Take Control of Your Career
Decreasing independence, not
declining dollars, is driving doctors from the profession. By taking
control of things you can, you can re-instill pleasure in your practice or
create a plan for a new career.
By robert f. priddy...Published May/June 2004
Physicians are seeking to leave practice in
unprecedented numbers. Recent studies by medical associations and
recruiter groups indicate that one in four graduating medical residents
would not choose medicine as their course of study if they could restart
their educations,1 and 44 percent of practicing physicians age 50 to 65
are planning a major career change in the next one to three
years.2Why are so many physicians looking
elsewhere for career options? The specific answers are as many and varied
as the physicians.
For experienced practitioners, the
reasons range from the high and increasing cost and/or unavailability of
malpractice coverage, to the “corporatization” of clinical practice, to
failing family relationships and the general absence of a personal life.
Among medical students and residents, feelings of being unprepared to
practice, both clinically and from a business perspective, are most often
cited.
Anyone who has spent time in
physician lounges at hospitals or had business relationships with
physicians has heard about declining incomes, increasing hours, and
increasing rules and regulations which generally create a
less-than-appealing practice environment.
The root of the problem
Much like the presenting symptom
that seems unrelated to the actual disease, “lounge complaints” often
focus on the obvious and do not acknowledge the underlying problems.
An on-line career assessment tool,
the Career Biopsy, sponsored by my organization, Physician Career Network of
Denver, Colorado, tracks physician opinions and concerns. Physicians go on
line to www.
careerlab.com/pcn_biopsy.htm, and respond to 15 personal opinion statements describing
practice and personal matters. Responses are sorted into three categories
representing financial, practice, and lifestyle issues, and a report is
sent to the completing physician.
What do the results tell us? The raw
data provides a snapshot of physicians’ overall feelings. Based on the
compiled responses of 387 physicians, the category of greatest
dissatisfaction is lifestyle, followed by practice dissatisfaction, and
lastly financial dissatisfaction. Within the raw data, several scores or
ratings are noteworthy. In the financial category, actual income is the
least dissatisfying component. Most dissatisfying is the effort required
to produce income, which the Biopsy translates into productivity.
In the practice category, the
greatest area of dissatisfaction is the perception of government
regulations and intrusions. That is followed by an erosion of the
doctor-patient relationship.
In the lifestyle category, not
spending enough time with outside interests is most dissatisfying,
followed by the belief that not enough time is spent improving clinical
skills (CME workshops, etc.).
Another telling factor is to compare
all CareerBiopsy responses against the statement, “I’d like to remain in
practice if I thought my practice could be fixed.” When all the
assessment’s statements are correlated against this one, the factor with
the highest correlation to a desire to leave practice is the absence of
time for outside interests. Second on that scale is the feeling of
excessive government regulations and intrusion into the practice setting,
and tying for third are deterioration of the once inviolate doctor-patient
relationship and not enough time for improving clinical skills.
The control factor
In-depth career testing conducted by
The Physician Career
Network3 shows that most
physicians possess a high need for independence in decision-making,
thought, and action. When these underlying needs are compared to
CareerBiopsy results, the picture comes into focus. When physicians
believe their independence is threatened or impaired, they may react
negatively to other challenges in their practices. That’s not to diminish
the importance of declining incomes and practices that don’t function
smoothly, but when such a driving need as independence is not met,
definable stress behaviors appear and increase the sense of career
dissatisfaction.
How can physicians improve practice
and career satisfaction? Much of it has to do with regaining control and a
sense of independence. How do you take control of the seemingly
uncontrollable? It’s a little like the adage of learning to control what
you can, accepting what you can’t, and understanding the difference. While
it’s critical to understand the difference, the greatest challenge is
recognizing just how much actually can be controlled.
In the practice setting, taking
control begins with critically analyzing dissatisfying factors. Here are
several ideas you can implement on your own:
• Talk with physicians who’ve
“been there, done that,” or with business experts to determine what is and
isn’t working. Put measurable processes in place to correct the problem.
For example, if revenues are declining, track gross charges, net charges,
and net collections, basing net charges on your contractual adjustment,
not actual adjustments.
• Think outside the box. Just
because everybody else does it one way doesn’t make it right. You might
consider giving your hospital work to a hospitalist. And, if you do (or
already have), increase your office time by a half hour at each end of the
day.
• Reduce barriers to change
among your staff. Most staff members base their actions and expectations
on past and ongoing work experiences. Encourage them to be creative in
proposing solutions to problems and accomplishing goals. Then take their
ideas seriously—don’t “kill the messenger.”
• Evaluate your personal and
professional priorities, and make suitable compromises.
Other options
If you determine that your practice
can’t be fixed, or if you don’t want to continue for other reasons, the
next move is often seeking non-clinical career alternatives. A comfortable
way for physicians to analyze this change is to follow a SOAP (Subjective,
Objective, Assessment and Plan ) note to guide the way:
• Subjectively identify
strengths and weaknesses, career needs and wants, as well as what would be
ideal career titles and working environments.
• Take an objective assessment
that will, like lab and x-ray tests, provide confirming data to support
the subjective assessment. Many types are available, but select one that
will provide actionable career change and management information, and not
just interests, temperament, or personality styles. The Birkman Method® (which we
have determined to yield both sound and actionable data for physicians.)
or the Myers-Briggs Type Indicator®
Instrument are examples of suitable
assessments.
• Draft the subjective and
objective findings and data into a blueprint—a picture of your future
career: your next career moves, target companies or business types,
locations, position titles, job responsibilities, and reporting
relationships.
• Create a treatment plan to
achieve the outcome your assessment describes. List specific letters to
write, people to meet, companies to gather intelligence on, financing
sources or needs, actions regarding present contractual agreements, the
disposition or transition of your present practice, as well as timelines
for all actions.
Whether you believe your practice
needs a simple tune up or your career requires a more complete overhaul,
you are still in charge. Start with a simple assessment of your likes and
dislikes, complete the career biopsy or other self-assessment exercises,
look for creative solutions, and then develop an implementation plan that
will take you into a more promising future. n
Robert F. Priddy is the Executive
Director of Physician CareerLab. Since 1986, he has worked with physicians and practice
administrators to build practices, fine-tune operations, and address
organizational and governance issues important to successful practice and
career development. He may be reached at pcn@careerlab.com.
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