Pasión por la medicina
How to Revive Career Satisfaction

By Lisette Hilton
Lisette Hilton is a writer for Physicians Practice

When physician recruitment firm Merritt, Hawkins & Associates polled 50- to 65-year-old physicians in 2004, 76 percent of them reported being less satisfied with the practice of medicine than when they began. Just over half — 52 percent — went so far as to say they wouldn’t choose medicine as a career if they had to do it over. Surprised? Probably not.

While physicians in the survey specified “patient relationships” and “intellectual stimulation” as their greatest sources of professional satisfaction, they said they were most frustrated by malpractice worries, Medicare/Medicaid regulations and the pressure of running a business. Some physicians contend medical school and residency instill in physicians a workaholic approach that, in the end, costs them career satisfaction and a healthy balance between their work and home lives.

Jim Welter, a former chief executive officer for large multispecialty group practices, and now a Chicago-based consultant, said physicians of all ages feel a loss of control. Physicians who came of age in the boom days of the 1970s are often frustrated with newer physicians who come in with different ideas about work schedules, distancing themselves from the endless hours of their predecessors in favor of new approaches like flex time and job sharing. Younger physicians sometimes feel overwhelmed by the larger role business acumen must play in their day-to-day practice, for which they feel unprepared.

As a result, some physicians have lost sight of the meaning of their work and their fulfillment in it, according to Hanna B. Sherman, M.D., a pediatrician who left clinical practice to become an independent educator and consultant focusing on physician well-being.

Change is good
In the worst cases, when physicians are no longer functioning effectively and may even exhibit behavior problems, they probably need to take a sabbatical, according to Welter. However, in less severe cases, there are some simple things physicians can do to help refuel their passion for the practice of medicine.

“There is a lot of self-examination that needs to be going on,” Welter said. “It is a time to start asking questions like ‘What is it that I am tolerating in my practice that I should no longer be tolerating? What am I doing in my practice that is no longer producing the results that I want?’”

“We all know in life that when our reserves are low — when we’re tired and don’t have anything more to draw from — that’s when things start not working for us. So it’s really important to get back some reserves,” Welter said.

How? Some suggestions include finding opportunities for new learning or adding new services, or altering your daily routine.

Howard Doyle, M.D., did not realize he needed a break from daily practice until he took one. Doyle, co-founder of Eye Associates of Boca Raton in Florida, had been in practice 18 years when he decided to do a three-month mini glaucoma fellowship at Harvard Medical School. The break and the learning gave his practice a necessary shot in the arm.

“When I got back I had more confidence in what I was doing in terms of seeing patients with glaucoma. I learned some new procedures, new techniques and things like that,” Doyle said.

He attended with well-known glaucoma physicians and established friendships. Years later, he continues to talk with those colleagues by phone and e-mail. Lifelong learning is key, Doyle said. “When you stop doing that, … it is not fair to you and it is not fair to patients,” he said.

In addition, take a look at the way you work in the practice on a day-to-day basis. There are some fairly simple changes that can make a world of difference.

Consider your schedule — how much control do you have to change it to meet your needs, while still being accessible to patients? People who have some flexibility over how their workday or workweek goes tend to feel less stressed. It might mean blocking out a couple of hours midday to get out for some exercise, then seeing patients in the early evening (when it might be more convenient for them).

Finding your balance
Physicians who are feeling distressed in practice often cite an inability to sustain balance between their personal and professional lives. A red flag: feeling like you’re pulled in too many directions and are not, in your mind, doing well in any of them.

“When I hear that [from physicians], the first thing that I think is they really need an opportunity to think about who they are — both in their personal [life] and how they express themselves as a physician,” Sherman said.

Think about the culture in your practice or organization. “The number-one thing a practice can do is have a medical director who can be the liaison between medical care and the financial [issues],” said William Clark, internist, who is also a course administrator for the American Academy on Physician and Patient, an organization that focuses on communication skills and professional renewal.

That doesn’t mean physicians shouldn’t keep an eye on the business; on the contrary, they must. But, the right systems and people should be in place so that, for the most part, the business runs smoothly without much physician micromanagement.

Sherman urges practices to “plan for flexibility,” whether it’s for a physician who wants to decrease his workload temporarily or needs to take leave for family reasons. Providing opportunities for physicians to support one another is also important, setting up mentoring or job-shadowing situations help physicians learn from one another.

“The practice [type] that people thrive best in is when they are flexible, and there is a mutual understanding that we all have multiple parts of our lives that are meaningful to us and that we can be highly committed to each of them,” Sherman said.

Completing today’s work today helps keep work from interfering with home life. Many physicians find it helpful to use templates for common types of visits, making it easy to document the physicals and sniffles without having to face stacks of files at the end of the day. Others employ the so-called “fourth exam room” in which physicians are scheduled for three consecutive patient visits, leaving the fourth time slot open for dictation and phone calls.

“As much as you can, complete the work while you’re still in the office so when you’re at home, you’re truly present,” said Sherman.

Getting to know you
While physicians are often taught to distance themselves from their emotional responses and remain objective and professional, Sherman believes they need to do just the opposite in order to nurture their own appreciation of what they do. She said physicians should be deliberate in recognizing their emotional responses to experiences; understanding what those responses mean to themselves and how they relate to their patients’ experiences; and using that understanding to effectively provide patient care.

An example of being reflective is practicing “narrative medicine,” in which physicians write their experiences in journals or take time to share them with colleagues.

Developing a supportive community of colleagues, family, friends or staff can also help physicians get back the meaning of their work. Sherman runs group meetings with physicians where they self-reflect and share stories with one other.

“Time and time again I have physicians — many of whom are leaders — say, ‘I have never felt such kinship with another physician,’” Sherman said. “There is always the sense of huge relief and joy of connecting on common ground.”

In today’s challenging medical environment, physicians owe it to themselves and their patients to rediscover the passion in their work.

“I think we have to be models of well-being for our patients and for society,” Sherman said. “It allows us to provide better quality of care that is relationship-based and to sustain ourselves throughout our careers.”

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