As A Physician, Can You Work For Someone Else?

How important is our autonomy as physicians?

Have you ever wondered how difficult it might be to work for someone else, when we're wired and trained to value our autonomy as one of the perks of being a physician?  Many physicians making a transition from clinical practice struggle with the impact of losing autonomy in their decisions and actions.  Here are some observations from my experiences that might help you as you contemplate making some changes in your life and career.

First, recognize that your biggest challenge as a physician in moving to working for Wall Street, a pharmaceutical firm, a start up company, an insurer, or just about any job that doesn't require you to be in direct patient care, will be adapting to your role in a heirarchy. Most physicians at ACPE cite this transition as their most difficult. After some awkward moments in making the transition, we all learn what we were never taught in our medical training!

To give up absolute autonomy doesn't mean that your input isn't important.  It's just one piece of input among many others. Good group process and good decisions requires multiple viewpoints, disagreement, and vigorous discussion. Physicians trained in the military, who are familiar with leadership principles, say the first step to good leadership is to understand "good followership".  Sometimes we're members of a team, other times we're asked to lead a team.  You've got to understand both roles.

Second, recognize that a good boss doesn't necessarily have anything to do with being a physician.  One of my top two bosses over the past twenty years was an insurance executive.  Chain smoker, equally comfortable in a plaid sports coat or a pin stripe suit, he was one of the most ethical, honest, and exciting people I've ever worked with. 

We disagreed frequently on issues, but I supported him when his actions made physicians upset because he never crossed an ethical boundary, and his intentions were good.  For example, one day he said he wanted to notify all physicians on our networks that their physician-owned malpractice company was going broke.  I told him the physician leaders of the company, who were also key figures in the medical society, would be furious.  As an insurance executive he felt obligated to notify the malpractice carrier's insureds that they could be left high and dry.  He asked for my support when the physician leaders reacted.  I gave him my support, and was there when they had that contentious face to face conversation in his office.  And the malpractice carrier did become insolvement about 9 months later.

In contrast, some of the worst bosses I've ever had were physicians. Maybe they turned out that way because they were so focused on themselves, and their autonomy? Conversely, maybe I didn't understand good followership? Whichever it was, it wasn't good for any of us.  

Third, keep your "physicianhood" in perspective. Though we're all very proud and honored to be part of our profession, other people and professionals are also proud of their hard work and commitment to their occupation or calling. Think of your training as a physician as the foundation for whatever else you want to do in life. If, because you're a physician, you think and act superior to others in business, art, publishing, or at the machine shop, you'll have a hard time working for someone else. 

Our "tribe" - physicians - makes it hard for us to venture in different directions from our clinical care training. We have to be aware of that, but be determined to listen to the pull of other non-clinical interests that are attracting us to new ventures. By exploring the issue of autonomy, and seeking to behave differently from our training, the path will become much clearer.

Managing The Transition From Clinical Practice To A Non-Clinical Career

Physicians seeking non-clinical careers will need to fine tune important life skills. 

A growing number of physicians are pursuing non-clinical careers. Some have discovered they can no longer sustain their purpose and passion through a clinical practice. Others feel trapped in their roles in traditional medicine—and want out.  

The good news is there is an alternative to staying trapped in your clinical practice. It involves “rewiring” yourself—rerouting the personal energy spent in your clinical work into deeply satisfying, work activities.  These personally customized work activities can transform your next chapter into the most fulfilling time of your life. But then, physicians who choose to rewire will need to fine tune a number of important life skills.  

Life skills for sustaining your purpose and passion in the phases of renewal: 

Click to read more ...

Physician Stress & Burnout

By Michelle Mudge-Riley DO MHA

Have you wondered about the impact stress and burnout might be having on you? 

Most physicians enter the medical field believing that hard work and dedication will lead to a happy, successful and satisfying career in the practice of medicine. The sacrifices made through the added years of education and training required to develop medical expertise seem to be well worth it in the journey that culminates in a successful career with wealth, stability and a sense of personal accomplishment and altruistic satisfaction. 

