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Success Stories

DOCTOR AS PATIENT

Can your work be a worthy expression of who you are?
Stephen Rosen, PhD and Celia Paul, MSW*

1. SYMPTOMS

His resume began, “Experienced M.D. with outstanding communication skills, proven record of business success, enthusiasm, dedication to relationship building and education within the medical community”.

      But in person he described his career circumstances differently: “I have not enjoyed much satisfaction in the practice of medicine. I would like to lose the pager and the angst…be able to express myself more creatively…have more time...perhaps eliminate my clinical practice…realistically explore my options.” (Full disclosure: we help physicians with their career complaints.)

       There’s no name for his condition in the Diagnostic and Statistical Manual of Mental Disorders (DSM). We call it 'career malaise', 'burn-out', 'discontented doctor syndrome', which may generate serious consequences. Tormented or dispirited physicians can bring about adverse outcomes in patient care and hospital safety.

      Twenty (or even ten) years ago, this kind of talk was not heard among physicians, and patients rarely knew (or cared) whether their doctor was happy or not. Physicians confessing to career disappointment were embarrassing, considered tantamount to acknowledging a character flaw, or admitting personal or professional failure.

      Not any more.

2. INVESTIGATION

Dr. Robert Neville (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 “healthy skepticism” about the methodology and process of making a career transition, and was hesitant to pay for career counseling services until he scrutinized detailed statistics and references on the past performance of the career management professionals he found on the web (us), 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 was not a matter of “Doctor: Heal thyself.” It was “three heads are better than one,” coupled with a suite of modern career diagnostic tests, paper-and-pencil exercises, cognitive ‘instruments’; a complete assessment of his most-enjoyable skills, personal and professional priorities; lengthy conversations about his symptoms, complaints, career angst and career assets. And interview practice using video-tape feedback to help him practice presenting his most positive and truest answers during stressful real-life job interviews. We have found that this improves physicians’ performance, no matter how good they are beforehand at job interviews. There is a learning curve—whether practicing surgical skills or practicing job interviewing skills. Further, video feedback is much more persuasive teacher than lecturing or hectoring a job-seeking candidate because they themselves actually see what they’re doing well, and which answers need work.

The first of a series of diagnostic tests revealed lack of balance, a disconnect, between Dr. Neville’s life and his life’s work. He enjoyed life. But his work was anguish.

‘Disgruntled’ was not strong enough to describe it; but ‘depressed’ didn’t capture his angst either. He enjoyed his hobbies, his relationships; he was not paralyzed with depression -- the ‘walking-in-lead-boots’ feeling that some of our other physician-clients so vividly present.

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

It is true that physicians find creativity in their profession. It is true that 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 to receive emotional satisfaction. It is true that a few physicians are even able to say, as one of our former clients said, “My work is a worthy expression of who I am.” But these are rare chosen ones who know early what they want to be, and who then stay engaged in a challenging profession during a productive life-time in straight-ahead pursuit of their work as meaning-and-purpose, as a ‘worthy expression of their well-lived lives’. Hippocrates, Galen, Maimonides, Albert Schweitzer come to mind.

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 had a career as a professional entertainer and performer.

Moreover, this outlet for his “creative expression” was neglected or missing from his life when he came to us for help to seek 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, of college major, of medical school, of medical specialty, of clinical practice) were, “safety, security, practicality, and compensation”. He said, “I have considered leaving medicine from day one, although it took me years to admit my dissatisfaction to myself—and [even] more years to admit it to anyone else. I have never felt fulfilled in my medical career, even though I am very optimistic about the rest of my life.”

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

After interpreting and discussing the test results together, we were able to identify 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 with 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 job-market data 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?”

All of the research on this process led to vast amounts of information. We insist on calling this “information-gathering,” not “networking,” because most people think networking means asking people you barely know for a job. In fact, all the studies show that people you know are not likely to know enough about your next job or career to be of much help -- but people they know, and people who know people they know, can be very helpful about the new direction if you know how to approach them properly.

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 any and 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 state of “total immersion” in the process -- in much the same way a surgeon prepares for a delicate operation, a lawyer prepares for a court appearance, or a scientist keeps a lab notebook.

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 enough 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, and so that you use your time efficiently and effectively.

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!” But with a little feedback and rehearsal, he was able to go from a five out of a possible ten (his initial evaluation of his practice session) to a nine out of ten (our evaluation).

2. RESOLUTION

This turned out to be a successful ‘career 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 (polished by job-interview practice) dove-tailed with the job specifications. His update on his new career: “…it’s great fun. I am enjoying the professional interaction, the travel, and the freedom to set my own schedule. The work is challenging…and there is great camaraderie…My computer skills are a great asset….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.”

His new compensation exceeded what he was earning in his clinical practice. ###