The Three Stages of a Physician's Career

Navigating from Training to Beyond Retirement

Neil Baum, Peter Moskowitz, Joel Blau

• Publisher: American Association for Physician Leadership
• Year: 2017
• ISBN:
  9780998498515
• Topic: Medicine
• Subtopic: Public Health, Administration & Care

Today's medical graduates are superbly trained to practice state-of-the art clinical medicine. However, only in rare instances are they trained to self-manage their careers and medical practices. This book fills that gap in training and knowledge. To assist students, interns, residents, fellows, and practicing physicians manage the many challenges of their career, the authors have divided physicians careers into three stages: Early-Career, Mid-Career, and Late-Career.

The goal of this book is to provide a go-to resource on strategic career and practice management, highlighting the unique issues, concerns and challenges doctors face during these three, very different stages of their career from medical school through post-retirement. This book, featuring insights from physician career and practice management experts, is an invaluable treasure trove of practical, hands-on advice from an author team gathering their expertise in one place. Jam-packed with easy-to-implement suggestions, you'll hear sage advice from a career coach for physicians, two certified financial planners, a healthcare attorney, a medical school dean for student advising, two experts who launch, merge, and sell physician practices, and a surgeon who literally wrote the book, on the business aspects of running a medical practice.

All are recognized authorities in their field, and the authors are joined by a distinguished group of contributors including, Randy Bauman, Keith Borglum, Thomas Shapira, and Dr. Neil Gesundheit. The contributors have decades of experience writing about the career and/or practice issues of physicians, and advising physicians and physicians-in-training.

The Early-Career section provides in-depth descriptions of career theory, choosing a medical field, renewing and balancing yourself, managing career transitions, and practical guidelines to navigate the many other challenges of early careers in medicine.

The Mid-Career section offers the broadest and most detailed information available regarding practice organization and management, building assets and retirement planning, estate planning, common legal issues, and how to manage the challenges of malpractice and/or impairment.

The Late-Career section covers deciding what to do after practice, closing the doors or selling a practice, and evolving estate and practice priorities so there is joy in a well-planned retirement filled with fun, meaning, and contribution.

This book will become your go to resource for critical topics such as these:

• Modern Career Theory as it pertains to medical careers
• Defining & managing the 3 types of medical career transitions.
• How to transition to a non-clinical career
• How to choose your area of medical specialization
• Self-Renewal, work-life balance, and the unique balance challenges of students and trainees
• The essentials of landing your first job

Chapter 1

Understanding Modern Career Theory

Peter S. Moskowitz, MD

Physicians raised in the 1950s, ’60s, and ’70s grew up with a set of assumptions about life and work. The most important of these assumptions was that careers were linear—that the harder and longer one worked, the greater the rewards from work. This Linear Rule is no longer valid in today’s rapidly evolving workplace. In its place is the Circular Rule, which stipulates that careers are cyclical over time and the phases of the cycle are predictable.

Career Transition Theory: The Career Cycle

To be more effective in the workplace and in managing their careers, physicians should understand this career cycle, which is illustrated by the Cycle of Renewal (Figure 1-1). The Cycle of Renewal is a conceptual representation of how careers and relationships change with time. Largely the work of Frederic Hudson,1 the Cycle of Renewal includes four quadrants that represent career phases:

Phase I: Go For It

Phase Two: The Doldrums

Phase Three: Cocooning

Phase Four: Getting Ready

The following is a description of each phase, as seen through the lens of a practicing physician.2

Phase 1: Go For It

This is the first phase we enter when we’ve completed our training and education. It is the phase during which we land our first “real” jobs and are excited about our career and what it holds. It is a time of building our practice. We have all the new knowledge, are energetic, and love what we are doing. Physicians often buy their first home and have their children during this phase.

We are living the American dream and believe that it will go on like this forever—and no one tells us otherwise. However, for 95% of us, the bliss of the Go For It phase does not go on forever. Eventually we reach a plateau. Things begin to change for the worse and we slowly begin to move into Phase 2.

