After Clinical Medicine, What’s The Next Chapter Of Your Life?

Professional coaching could be “just what the doctor ordered” for those seeking help in finding and following their call.  

A growing number of physicians are disenchanted with their clinical practice but may have difficulty pursuing a new calling.  The resulting dilemma creates an opening for a coaching relationship.  A professional coach—such as Freelance MD author, Ashley Wendell —could be the right “prescription” for physicians in transition.          

Deep within every heart is a longing for meaning, a quest for purpose.  But for most of us, the search for meaning is a journey.  And physicians are no exception.  They will need a plan for the journey, a roadmap for success.  When they get to a “fork in the road,” they may need help in deciding which way to go.  They may encounter dangers and detours along the way and need guidance to be able to slow down and avoid disaster.  And, they will need a friend for the journey.

1.  Callings: In Search of a Real Life

Calls may come in many disguises.  They may be calls to do something or calls to be something.  They may be calls toward something or calls away from something.  They may be calls to change something.  Or they may be calls toward whatever we’ve dared ourselves to do for as long as we can remember.

Coaches can help their physician clients explore the psychological, spiritual, and practical processes they encounter in listening and responding to their callings.  While honoring a calling’s essential mystery, coaches may also help their physician clients explore the questions that bloom naturally in the presence of a calling:  What does it ask of us?  How do we learn to separate our calls from the background noise in our lives?  How do we tell the true call from the siren call—an enticing appeal for something alluring but potentially dangerous.  How do we handle our resistance to it?

The challenge in coaching is to help us know whether our calls are true or false, to know how and when to respond to them, and to know whether a call really belongs to us or not.  This requires the coach to help their clients tread a path between two essential questions: “what is right for me?” and “where am I willing to be led?”

2.  Finding Your Call    

Coaching can help physicians “find their path” by exploring what their life and talents are calling them to “do.” Coaches can facilitate this process by helping their clients clarify their values, beliefs, and purpose. 

Perhaps the biggest challenge in helping physicians find their path is to get them to slow down or stop long enough to “take the call.”  We belong to a work-obsessesed culture whose busyness-as–usual makes us forget when to “knock-off,” or stop doing something.    

Coaching can also help cultivate the key social roles and relationships of their clients.  This can help them define how they will schedule their time in to specific roles and activities that represent what their passion and purpose are all about.  Similarly, it can be used to help them define what roles and activities in their current schedule need to be reduced or eliminated if they are going to live with authenticity.

The next step is to help their clients learn to stop looking for answers.  Instead, they should concentrate on asking questions.  Asking questions seems to engage us in a way that makes hearing our inner guidance more possible.  Nothing shapes our lives so much as the questions we ask.

3.  Turning Resistance Into Response

We all have a part of us that fears change and reacts to it with a reflexive flinch, the way snails recoil at the touch.  A calling, however, is a messenger of change, and by ignoring it, we risk the corrosive effects of avoidance and tempt wake up calls.  Responding to a call means doing something about it.  A calling requires action, decision-making, and change.

Resistance may actually be a good sign.  It could mean we are close to something vital and the calling is worthy of us.  The degree of resistance is usually equal to the amount of power waiting to be unleashed.  Coaches can provide the “push,” much like an eagle in teaching its young to soar.

If the calling we seek becomes the treasures, the obstacles to their path become the tests of commitment.  We must be willing to be “shaken up.”  Stress often prompts breakthroughs, crises point toward opportunities.  A call “rocks the boat” because it often points to our passions.

Generally, people won’t pursue their callings until the pain of doing so is exceeded by the pain of not doing so.  The main reason we ignore calls is that we know they will cost us something.  To be authentic, we may have to give up something dear—a job, a house, a relationship, a belief, and a lifestyle to which we’ve become accustomed. 