Over the past few decades, amidst growing worries about health care costs and quality, the era of external surveillance and accountability grew. Managed care was born and the large number of preventable medical deaths that occur each year as an unintended outcome of medical interventions was highlighted through media and other channels. This was followed by pay for performance and now new legislation with emphasis on Medicare reimbursement rates and prevention. In short, there has been an increase on the external monitoring and interference on doctors, telling us what we can and cannot do and paying us less for doing it.

A recent article in The Annals of Surgery reported that 40 percent of surgeons reported being burned out and 30 percent screened positive for symptoms of depression. Several other peer-reviewed articles suggest that many of these problems may actually begin during medical school and residency training.  One study reported a 50 percent burnout rate in medical students with 10 percent experiencing suicidal thoughts. 

Last year, a survey conducted by The Physician’s Foundation found that 78 percent of physicians think medicine is either “no longer rewarding” or “less rewarding” and 49 percent of primary care physicians say they will reduce the number of patients they see over the next three years.

Physician burnout is more common than it should be. There are a number of steps you can take if you suspect stress and burnout may be affecting you.

Recognize The Symptoms

Many times, physicians don’t perceive that they’re working under any undue stress, and even if they do, they look at stress as being part of the job. You may recognize the more obvious physical symptoms of stress such as chest pain, palpitations, headaches, muscle pains, panic/anxiety attacks, and gastrointestinal distress, but you may not recognize the more subtle symptoms such as anger, irritability, mood swings, apathy, loss of focus, sleep disturbance, isolation, and an overall sense of frustration and dissatisfaction with what you are doing. Understanding, acknowledging and accepting the fact that you are stressed and that the stress is affecting your moods and behaviors opens the door for the next steps.

Remind Yourself This Is Not A Character Weakness

Remind yourself that you are not invincible, that reacting to stress is not a character weakness, and that you can take steps on your own to help adjust to the pressures of the surrounding environment.  Introspection is often involved and includes re-visiting the question of why you became a doctor, what the you enjoy about the profession and what you could do to reenergize the passion in your medical career.

Reach Out To A Mentor Or Physician Coach

Taking advantage of a physician coach or mentor will help provide the needed expertise to move forward. An external “big picture view” from a knowledgeable person with experience in doing this with physicians can help you put things into perspective and create an action plan to move forward.  This can culminate in a desire to change or offer a new perspective on the current situation.  A recent study concluded that physicians who are dissatisfied might greatly benefit from a personal coach or mentor to decrease the chance that the process of burnout will get out of hand.

Diversify Yourself & Your Career

You may want to take steps to innovate and diversify your current model of practice. You could explore opportunities in a field that is complementary to your current field and interests such as informational technology, public health, genomics, or aging. You could pursue more of an administrative role as a medical director.

Some of the options for a physician who wants to use his or her medical knowledge and skills to do more than practice direct clinical care include medical communications and writing, consulting, teaching, starting a business, working in the medical device or pharmaceutical industry, the wellness and health promotion industry, marketing and sales, business development, finance or grant writing.

A physician is uniquely qualified to pursue any of these options but you must take specific steps to move from the clinical to the non-clinical realm. Although physicians make excellent managers, organizational leaders or entrepreneurs, for a physician to step out of the clinical world into any other job requires a shift in focus and some new skills.  In addition, all of these options carry a particular set of job and lifestyle considerations—for example, what is the salary? Are there opportunities to move up the career ladder? What is lifestyle like? Will travel be involved?

It’s important to realize there are options and there is hope.   Exploring sites like this one, finding others and reaching out to those who have been there or who may be doing what you want to do can be an important and empowering first step.

From the following peer-reviewed article:  Rosenstein, Alan and Mudge-Riley, Michelle.  “The Impact of Stress and Burnout on Physician Satisfaction and Behaviors”.  Physician Executive Journal Vol. 36 No.6, Nov-Dec 2010, p.16-23.

About: Michelle Mudge-Riley DO MHA successfully made the transition from clinical practice to non-direct clinical work and now works for a brokerage firm in Richmond, Virginia as Director of Wellness and Health Promotion.