Phase 2: The Doldrums

The Doldrums phase usually begins with a subtle shift in attitude. What used to be an exciting job starts to become dreary, dull, and boring. The partners we used to enjoy and find stimulating are beginning to become a pain in the rear. We no longer agree with the decisions and directions of our work partners. We lose interest in reading our medical journals. We find ourselves antsy with patients, lacking empathy, distracted. We get into conflicts with our co-workers and patients more often. We blame the system, hospital managers, and managed care.

We feel like victims, powerless to change the system. We long for things to return to the way they were in Phase I. We secretly feel guilty and depressed for having these feelings and are reluctant to discuss them with colleagues and friends. Or, we deny these thoughts and feelings as long as we can, preferring to suffer in silence.

Eventually we may begin to self-medicate with work, alcohol, prescription drugs, sex, gambling, or other unhealthy behaviors to escape the feeling of being trapped by our lifestyle and our own expectations and those of others.

Some stay stuck in this stage for many years. Others eventually “hit the wall” and experience a crisis of self-confidence and self-doubt that erupts into their work and relationships. We ease into Phase 3.

Phase 3: Cocooning

Cocooning is a phase of low energy in which we reduce our commitments to career and devote an increasing amount of time to self-exploration. It is a time when we deliberately slow down and work less. It is a time for thinking and being, rather than doing. We spend time alone in quiet reflection.

For some, it may mean taking a sabbatical; for others, it may mean taking an extra day off each week, taking an extra hour each day at lunch and going for a long walk alone, or reading alone for an hour or two each day. Some physicians participate in psychotherapy or career coaching.

This is a time to reevaluate and decide what is truly important in our lives. What is our purpose? What are our values and passions? What is our calling? These are questions we may not have thought about since our college days. We have not taken the time to allow our life experience and personal growth to catch up with our vision of who we were in our 20s. For many of us, our values and purpose have shifted and left us out of synch with the values and expectations of our current workplace. As we explore and re-familiarize ourselves with who we have become, we slowly enter Phase 4.

Phase 4: Getting Ready

Our self-assessment has uncovered past interests, hobbies, and passions that we had to abandon during the rigorous years of education and training. Perhaps they are things we had always intended to learn about, but ran out of time and energy. In Phase 4, we begin to explore them.

We take night classes at the local community college. We read books. We find that we have aptitudes we never knew we had. We re-engage with old interests, hobbies, and sports. We discover new talents, abilities, and passions. Some of these bring such joy that we want to do them more regularly. Some of these things may even open the door to potentially profitable new careers!

Intrigued, we begin to network with people who are doing those things as a career, learn how they got their breaks, what the outlook is for these careers, and how much money can be made—this is called informational interviewing. We make new commitments to move forward with those new dreams. This may require more education, perhaps a master’s degree, a new residency, a new professional degree, or some form of professional certification training.

This career change fills up Phase 4. Eventually, we are retrained and acquire new skills and abilities. We begin a new career, a substantially different clinical career, non-clinical career, or a new career outside of healthcare. As we put that new training into action, we find ourselves back in Phase 1 again. But this time we’re older, wiser, with new skills, and enjoying a career that is substantially different than the one we began many years earlier.

Back to the Beginning

For most professionals, a trip around the periphery of the career cycle map takes a couple of years—although for some, the trip is shorter or longer. What is certain is that working with a career coach or career counselor will shorten the duration of your trip around the cycle to get back to Go For It.

There is the option of cutting across the career cycle, going directly from the Doldrums back to Go For It, in a move known as a mini-transition. Mini-transitions have one important advantage over full-career transitions: mini-transitions typically take six months or less. Mini-transitions are discussed in greater detail in Chapter 8.

Knowledge of the fo...

Table of contents

• Dedication
• About the Authors
• About the Contributors
• Introduction
• Chapter 1
• Chapter 2
• Chapter 3
• Chapter 4
• Chapter 5
• Chapter 6
• Chapter 7
• Chapter 8
• Managing a Practice or Career Transition
• Chapter 9
• Chapter 10
• Chapter 11
• Chapter 12
• Managing the Unwanted: Malpractice, Disability, and Impairment
• Chapter 13
• Chapter 14
• Chapter 15
• Chapter 16
• Afterword