (actually, significant numbers of physicians are downright miserable, regretting their career choice and discouraging their children from pursuing medicine).