It is one thing to ask ourselves the question, “What do I want?”  It is another to ask ourselves—and to answer honestly: “What am I willing to give up or do to make this happen?”  This is sacrifice—the “letting go” of something we feel is “holy” in our lives.  It means stepping out of our “at home feeling” and leaving the familiar surroundings of our “birdcage.”  Every sacrifice, every step toward action, every response to a call necessitates a “leap of faith” and is done without knowing the outcome. 

Coaching can help us look at how we resist our callings, and what the challenges and blessings are from moving from “No” to “Yes.” Do we experience complete freedom to step out and make the most of our abilities?  Or are we hindered, like many people, by our own doubts or your capabilities to fulfill our potential? 

Coaching may help us discover how to overcome our trials, setbacks, and self-doubt as we press toward the reality of experiencing you dreams.  The focus can be shifted from “Why is this happening to me?” to “What is the teaching here?” and “What can I learn from this?”

4.  Following Your Calling

Much like college students who struggle to declare a major, students in the “school of life” often struggle to know and follow their passions.  They exert great effort to negotiate the tight passages of career choice or career transition and to create a match between who they are and what they do—the best kind of success.  These decisions need to be made from the heart more than the head.  What’s at stake is a life of integrity, a life that honors passion and purpose. 

Some may need all the help they can get in following their calls.  Coaches can serve not only as their guide but also their friend. 

Coaches can help their clients identify the emerging development tasks in your vision of the future, formulated as a “plan” for the next chapter of your lives.  Coaches can also help their clients create a vital learning agenda, and make learning a major part of the next chapter of their lives.  With this tool, they can learn when and how to take advantage of change in their lives by “holding on” to their values, “letting go” of bad habits, “taking on” new knowledge and skills, and “moving on” with their plan for the next chapter of their lives.

A growing number of physicians are looking for a practical guide to discovering their calling.  They need help in nurturing the process of listening and following their calling, for creating meaning in their life and work.  Professional coaching can provide the guidance they need to ensure a successful journey.

Getting Started In International Medicine

Alright, so you want a career in international medicine.  Where do you begin?

You’ve finished your specialty training and you’re looking for opportunities to work overseas.  Great.  You know how to run a code and diagnose a pneumonia.  Fantastic.

Now the work begins.

International medicine is such a broad field that whenever I am approached by a physician who wants to work overseas I always ask them to tell me a little about their overall goals.  Do you want to make international medicine a career pursuit?  Is your goal to work short-term in a variety of locations while holding a full-time position back home?   Where do you see yourself in 5-10 years?

It’s true that life has a way of rerouting even our best-laid plans, but it’s always better to have some sort of plan before embarking on a new career pursuit.  For those that don’t really know where to begin, I recommend the following:

1. Just get some experience

You can’t go wrong just getting a few short trips under your belt.  Whether you want to simply dabble in international health as a side career or begin to build a full-time career as an international medicine specialist with hopes of leading  a non-governmental organization (NGO) or academic research group, the place to start is with a few short volunteer trips.  No NGO or credible organization is going to actually pay you to do international health if you’ve never worked “in the field.” If you ask any seasoned person in international medicine, they always say time in the field is one of the biggest criteria they have for important hires.  You might be brilliant. You might have great “people skills.”  You might have incredible letters of recommendation, but if you’ve never packed your bags and lived in a remote place for a time providing medical care, then you’re basically an untested commodity.  No credible organization will take a chance on an untested person and place them in a position of responsibility if they can avoid it.  If you want to make international health a part of your life, you need to get some experience.

Where do you go to get experience?  Well, there are two easy places to begin.

First, visit your local faith centers or nonprofits and see if there are any positions available for volunteer physicians overseas.  In today’s world, you’d be surprised how many local religious organizations and nonprofits are sending people to obscure places and would absolutely love to have a physician come along (especially if the physician is paying their own way—and you need to be prepared to pay your own way in the beginning).  This is a great way to practice preparing for a trip, evaluating the medical gear you will and will not need, working with others (not a physician strong suit typically), and working in an unfamiliar environment.  Many individuals who go on to formal international medicine careers begin as volunteers in positions just like this. 