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Physicians: Is Management Consulting For You?

Consulting is a great option for physicians, whether it is for a boutique or “Big Four” firm… but one caveat:  know what you’re signing up for.

I know of which I speak. For a number of years I was one of the road-warriors that worked for a Big Four firm – in my case, Accenture (formerly Andersen Consulting), as a Senior Change Management Consultant. It was an incredible, exhausting career – with both big highs, and big lows.

I saw a posting the other day for a “Physician Management Consultant”, and it made me think. The location of the role was stated as “Virtual – Candidates can be located anywhere near a major airport within the Continental U.S.”. And did this bring back memories of my life as a management consultant, oh yes.

When I joined Accenture, I was working hard in graduate school, getting my degree in clinical psychology. When the interest came from them to recruit me, I thought “why not”, what would I have to lose?  I thought I would try management consulting for 6 months to a year (which was as long as I could convince them to hold my place in the Ph.D. program), was sure that I wouldn’t enjoy it, and was convinced I’d be back completing my degree by the following  winter. Well, that didn’t actually happen.  Management consulting turned out to be more interesting than I expected… more rewarding financially than graduate school or an entry level role for a Ph.D. clinician (go figure!)… and more exciting, more fun.  So I stayed … and learned things on the ground in global organizations that I never would have gained by staying in a clinical career. It was fascinating work - and exhausting, demanding work too… physically, emotionally, and intellectually. During my tenure I learned things about myself, about how the corporate world works, about priorities and “bottom-lines”, and about how people function professionally and personally in the context of their work.

In my role as a physician executive coach I’ve worked with docs who have decided they wanted to leave the clinical world to go work for one of the big consulting firms. They may be attracted by the possibility of utilizing their expertise in a bigger way, by the credibility of affiliating themselves with a “top firm”, by the glamour that a consulting role seems to hold. I support whatever non-clinical path my clients feel is the right fit for them, but I do feel strongly about giving my docs a “reality-check” when it comes to the lifestyle and demands associated with management consulting.  I’ve been there, I’ve done that.  Until you’ve been in the trenches it is hard to know what it is really like. 

So for any of you physicians interested in a non-clinical career in consulting, here are my thoughts: I call it “Management Consulting 101” or simply, “Know What You’re Getting Into”.

Expectations

The expectations for consultants can be both overt (shared in hiring/orientation) or more subtle - inherently part of the culture and used to assess whether you as an individual are both “cut out for” consulting or will be successful in the firm. 

Regardless of whether it is a large firm or smaller, boutique outfit, these expectations are pretty much the same: 

• Be willing to go anywhere, anytime – the clients’ needs always come first
• You must have complete mobility – and be highly adaptable to new situations, new teams, new problems to solve, and new locations
• You must deal well with sharp learning curves and high expectations from clients – you must add value from the moment you arrive on a new client site, and hit the ground running
• You must have the ability to collaborate on larger, mixed consultant/client teams, and be skilled in managing conflict/challenges that arise
• You must have incredibly high levels of professionalism, communication and accountability, and the ability to deliver results, and to truly “team” (i.e., trust your team-mates, delegate, work together for a common goal, stay accountable and meet expected outcomes)

In my experience these are things that most physicians who choose consulting either have a natural affinity for, or are able to get their arms around and excel in. However, there are some who have gotten tripped up over their lack of awareness of these expectations, or their lack of preparation / skill in these areas. The good news is that these are things that can be learned, either on the ground (although this may make your learning curve a little steeper and longer), or with some specialized, up-front skill development while still in clinical practice. The key is knowing what the expectations are for consulting work, and doing some introspective work to assess yourself on both your interest and skill level in these areas. Then find someone who can help you develop – either learning from a colleague who is  in consulting already, or finding a mentor who will help you walk through the steps, working with a coach, or getting feedback from a supportive peer.

