"The afternoon knows what the morning only suspects."
"It’s not that I’m smart, it’s just that I stay with problems a bit longer" - Albert Einstein
In business parlance, a barrier to entry is an obstacle in the path of a firm wanting to enter a given market. Barriers to entry for physicians wishing to explore alternate careers can be considered under two categories, endogenous or exogenous.
Mike, a 48-year old gastroenterologist at an academic center called to say he "badly wanted out". For at least five years he’d been dreaming about being independently wealthy, a master furniture maker or a stay-at-home dad. Any of these options seemed more appealing than endless endoscopies, waves of patients with irritable bowel or more committees. He envied his wife her enjoyment of part-time work as a community internist. Tests through a career guidance service indicated he was highly suited to his profession. The few career prospects that had surfaced in academic administration or the pharmaceutical industry held no great appeal.
"I’m afraid I’ll dream the next decade away but end up right where I am. What might be blocking me?"
In a profession where the gestation of a new member is lengthy, pressures to imitate and comply dominant, and conservative tendencies a cultural norm, it can be hard to, as the saying goes, be who you want to be. It might be refreshing therefore to those with an instinct to plough their own furrow to read a new biography of the great Scottish surgeon, John Hunter... Read More
While other may add, subtract or otherwise modify my list, what is striking is how exogenous barriers are fewer in number and easier to work around than the endogenous ones. Most of the Mikes who end up in communication with me are holding themselves back. Daring and entrepreneurial doctors are not that numerous. Exciting opportunities are available but they take courage and creativity, both traits that may be suppressed in someone experiencing career disillusionment
Career doubters need the constructive help of others to jumpstart a resolution. Others may be their spouse, pastor or rabbi, a friend sitting side-by-side on barstools or a professional career advisor. What matters most is that these are problems that take two heads to heal. "One thing we know about creativity is that it typically occurs when people who have mastered two or more fields use the framework in one to think afresh about the other" says Marc Tucker, of the National Center for Education and Economy, an organization proposing an overhaul of the US education system.
A modification of Tucker’s viewpoint is that creativity may emerge when two or more people approach a problem from their different individual perspectives and experiences and work collaboratively to fashion a solution.
Physicians and other seeking a creative resolution of their career dilemma will do well to draw on the wisdom and insight of others, most especially those outside their habitual professional milieu.
"Twenty years from now, you will be more disappointed by the things you didn’t do, than by the ones you did. So, throw off the bowlines. Sail away from the safe harbor. Catch the trade winds in your sails. Explore. Dream. Discover." - Mark Twain
I’ve worked with highly competent physicians eager to pursue non-clinical careers whose aspirations have wilted under the challenges. Nine times out of ten the rate-limiting factors were in matters of their mindset. The points I raise here are a product of my own experience in working and consulting in the world of biotechnology and startup companies and my work advising other physicians about how best to successfully transition to non-clinical careers. Absorbing them is crucial.
For all our independence, physicians are often quite sensitive to the reaction of others. I see this as a product of spending our formative years in medicine being judged by others. Is he good enough to be in our medical school? Do we want her in our residency program? Compliance with rules both spoken and unspoken and the prevailing orthodoxy is wise during our education, and even as a young staff physician it can be almost as hard to stand outside the status quo.
Fear of criticism, including the self-critical nature that is a frequent component of the physician persona holds many back from bold decision making.
To restore balance, consider the following quotations from critics of the critics:
The playwright Arthur Miller said critics were: "People who can’t sing or dance."
Picasso, no stranger to criticism of his art and his personal life said: "Every critic is a priest of a dogma, of a system, and condemns implacably what he finds to be out of his faith, a faith not reasoned but imposed."
There are critics who are thoughtful and attuned to their own biases. Unfortunately, much else of what passes for criticism is dull edged hewing to the status quo. As you put your career under the microscope, mind who you listen to and what their underlying agenda is.
Our responses to real or perceived criticism are commonly inversely proportional to our level of self-confidence. What passes as confidence in our hectic world today is often the sophomoric behavior of some braggart than the real thing. It’s a false confidence as easily punctured as a balloon and as useless thereafter. Quiet unassuming confidence is the real deal. It allows one come up short, err, or experience doubt. It allows one say; "I’ve got to think through this".