Second, there are multiple locum tenens companies who are placing more and more physicians in foreign environments.  Obviously, working in a fully staffed hospital in Australia is much different than working in a remote clinic like the Everest Base Camp ER, but you have to start somewhere and using a locums company like Global Medical Staffing to get your initial experience internationally can be a good place to start. 

2. Network

I’m not a fan of joining organizations simply for the sake of joining. However, there is a lot to be said for joining a couple of organizations in the beginning and attending a few medical conferences designed for international medicine, especially if you don’t have a lot of connections in these fields already.

In the United States, the three organizations that seem to most help individuals looking for opportunities in international medicine are (in no particular order) the Wilderness Medical Society (WMS), the International Society of Travel Medicine (ISTM), and The American Society of Tropical Medicine and Hygiene (ASTMH).  All of these organizations offer medical conferences where you can meet potential mentors and network with other event participants.  In addition to these organizations, there are a couple of private conferences that always garner great participant reviews.  The first is our ExpedMed events (yes, I direct these events and I am biased, but we do get great reviews and we draw top talent from the WMS, ISTM, and ASTMH, as well as many academic institutions, as speakers each year).  Information on ExpedMed can be found at www.ExpedMed.org  .  The other private group that always receives great reviews are the folks at  www.Wilderness-Medicine.com  .  Yes, I guess the reality is that these guys are really competitors of ExpedMed, but we use some of the same faculty and we consider them friends, so I don’t have a problem recommending them. 

I’m sure there are plenty of other great organizations and events that I could mention here, but these are the ones I hear about the most and the ones with which I have personal experience.  If you need a good place to start, I’d begin with one of these entities.

3.  Read

It goes without saying that if you’re interested in a career in international medicine you should be reading about the subject.  There are some great journals and textbooks out there, including our Expedition & Wilderness Medicine textbook, but don’t just stop there.  Read blogs about international medicine.  Get some adventure stories that are non-medical but involve international health in some fashion (Shackleton’s adventure for instance or Teddy Roosevelt’s River of Doubt journey).  Use these resources to not only stimulate your desire to travel but also to learn the history of the field you’re entering.  Oh, and when you read the academic work, don’t just read for clinical knowledge, read to see who the authors are and where they’re working. Look through the bibliography and see who is cited and where the research is taking place.  You never know where this sort of “sleuthing” might take you or what connections you might make.

4. Investigate formal training opportunities

I say "investigate" because depending on your career goals you may or may not need/want formal training. However, it's worth looking into since there are some great programs to teach things like tropical medicine or public health in disaster situations.

For Emergency Medicine specialists, formal fellowships in International Emergency Medicine are available around the country.  I completed one of these programs at Johns Hopkins in 2004, and really enjoyed the experience.  I wrote a prior post on the subject of International Emergency Medicine and for EM docs looking to move into the world of international medicine in a formal way, a fellowship is a great way to jump-start the process.

If tropical medicine is your thing, there are some excellent 3-4 month courses around the world that offer intensive tropical medicine education.  The two most famous are the Gorgas Course in Lima, Peru, and the course at the London School of Hygiene & Tropical Medicine.  I have friends who have graduated from and teach at these events and both are widely respected. You can check out a prior post here on Freelance MD that serves as an introduction to these courses.

The Health Emergencies in Large Populations (HELP) course is a great way to get exposure to handling public health issues after disasters (more information on this course can be found here ), and for those who really want to go deep, a Masters degree in Public Health from a university with an international focus like Hopkins or Harvard, will significantly broaden your view while deepening your understanding of international public health issues.

These tips should get you going and when you have some experience under your belt and some colleagues in the field to call, you’ll be surprised at the opportunities that begin presenting themselves.  