Lifestyle

One of the hardest things in consulting is the lifestyle. Many docs I work with are unclear about how the work is done, and expect that they will be able to conduct their consulting projects within their home area, and travel only occasionally. Unless you live in a major metropolitan area that houses the headquarters of the kinds of organizations that you want to specialize in (e.g., Pharma, Biotech, etc.), and there is a demand for projects in your area, you will be on the road. This is one thing when you are young, enthusiastic, and have no family ties to keep you in one place. Then consulting, and the significant travel it requires, is exciting and an incredible opportunity to travel the world for work. 

But when you have a family, or ties to one geographic location, the option of consulting work is a little more complicated. The truth of the matter is that you go where the work is. It is a fact of life, and one that was well-validated by the online posting for the Physician Consultant that I mentioned above.

So a reality check about the consulting lifestyle?

• Get used to being a “road warrior” – remember that movie with George Clooney called “Up In The Air”?  That was my life, and is the life of many, many management consultants.  It is more typical than not. 
• You will have to spend a lot of time away from your home location and family – The majority of my consulting life I was out-of-town Mondays through Thursdays/Fridays, depending on whether the client demanded that I be “in office” on Fridays.  Most consultants do the same thing.  If you have a very forgiving client, or belong to a firm that highly values the personal needs of their employees, you may be able to do a Monday-Wednesday and work virtually Thursday and Friday, or some combination thereof.  But don’t count on it.
• Be “on call” to fly wherever, whenever – again, the clients’ needs come first – if they need you on a plane at 6am the next morning, get your bag packed, and arrive at the airport at 5:00am with a smile.
• Get to know, and love, your home airport – once you know the routines of your home airport it will be as familiar to you as your own house.  Get to know your regular gate crew (if you’re flying the same airline most of the time, which you should), they will be nice to you, which is always a good thing when you’re trying to upgrade, standby, or get priority seating.
• Get to love hotels – this too is a reality of the consulting lifestyle … while often fun at first, hotels become just that, hotels, after a while.  If you can maintain a routine and take advantage of their perks (i.e., gyms, room service, hotel points, etc.), you will start to find your own rhythm to make yourself at home.
• Long hours, high client demands – you will be adding value from the moment you arrive on-site to the moment you leave (consultant’s rule of thumb? You should always arrive before your client, and leave after them).  You are your bill-rate, and the client doesn’t forget that.  You can’t either.
• Changing teams – don’t get attached!  One thing that is true is that you can be working with a team of people for months, and then all of a sudden have the team disbanded and the project ended at the need of the client.  Another rule of thumb – don’t get too attached to any one project team, or any one organization.  Before you know it, you’re flying to another city to be part of another team.

Now I don’t want to give the impression that management consulting is all hard and difficult. There are elements to it that are incredible and unique – you will never do work like it. Some of the reasons why people do it, and find it incredibly rewarding (including me!):

• You have the opportunity to work on exciting teams, doing exciting, cutting-edge work:  Everything that is done in consulting work is the latest and greatest. You will have the chance to meet and work with incredibly smart professionals, who are passionate and interested in the same things you are. You will be learning the newest methodologies, technologies, and processes in your given field, and you will be able to apply your medical knowledge/experience in a way that supports your clients’/projects’ efforts and success. You will see tangible results of your work in finite time periods.
• You will be able to travel internationally, collaborating with global teams/clients: This is an incredible learning opportunity, both as a professional and as a human being. One of my favorite parts of my work at Accenture was collaborating with colleagues in Sweden, Japan, Australia, and Germany (to name a few) on different clients/projects, to solve different problems. 
• Air miles! This starts to matter. Some of the best vacations my husband and I took were during my tenure with Accenture, since all of those hotel points and air miles start to rack up and provide the wonderful opportunity for free international travel (China!  Australia! Greece! Spain! Italy!) and free hotel stays. Not too shabby.
• Interesting, changing work:  One of the best things about management consulting is that it never gets dull. Your intellectual and “EQ” (Emotional Intelligence) abilities are constantly put to the test, as you are required to solve your clients’ problems in different ways, with different people, and in different organizational cultures, on a regular basis. If you like change and variety, then consulting work provides that.  If you are a natural problem-solver, like many physicians, you will feel right at home with the challenges that your clients provide you with. Consulting is not for everybody, but it could very well be for you. Only you can decide that.

