Doctor as Patient: To Be, Or Not To Be, an MD?

“Physician confession about career disappointment was embarrassing—tantamount to acknowledging a character failure. Not any more.”—Stephen Rosen, PhD

SymptomsHis resume began, “Experienced MD with outstanding communication skills, proven record of business success, enthusiastic, dedicated to relationship building and education within the medical community.”

When he approached a career counselor, however, he described things differently: “I haven’t enjoyed much satisfaction in medical practice. I’d like to lose the pager. Be able to express myself more creatively. Have more time. Perhaps eliminate my clinical practice. Realistically explore my options.”

There’s no name for this in the Diagnostic and Statistical Manual of Mental Disorders. But we have names for it—“career malaise,” “burn-out, “dissatisfied doctor syndrome.” Dispirited physicians can adversely affect patient well-being and hospital safety.

Years ago, this kind of talk was unheard of among physicians, and patients rarely knew about doctor happiness. Physician confession about career disappointment was embarrassing—tantamount to acknowledging a character failure. Not any more.

Investigation

Robert Neville, MD (not his real name) presents himself as an optimistic, energetic, intelligent extrovert, both in person and on his resume. He is warm, articulate, with considerable social skills and a pleasant personality. He is very clear about the mismatch between who he is and what he does as a physician.

He admitted to a “healthy skepticism” about the methodology and process of making a career transition, and was hesitant to pay for career counseling services until he scrutinized some actual statistics on the past performance of the career management professionals, and embarked upon the career transition process.

So how does an intelligent, highly-functional, formerly-satisfied successful physician deal with serious career complaints, with a virtual vocational crisis? For Dr. Neville it’s not a matter of “Physician, Heal Thyself.” It’s “three heads are better than one”—coupled with a suite of modern career diagnostic tests, paper-and-pencil exercises, and cognitive “instruments.” Plus a lot of discussion of symptoms and complaints and career assets.

The first of the series of diagnostic tests revealed a lack of balance (really, a disconnect) between Dr. Neville’s enjoyment of life versus his displeasure with his life’s work. Disgruntled didn’t describe it; neither did depressed. He enjoyed his hobbies and relationships; he wasn’t paralyzed with the “walking-in-lead-boots” feeling that other physician-clients so vividly depicted.

The second test revealed that his paramount priority was not “time freedom,” “intellectual challenge,” “high earnings advancement” or “helping society.” It was “creative artistic expression.”

(It is true that physicians find creativity in their profession. Many young medical students, interns, and residents, and some practicing physicians find their specialties rewarding and are able to endow it with creative energy and obtain emotional satisfaction. A few physicians are even able to say, “My work is a worthy expression of who I am.” But these are the rare chosen ones who know early what they want to be, and who then stay engaged in a challenging profession during a productive lifetime in straight-ahead pursuit of their work as meaning-and-purpose, as a “worthy expression of their well-lived lives.” Think, Hippocrates. Galen. Maimonides. Albert Schweitzer.)

Digging Deeper

Another diagnostic test revealed that among Dr. Neville’s most enjoyable and deeply satisfying accomplishments were not only “devising several previously undescribed [medical] operations and incorporating them into my practice;” not only developing “standardized written post-operative patient instruction forms for the five most-common operative procedures in my specialty;” not only his decision to “leave a lucrative partnership in a previous medical practice” which led to “a major improvement in my personal and professional satisfaction;” but also having a career as a professional entertainer and performer.

Moreover, this outlet for his “creative expression” was neglected or missing from his life when he sought a new career and a way out of his career malaise.

Dr. Neville declared that the factor that most influenced his prior career decisions (choice of college, medical school, and specialty) were, “safety, security, practicality, and compensation." He said, “I've considered leaving medicine from day-one, although it took me years to admit my dissatisfaction to myself—and even longer to admit it to anyone else. I've never felt fulfilled in my medical career, even though I'm very optimistic about the rest of my life.

He added, “I made career decisions using a limited amount of information … I had little advice from people knowledgeable in my areas of interest. Lack of contacts and facts about every day clinical practice was a big factor in choosing my partners and group practice.”

After interpreting and discussing the test results together, we identified a number of career options that Dr. Neville agreed were compatible with his personal and professional priorities, his goals, his most-enjoyable and transferable skills, his value-system, his preferences, and his geographical and financial constraints. These options included non-clinical management positions in medical device developers, or hospitals, or pharmaceutical firms.

Detailed scrutiny of each of these options over a period of some five months led to individuals who were doing the kinds of work that Dr. Neville thought were directions for him to pursue. He learned very quickly how to gather real marketplace data from these individuals by doing what we call “information-gathering interviews.” These are not job interviews because Dr. Neville asked most of the questions in order to glean from real-world performers. Examples: “How did you get this job? What do you like and dislike about the work? Who are your counterparts at organizations similar to yours? May I contact them and mention your name?”

Keeping Track

All of the research on this process (we call it “information-gathering, not “networking” because most people think the latter means asking people you barely know for a job) led to vast amounts of information. We urged Dr. Neville to keep a career journal or diary of these interviews, and of anything else related to his job search. The purpose is to capture in permanent form all thoughts, associated ideas, and insights that arrived during the search. This cumulative record proved to be invaluable going forward, and produced a “critical mass” of career reflections, a form approaching “total immersion” in the process, in much the same way a surgeon prepares for a delicate operation.

A few months into the transition process, these scripted information-gathering interviews led to actual job interviews—usually in the “second- or third-degree of separation” or "generation" of contacts. As a matter of fact, all studies show that the people you know (colleagues, friends, relatives) who would be eager to help you, usually don’t know about the new career options you are pursuing, so it becomes necessary to reach beyond them to people you don’t know. This means organizing and systematizing your efforts at information-gathering, so that you do not waste their time or yours.

The last phase of Dr. Neville’s “treatment plan” consisted of video-taping him during practice job-interviewing sessions in advance of his actual job interviews. This helped him see how he would present himself in the actual job interview, to sharpen and objectify his answers to the typical questions asked (“Tell me why I should hire you! Why are you leaving your present occupation?), and to improve his performance. When we watched the tape together, he said, “I can’t believe I look like that!” With some feedback and rehearsal, however, he was able to go from a 5 out of a possible 10 (his initial evaluation of his practice session) to a 9 out of 10 (our evaluation).

Resolution

This turned out to be a successful intervention, and he was offered a management position with a major pharmaceutical firm. His responsibilities were to “provide formal presentations and scientific support to key managed care and health professionals, and to institutional and federal customers, to provide knowledge management and exchange with medical leaders, to communicate and evaluate the content of key clinical trials."

He was very pleased that his strong communications and social skills dove-tailed with the job specifications. His update on his new career: “…it’s great fun. I’m enjoying the professional interaction, the travel, and the freedom to set my own schedule. The work is challenging and there is great camaraderie. The most striking change in this new environment is the somewhat diminished communications, which I am helping to overcome. My creativity and innovation are accepted, and even encouraged, which is a tremendously uplifting change from clinical practice, and several of my ideas have already been recognized—and rewarded." And all at a compensation that exceeded what he was earning in his clinical practice.

Dr. Stephen Rosen is chairman of NYC-based Celia Paul Associates, which specializes in distance counseling for physicians and other professionals who are seeking career development and change. He welcomes comments at 212-397-1020 or srosenc@verizon.net.