Patient Protection & Affordable Care Act, A British Perspective

By Dr. Diego Fox

Patient Protection and Affordable Care Act, a British perspective

It has long been a commonly held British view that falling ill in the United States of America can be a very expensive business for the patient. When President Obama declared his intention to address this problem, many here naturally assumed he intended to introduce an American version of our NHS. We also naturally assumed that this idea would be almost universally welcomed by Americans. The subsequent bitter and sustained opposition is something few Brits can understand, particularly when it is seen that the proposed changes are, to us, just a tiny step towards what we were perhaps expecting.

To understand our perception you first would have to understand a little of our system of healthcare.

At the beginning of the twentieth century in the coal mining communities of the Welsh valleys a new means of health provision was being tried. Every employee would contribute a small part of his wages into a central fund. This fund was used to enable the community to employ one or more doctors, who would then provide health care to the miners and their families. No payment was required for treatment, but only those who paid into the scheme could benefit. Some schemes were even able to provide for a hospital, such as the one at Tredegar, which opened in 1904.

These schemes were run by trustees, one of whom was Aneurin Bevan, who subsequently became government Minister for Health, just after the second world war. In 1948 he applied exactly this scheme on a national scale as the National Health Service. Literally overnight, on July 5 1948, almost every hospital in Britain became state owned and run, and almost every hospital doctor became a state employee. General practitioners, although supposedly independent, were nonetheless paid by the state also. The system is paid for by a specific tax, “National Insurance”, paid by all employees, and there is also an employer contribution for each worker. This contribution is compulsory.

Despite 15 major reorganisations since 1948 these principles remain. Most hospitals remain state owned, and virtually all doctors are employed, directly or indirectly by the state. To this day no patient is ever asked for money for NHS treatment. The medical profession, who in 1948, bitterly opposed the inception of the NHS are now almost to a man totally committed to it. Any perceived threat to the NHS arouses the most bitter and universal opposition from doctors and the general population alike.

Compared to the creation of the NHS, the US reforms are modest indeed. In essence there is to be some extension in eligibility for the already existing medicare and medicaid. There is also to be improvement in affordability of health insurance, and assistance with premiums for those of low/moderate income. These are hardly ground shaking changes. Also firms are to be encouraged to make provision for employee’s healthcare, something better employers do already.

So what the objectors are so angry about is difficult to understand, certainly to us in the UK. I have had a good look at a web site called obamacaretruth.org  where many of the arguments are cited to try and get a feel for the objections and I am still really none the wiser. I was particularly interested that they cited the Stafford scandal, implying that the entire NHS is like that. Now the NHS has many imperfections and if I were to go into them this article would double in length. But In fact although one or two places have caused serious concern the vast majority of our patients in the UK view their experiences of NHS care in a very positive light. Most are grateful and appreciative. Particularly those who have had expensive treatment of life threatening conditions, without having to worry about paying for it.

I am left with the impression that the objections boil down to a perception that those who will get free healthcare are somehow “freeloading”, as if they get deliberately ill in order to get free treatment.

So should the American medical profession have anything to fear from the reforms? I can’t see that they should. Unlike the NHS, American  hospitals are not about to be taken over by the government, and doctors are not about to be forced to work for the state. As far as doctors are concerned it should be very much business as usual.

It has long been a source of puzzlement to Europeans that the richest country in the world should be so reluctant to provide decent health cover for it’s poor. Is this because in Europe decent healthcare is considered a right, whereas in the US it is considered a commodity? It is my view that one of the hallmarks of a truly civilised nation is that it looks after it’s sick. Aneurin Bevan thought exactly the same when he said, “We ought to take pride in the fact that, despite our financial and economic anxieties, we are still able to do the most civilised thing in the world - put the welfare of the sick in front of every other consideration.”

The US healthcare reforms are a long way short of providing this ideal, but they are a small step in that direction. If even this small step fails the rest of the civilised world will simply not understand.