For further reading on management consulting as a non-clinical career choice, I recommend the book “Management Consulting Today and Tomorrow:  Perspectives and Advice from 27 Leading World Experts” (2009, by Larry Greiner and Flemming Poulfelt).

Another very good resource was written by a consultant, titled: “How to Get Into the Top Consulting Firms: A Surefire Case Interview Method” (2009, by Tim Darling). It provides not only a realistic overview of the consulting lifestyle (who succeeds, what it’s like, what you need), but also provides a primer for making yourself a desirable candidate (how to succeed in a problem-solving interview, resume prep, etc.). I highly recommend this book if you’re even thinking about consulting as a non-clinical option.

Physician Excuses For Not Making Your Ideas Happen

If you're a physician that wants the freedom to control your career and lifestyle, you're going to have to act.

Here are the most common excuses that physicians give for why they can't actually take control of their career and lifestyle and actually do what they want. (You'll also notice that it's the same list that everyone else has.)

It's quite a list and there are plenty of pegs for most physicians to hang their hats on and, indeed, most docs will never have real control or freedom. But, as the wise man once said, the world needs ditch-diggers too.

If you're risk-adverse and choose security over opportunity every time, here's your list courtesy of 99%:

1. I DON’T HAVE ENOUGH TIME.
Extra time, like money, rarely just materializes out of thin air. We have to work for it. If “finding creative time” is a struggle for you, consider getting proactive about carving it out, and doing the most important work first.

2. I’M AFRAID OF FAILURE.
If we really push ourselves, we will fail more than we’ll succeed. But that’s how we gain experience, how we learn, how we grow. The greater failure is to never risk failure at all. Choreographer Twyla Tharp: “If you do only what you know and do it very, very well, chances are that you won’t fail. You’ll just stagnate, and your work will get less and less interesting, and that’s failure by erosion.” 

3. I’M NOT INSPIRED.
Inspiration comes from action, not the other way around. Our friends at Red Lemon Club shared this insightful tidbit from leadership guru John C. Maxwell: “"The whole idea of motivation is a trap. Forget motivation. Just do it. Exercise, lose weight, test your blood sugar, or whatever. Do it without motivation. And then, guess what? After you start doing the thing, that’s when the motivation comes and makes it easy for you to keep on doing it."

4. I NEED TO FIND BALANCE IN MY WORK AND HOME LIFE. 
Living a full, balanced life is a wonderful goal. But does that mean doing less work and having more leisure time at home, or doing better work and feeling more fulfilled? Seasoned non-conformist and entrepreneur Chris Guillebeau makes the case for better work and bigger dreams, arguing that balanced people don’t change the world.

5. I CAN’T OVERCOME MY INERTIA.
Getting started can be hard. Once you’re sitting still, once you’re in your comfort zone, the easiest thing to do is just stay there. As serial entrepreneur Andy Swan has written, one of the most common mistakes when we’re just beginning a project is to “set lofty goals from a resting start.” With images of fame and success dancing in our heads, we set the bar too high, fail to make the grade, and quit because we’re discouraged. Instead, build momentum by starting with small, achievable goals, and work from there.

6. IT’S NOT ORIGINAL ENOUGH.
Originality is immaterial. Filmmaker Jim Jarmusch puts it like this: “Nothing is original. Steal from anywhere that resonates with inspiration or fuels your imagination… Select only things to steal from that speak directly to your soul. If you do this, your work (and theft) will be authentic. Authenticity is invaluable; originality is non-existent… Remember what Jean-Luc Godard said, ‘It’s not where you take things from – it’s where you take them to.’” 

7. I’M AFRAID OF THE COMPETITION.
If someone else is doing something similar that needn’t be a reason to give up. In fact, it’s a great reason to get more excited. As Seth Godin has said, competition validates your idea by creating a category. It also lights a fire under your ass. 