Doubt is not a synonym for indecision, rather a manifestation of an active questioning mind, and a tolerance for ambiguity that is a mark of maturity. We doctors like many other highly educated successful professionals often struggle to admit doubt. Paradoxically, possessing the humility to admit both to doubts about our career and the need for assistance in finding alternative professional opportunities strengthens rather than undermines our self-confidence. A willingness to open ourselves up to others results in our being more mentally flexible, more willing to listen well, and to be seen by individuals helping us or considering us for new career positions as more receptive and possessing greater potential.
Robert Frost may have taken the "road less traveled", but I’m guessing he stood at the diverging point in the woods for a while and pondered... Read More
Putting your professional life under the microscope is a lot easier in theory than practice. I’ve a sense for the language and behavior of the physician serious about achieving change and those for whom the idea is a flirtation. An intermediate group includes those doctors who sincerely wish for change but whose efforts perish from the twin sins of the undecided, prevarication and procrastination.
Sounding like a neologism from a Tolkein novel, middleageism is the negative stereotype about our middle years. The distinguishing twist from ageism is that this prejudice is held more by the middle-aged themselves and much less by others frowning on them. Read More
One usage of prevarication connotes equivocation with the word itself derived from the Latin ‘prae’ before, and ‘varicare’ to straddle. At least moderately unhappy with their professional lives, certainly going well beyond the bad-day-at-the-office or horrible-call-night sets, they sit on a fairly comfortable fence between the moderately uncomfortable known and the moderately scary unknown. These are the physicians who read books about career change, attend seminars and career advisors on a spasmodic basis, or alternate between taking three steps forwards then three steps backwards and three steps backwards then three steps forwards. Theirs’ is a fence wide enough to do such, one you can spend many years on.
The procrastinators stay situated on one side of the fence longingly looking over at the other side. Longingly may describe both emotional state and the duration of their gaze. They keep more to themselves, grounded alongside the fence, much less likely to seek the counsel of others or even acknowledge doubts about their professional lives, sometimes to themselves but certainly to spouses, friends or colleagues.
Moving beyond these rate and state limiting behaviors requires accepting that the process of career assessment and change is an inherently stressful one. A successful outcome is most likely to emerge when the physician concerned possesses what is known as "Stress Hardiness".
In the 1970s, while studying business executives, Dr. Suzanne Kobasa developed the concept of "Stress Hardiness". The more stress hardy executives had three distinguishing characteristics. I’ve adapted the three Cs of Kobasa [and added a fourth] to the issue of career examination as follows:
Commitment: Physicians with a strong sense of commitment to themselves, their families, their work or a personal cause. They believe in their self-worth. They want either to feel better about their current field of professional engagement or find other outlets that will suit them better.
Challenge: Physicians who see life as a challenge, welcome considering new career options, and see opportunities not obstacles, and potential not problems.
Control: Physicians who feel a sense of control over their lives, and pay attention to the power they have, rather than feeling at the mercy of external influences.
Confidence: Physicians with self-confidence in their ability to solve their career dilemma. This confidence is both a byproduct of their commitment, love of challenge and sense of personal control over the outcome and serves via feedback to engender yet more of those qualities.
Every physician who successfully completed medical school, residency and years in practice has these personal characteristics in abundance. Marshalling them now in your own self-interest is within your capability, and will keep your career assessment moving forward.
Goals are the resolutions we make between January 10th and December 26th. They’re as wonderful and as evanescent as a hibiscus blossom. Making them stick is the trick.
How can you keep your New Year resolutions from dissolving to nothing like the fading bubbly of December 31st leaving you feeling irresolute and stuck in the January slush? How can you make your unachieved goals leaving you feeling discouraged during the rest of the year? Reaching your targets involves keeping them realistic and thinking through the tactics and strategies you’ll use to turn those thought bubbles into something more solid.
There’s a whole school of mnemonics-makers out there to help you reach your targets. Are you SURE for Specific, Understand what’s involved, Realistic and Enthusiastic? How about being SMART for Specific, Measurable, Attainable, Realistic and Tangible? Somehow these don’t cut it if you’re after bigger fish than a better exercise schedule. So, I, less sure and smart about the merits of mnemonics, offer the following ideas to convert the faded dross of failed resolutions into something approaching gold.