About: Dr. Diego Fox (Dr Zorro) is a full time NHS Consultant in his late 50s. He blogs at http://vulpesmax.blogspot.com

Submit a guest post and be heard.

Emergent Field Medicine

In a prior post I mentioned the Health Emergencies in Large Populations (HELP) course for those who are interested in working in disaster areas providing humanitarian assistance.

Reviewing information about the HELP course reminded me of a great manual for those interested in humanitarian assistance.

The book Emergent Field Medicine was published a few years ago to help those who are providing care in under-developed regions and disaster areas.  My view of this textbook is biased– mainly because I am friends with a number of the editors and contributors of this text– but I still believe it is a great tool for anyone going to a remote area to provide care.

The text was written by a stellar group of experts and provides an overview of a variety of topics including public health, tropical infectious disease, refugee health, nutrition, and dental emergencies to name a few.  The format provides a reader with information that is easily accessible and of appropriate depth for a field manual.

For those who are considering working in a remote area, Emergent Field Medicine is a good way to prepare before you go, and a good resource to use while you’re away.

Physician Investing: Vacation Home Rentals - Part 2

In my last post I discussed the pros and cons of vacation home rentals.

By way of example, I will tell you about our experience. We have a guest house on the spectacular Mendocino Coast of Northern California. It is part of our large ocean-view DragonMist Estate property we have for our primary residence. When are son went off to college, he in no uncertain terms informed us that he would not be a "failure to launch" candidate and would not be returning home, other than occasional respites (for some home cooking and laundry).  So we took a long and hard look at our property, our expenses and most important our life style in this empty nest portion of our lives.  It became obvious that there was no reason why the property couldn't start paying for itself.  So we started looking at managing our own vacation home rental.

The first step was converting part of our primary residence to a rental.  The guest house was originally designed to house friends and family when they came up from Southern California or points beyond for a visit. We wanted that extra space so our guests would feel comfortable and so that we didn't have to give up our living space to accommodate them.  A planning point - when we asked our architect why the closet in one of the guest bedrooms in our main house was so small, he said that if our guests are staying longer than a couple of days, then they should be staying in the guest house.  

Our guest house is connected to the main house by way of our recreation room.  But to provide privacy for our guests and once again, to lessen the impact on us, the guest house has its own private entrance and parking.  We also built in a small kitchen. There are two bedrooms, one and a half baths, fireplace and living and dining areas. Immediately outside is an eight-person ocean-view jacuzzi spa. 

So when we decided to rent the guest house to the public, we felt that we already had a good start.  But it was also obvious that we needed to make some modifications to make it appropriate for public guests versus personal friends and family. The first thing was privacy. To enhance the ocean view, we had originally designed the bedrooms and living space without doors and no window coverings.  After all, the deer didn't mind us looking at them.  So we installed privacy shades on the windows.  We then installed screens for the upstairs loft bedroom and sliding doors for the downstairs bedroom. We also installed a built-in combination lock on the guest house front door.  For each guest, we re-program the combination to the guest's zip code. That way it's easy for them to remember it.  

We would give the guests access to all the outdoor amenities - jacuzzi, firepit, barbecue, tree swing, horseshoes, bocce, basketball, ocean view benches and all the walking trails. And we would go out of our way to stay out of their way, unless they want to contact us.

Now we felt it was time to market our new rental. We knew that the internet was the obvious choice, and after much research agreed upon using the VRBO.com (Vacation Rental By Owner) site.  They are also linked with Home Away.  There are other internet vacation home rental sites that we may soon explore and start using, but we've have tremendous success with VRBO.  Costs per year are several hundred dollars but you'll never find more cost-effective marketing.  You create a description of your property, download digital pictures, and set up your rates and your reservation calendar. You change all the above at any time with a click of the mouse.  The guests make an email inquiry. You can email them a reservation contract and arrange payment.