8. I GOT MY EXPECTATIONS TOO HIGH JUST THINKING ABOUT IT…
It’s easy to get high on the idea of executing your idea. You daydream about how great it will be, the recognition and acclaim that will inevitably follow its launch. You build it up so much that the reality of actually executing the idea starts to seem unappealing. Ze Frank calls these un-executed ideas “brain crack” – it’s a dangerous addiction. 

9. IT’S NOT THE RIGHT MOMENT TO DO IT.
Occasionally, this excuse has the merit of actually being valid. Twitter creator Jack Dorsey had the idea for the service back in 2000. Unfortunately, the technology that would help Twitter thrive wasn’t in place yet. But how did he recognize this? Dorsey did a small-scale implementation of the idea that flopped. Even though it failed then, the exercise crystallized the idea in his mind, and Dorsey was able to revive it later when the timing was right. 

10. I HAVE TO PLAN EVERYTHING FIRST.
At this year’s 99% Conference, author and entrepreneur Frans Johansson argued that humans are very bad at predicting which ideas are going to be a success. Thus, nearly every major breakthrough innovation has been preceded by a string of failed or misguided executions. The moral of the story? Spend more time doing, and less time planning.

11. THE PRODUCTION IS TAKING TOO LONG.
Nobody ever said creative execution was sexy. In fact, it’s grueling. Author Junot Diaz battled writers block for 5 years before finishing his Pulitzer Prize-winning novel. Inventor James Dyson built over 5,000 prototypes before he found the right design for his vacuum. And the list goes on. We must find joy in the process of execution, not just the end product.

12. MY IDEA ISN’T POLISHED ENOUGH YET.
Charles Darwin spent 20 years developing his theory of natural selection, and planned to eventually publish his research in a multi-volume tome. But in 1858, he received a letter from the naturalist Alfred Russel Wallace essentially summarizing the theory he’d been cultivating over decades. Darwin scrapped his plans for a tome and quickly published his now-famous abstract, On the Origin of Species. Without Wallace nipping at his heels, though, how long might Darwin have gone on perfecting his world-changing theory? Sometimes it’s best to launch a project before it’s “perfect.” 

13. I NEED TO DO MARKET RESEARCH.
If you think about real, game-changing inventions and discoveries – the electric lightbulb, the double helix of DNA, the airplane – almost none of them had the support of the masses in the early days. Being a visionary means being able to see what other people can’t even imagine. That’s why companies like Apple don’t do market research. 

14. I HAVE YOUNG CHILDREN.
This excuse reminded us of a great piece from writer Rebecca Cantrell, who struggled with the impact her newborn had on her writing. Though initially she lost her will to work as she focused on child-rearing, Cantrell found – in watching her son’s willingness to experiment and fail and never give up – that the experience actually inspired her and improved her writing practice. 

15. I’VE GOT TO PAY THE BILLS.
Here's the big one for most physicians. Going with the status quo, we tend to give high priority to things like wealth and stability. And once we have them, it’s extremely difficult to imagine life without them. (To wit: “The three most harmful addictions are heroin, carbohydrates, and a monthly salary.”) But should these things come at the expense of pursuing big, bold ideas? Paying the bills won’t necessarily earn you a legacy.

The enjoyment of control and freedom isn't something that's ever going to be handed to you. You'll have to earn it through action.

You're a Physician. What Are You Worth?

You're a physician but what are you worth as a business asset? Here are 3 Ways to determine your price.

One of the key decisions every seller has to  make , whether it's a house, a business or any other asset for sale, is to detemine its value and price. I'm married to a residential real estate broker, one of the dwindling few left standing, it seems, in a business that's been in a tailspin for the last 3 years. Consequently, I hear lots of stories about how much people want for their houses and how they make the decision. Typically, sellers overprice, figuring that the largest drop in housing prices in 30 years does not apply to them, that they are entitled to recover every cent they spent on their gourmet kitchen renovation, and they need to build in some wiggle room in the price anyway since they know they will have to negotiate some away later. Then, of course, there is dreaded realtor's commission to factor into the equation.