"One thing we know about creativity is that it typically occurs when people who have mastered two or more fields use the framework in one to think afresh about the other" - Marc Tucker, of the National Center for Education and Economy, an organization proposing an overhaul of the US education system.
You may have some misgivings about your career in medicine and wonder how you could improve your options. As you go about your work at the hospital or clinic you note some or all of the following:
So, very reasonably, you entertain the thought that an MBA degree might open up all sorts of new career vistas.
In mid-career and at age 47 I obtained an MBA. I’ve been actively involved in physician management, in startups, and as an advisor to industry. Frequently I’m asked by physicians about the merits of heading back to the classroom. While there are specific considerations for each physician, the following general issues should be thought through carefully.
One final note. Statistics speaks volumes. The laws of supply and demand that you’ll hear about in economics classes are to be respected. The national center for education statistics [http://nces.ed.gov/programs/digest/] provides sober reading on the numbers of advanced degrees awarded annually. For the year 2003-2004, the last year for which full information is available, the counts were:
M.D. 15,442
J.D. 40,209
M.B.A. 139,347
Numeric strength isn’t everything. This 1:9 ratio between MD and MBA degrees is a difference whose valence is vastly more dilution effect than strength in numbers.
On a day when there’s been one snafu after another in the clinic and an administrator 20 years your junior made you feel like you were 12 years old, you may start thinking how a non-clinical career would be Nirvana.
Should you head for Nirvana, you may to your dismay find a hell. A hell of deadlines, budgets, quarterly numbers, job insecurity, stress because it’s new, stress because it’s stressful - and, if all that wasn’t bad enough, you’re feeling like you really miss taking care of patients, even the depressed, angry, non-compliant ones who may have caused you to head for the hills in the first place.
"You were trained as a trauma surgeon. Do you still practice medicine?"
"No, unfortunately. I take care of populations instead of patients now. I used to be a real doctor. Now I just play one on TV." Read More
So, before you jump, consider the following.
Act as a response to positive-minded personal aspirations, not to negative feelings or other emotions. Elect to pursue a non-clinical care job opportunity because you like medical administration, the pharmaceutical industry, or public policy issues in healthcare. Your career should show an evolution consistent with that direction over a period of some years.
The process of career modification should follow a logical and progressive path. You should have worked through the steps outlined in essay V of this material. If you’ve worked through the career transition process carefully you are highly likely to find a suitable career alternative and much less likely to look back wistfully on the good old days.
"The biological function of intelligence is to protect the organism from bodily risk and to satisfy its wants with the least possible chance of recording failure on the environment." - Thurstone, L. L. (1924). The Nature of Intelligence.
Assuming fundamental qualifications and competencies, our success or struggle in particular professional milieus is chiefly a product of the degree of cultural fit. Our capacity to tune into and work comfortably on the same wavelength as the prevailing culture of profession, specialty, and employing organization determines our professional satisfaction. In our increasingly global and mobile world competitive advantages accrue to those individuals and organizations with the flexibility to work well with members of different cultural groups.
Cultural intelligence is sensitivity to the variety of traditions, habits, beliefs, values, attitudes, expectations and assumptions that exist within different cultural groups, and an acceptance that those qualities within any such cultural group are as meritorious as one’s own.
Thurstone’s superb definition above is robust enough to withstand the many varieties of intelligence we now allow for. If I treat a patient from a different cultural background than my own and am insufficiently sensitive and accepting of them, is there not a high likelihood of a "failure on the environment". If I leave clinical medicine to work in the pharmaceutical industry but want to be top dog in a team or to disregard the opinions of colleagues in areas like sales and marketing, I will struggle, not succeed.
If realtors tell you that the three most important words in real estate are location, location, location, the three most important words in career success are fit, fit, fit; goodness of cultural fit, that is.
When we stumble in the workplace as human beings and as physicians the reasons lie overwhelmingly in our shortcomings in qualities such as understanding, tolerance and sensitivity, and much more rarely in qualities like competency and caring.
Tuning in to the importance of cultural intelligence and working to build our cultural flexibility would smooth out many bumps in our work lives and enhance our career change quest opportunities.
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