We have been renting our guest house now for about a year and a half, and it has overwhelmingly been a positive experience.  We have had guests from 18 states and 3 countries.  With very few exceptions, the guests have been delightful and have all appreciated opening our house and property to them. We've had many return guests and they can easily post their comments on our VRBO site.  Check us out at "VRBO.com" and look at Listing # 213704. View our listing here. 

Maybe, we'll even see you on Mendocino Coast as our guests!

Medical Fusion in the "News"

The good folks at Health 2.0 mentioned our Medical Fusion Conference in one of their recent News &Updates posts.

You can check out their news piece here. We've been told this particular news post has already had a large number of page views, so we're happy to keep the momentum rolling.

It's exciting for us here at Freelance MD to see more and more people become enthusiastic about Medical Fusion and our other learning opportunities.  Thanks to Health 2.0 for helping spread the word.

Be sure to stop by the Health 2.0 site sometime and try to attend one of their inspiring events in the near future.

It's The Hard Docs Life

Clinical medicine still has some humor left.

I ran accross ZdoggMD (Zubin Damania MD) on LinkedIn. He's a doc that has a rather specialized niche in medical comedy and produces music videos like this one. 

Thanks to ZdoggMD.com

Yo, ZDoggMD dropping some mad verse ’bout the struggles of being a hospitalist. Strictly for my homies!

Here are the lyrics.

It’s the Hard Doc’s Life for us
Hospital Doc’s Life for us
Specialists, they got it made
We do the work while they get paid
It’s the Hard Doc’s Life

From standing on the unit roundin’
To learning some of the thickest charts a doc has ever seen
and hearing some of the sickest hearts a doc has ever heard
Do the weekend, working nights and, all the shifts between
You know me well from Pull & Pray and the Ulcer Rap
Still I take crap from insurance and the housestaff
Eff that

To PCPs treatin’ sick folks
Mad props
While the consultant’s tellin’ dick jokes
That flop

I fill out paperwork all day long
No doubt
Then nurses tell me that I did it wrong
White out

See 20 patients but get paid squat, uh uh
The radiologist just bought a yacht, what the?!?
Nurses be laughin’ at the ties I bought
Shop frugally and save money at Marshalls and Ross
Payless
They call a code when I come thru
Just don’t be asking me to run it, man, I got notes to do.

It’s the Hard Doc’s Life for us
Orthopods consulting us
See their train wrecks every day
They fix the bone then walk away
It’s the Hard Doc’s Life

I flow for those gomed out; sundowning
Locked down in the Posey vest, just tryin’ to bust out
I roll with old folks, got no veins for IV pokes
Septic and found down, in stool, a Code Brown
Yellow gown itchin’, deep in debt from med school tuition
c diff, MRSA, up in my kitchen?!?

Intern’s bitchin’ bout work hours, he’s checkin’ the clock
But I’mma be on call whether I’m on call or not
We went from lukewarm to hot; fillin’ the hospitals with docs
Who practice evidence based logic like Spock
Straight talk from my homies who work in the ED
Mad luv, ‘less you’re calling ’bout another syncope
I disagree with the phony UM docs, mess with my homies
I’m like still, y’all don’t control me, s***
I like to bill, but when my patient census ain’t improving
I’m tryin’ to dispo everything moving

It’s the Hard Doc’s Life for us
Too many patients for each of us
Try to discharge, make ‘em pack
Overdo it, they bounce back
It’s the Hard Doc’s Life for us
Hospital Doc’s Life for us
Hardest job we’ll ever do
Next to cleanin’ baby poo
It’s the Hard Doc’s Life

About: Zubin Damania MD is a physician specializing in inpatient internal medicine and a member of the multi-specialty Palo Alto Medical Foundation. He practices at Stanford University Medical Center and Washington Hospital (in Fremont, CA). His current project merges his medical background with his extensive experience teaching and performing stand-up comedy for diverse audiences. As ZDoggMD, he writes, performs, produces, and distributes satirical yet educational videos and music relating to important topics in healthcare.