When it comes to selling a business, there are three basic ways to value it.

The first approach is known as the Asset Based Approach. This approach derives an indication of value based on the costs to replace the tangible assets in depreciated or replacement cost condition. Some businesses for sale are generating negligible cash, so the assets are the only thing that has value. True, intangible assets, like intellectual property, and future market growth might have value, but let's keep this simple for now.

The Market Approach derives indications of value using ratios or factors derived from the earnings, sales and/or assets of past transactions of similar businesses. This approach is like getting comparables for house, asking what a similar house in a similar location has sold for in the recent past. In the case of businesses, the value is determined by comparing it to the selling prices of similar businesses.
 
The Income Approach derives indications of value by converting some level of earnings into a value using a capitalization rate, discount rate or multiple. There are several ways to calculate this net present value, but basically it has to do with using historical revenue numbers and applying a discount rate to determine the value of the revenue streams.

http://www.score.org/article_business_valuation.html

If you are considering branching out from your medical practice or leaving it all together, suppose you were to apply the same technique to valuing yourself?

Using the asset method, the monetary value of the chemicals and proteins in the human body is $4.50.

http://www.savingadvice.com/forums/everything-else/22337-how-much-your-body-worth.html

Using the comparables method, you are probably worth what most others who do what you do are worth. The average salary of a realtor, for example,  is about $45K and it is all commission based. But, don't tell that to all the ex-realtors trading resumes at Starbucks or Ms. Bigbucks still selling the occaisional multi-million McMansion.

Using the NPV method, you are worth the discounted net present value of the future cash flows you can generate compared to what you make doing what you are doing now.

Inevitably, despite the self-actualization talk, docs and  their families want to know how much they'd be worth if Mommy or Daddy did something different. Go figure.

Don't Be A Lame Doc

The lame duck Congress is scrambling to get things done before there is a shift in the balance of power.

The term “lame duck” originally applied to brokers who couldn’t pay their debts. Only later was it applied to Congress people still sitting but ousted in the previous election.  The 20^th Amendment to the US Constitution shortened the lame duck session from March 3 to January 3, but did not eliminate it. The present lame duck Congress has passed the tax cut extensions and repealed Don’t Ask Don’t Tell. This, despite the fact that lots of the votes are coming from senators and congress members voted out of office in November. American history is full of important lame duck decisions, like the decision President Buchanan made not to intercede when Southern states seceded or Bill Clinton’s impeachment hearings. Don’t make the same mistake. Once you decide to move on, move on quickly. Flip the switch and start anew. Give yourself permission to divorce your new self from your old self as quickly as possible.

How? Take a page from the smoking cessation playbook. http://www.webmd.com/smoking-cessation/quitting-tobacco-use-strategies-and-skills-for-quitting

Manage the stress with diet, exercise and relaxation

You will probably go through career alternation withdrawal syndrome (CAWS). Instead of taking nicotine gum,  treat the withdrawal symptoms with stress reduction techniques. Put the time and day of a 3x/week exercise schedule in your calendar. Pay more attention to what you eat and what you weigh. Give yourself at least 15 minutes of meditative relief each day.

Get support

You’ll need help getting through  the CAWS so surround yourself with allies and helpers. Read Freelance MD a lot and comment on the blogs describing what you are going through. Keep a journal.  Consult a career of executive coach if need be. Call 1-800-NEW-LIFE if necessary.

Make a plan and stick to it

My friend, a practicing infectious disease doctor, told the rest of the members of his group that he was moving on after graduating with his MBA last May. He’s still treating pneumonia. Break the plan down into small steps and reward yourself when you hit each benchmark successfully.

Keep reminding yourself of why you are doing this

Inevitably, self doubts will reappear and contradictory thoughts will re-emerge in your mind. Drive them out. When you hear “I can’t believe I’m doing this”, shut if off. When a little voice says “But I trained my whole life to be a doctor”, turn down the volume. Remember what motivated you in the first place.

Making a career modification or change takes courage and self-discipline. You can do this. Don’t be a lame doc.