Life After Medicine: what Roadburg missed (part 2)

In my previous post (part 1), I outlined some of the many reasons why doctors have become so deeply invested in their careers, even after just completing their training. Since this initial medical bonding process can span a decade or more, it is easy to see why physicians would already have such difficulty leaving their career, even several decades later.

Life in medical practice.

After training, embracing medical practice only deepens these themes. In the controlled chaos of a developing clinical career, there are many continuing challenges: Long and erratic hours; a persistent need to stay academically current; chronic sleep deprivation; the need for eternal patience; always putting others’ needs first; making and living with difficult medical decisions, some of which have to be made quickly and without enough information; the frequent need to be in two places at once; balancing patient needs and demands with limited resources; meeting hospital, College, and billing obligations in a timely fashion; and practicing defensively, with a growing awareness that, with every passing year, there is ever more to lose. For some physicians, it means giving up almost everything personally meaningful–hobbies, sports interests, time with family and significant others, personal downtime–usually to their detriment, but all in the name of career preservation.

The unending desire to help.

It doesn’t help that most physicians chose their career because of their desire to fulfill their personal learning potential, along with a desire to be both needed by, respected by, and useful to, individuals and communities; it all makes saying no–to one more patient, one more shift, one more OR case, one more nighttime phone call, one more journal article to read or CME talk to attend–all but impossible, even when there is nothing left to give. Because these continued sacrifices reflect, and add to, the already deep commitment to medicine, it becomes ever more difficult to walk away, whether early, mid-, or late career, even as additive stresses mount. As the physician’s outside life atrophies to a shell, there is no where else left to go.

It doesn’t help either that a mid- or late career physician has developed significant skill sets that allow a comfortable income. Since there are few other careers that can come close to providing the same level of income, physicians may feel stuck and dependent on their island should they start feeling the need for a career change, especially once they have become dug in to the financial obligations of building a career and supporting a family and a mortgage. Quick changes of direction that would have been easy early on, are now all but impossible.

Trapped in a medical career

This difficulty is enhanced when it is recognized that the skills that physicians have developed may not be readily transferrable to another career. Doctor’s skills–most unfortunately very unique to medicine–include suturing, surgical skills, obstetrical skills, interventional radiological skills, history taking, risk assessment, pharmacological prescribing, bedside manner, and physical examination. But where are the transferrable skills in all of that? Other physician skills, like knowledge of anatomy, interviewing skills, medical shorthand, problem solving, business skills, may be more transferrable, but are not usually associated with work as satisfying, as respected or as high paying.

While the realization that doctors may paradoxically come to see themselves as being stuck in a job with limited options for upward mobility, some who need a change may consider adding to their training, to learn new skills, to reinvent themselves. However, there may be little appetite, time or money for some form of retraining; sadly, then, because this barrier is a bridge too far, it only doubles down the commitment to their existing career, since they may also feel that they are too old or too tired to learn anything new, or they simply have no other directions of interest. For a professional group that was once chosen for their superior academic abilities, intelligence and determination, the perception that they are now trapped in their career, having to survive it since they have nowhere else to go, can be both shocking and depressing. Can a medical career be thought of as a dead-end job?

Burnout

Clearly, a career in medicine is hard to leave. In fact, most don’t, preferring to soldier on until they are either forced out for mental or physical health reasons, for failing to keep up with their many obligations, or until they all but die at their desks. Others can’t seem to find their way out, unfortunately to their own detriment; recently, the 2017 Medscape Physician Lifestyle Report suggested that 50% of physicians in the United States were reporting signs of burnout, a trend that has been steadily increasing in the last decade.  Although burnout can take years to become recognized, it is associated with increased risk for cardiovascular disease and shorter life expectancy, problematic alcohol use, broken relationships, depression, and alarmingly high rates of suicide—higher than any other profession. And not surprisingly, it adversely affects patient care.

Given the disturbing rates of physician burnout and suicide, many physicians need help to preserve their dignity and wellbeing, and be able to envision a fulfilled life beyond an unhappy medical career. Changing medical careers, finding a non-clinical career, or retiring from medicine completely, are all viable options, yet there is very little mentoring or guidance available for those who need it most. Most of those who have been successful at such a transition have been lucky to find a meaningful option available. The next few blogs provide some strategies for how to start the escape process–to a lighter load, an alternative career (either in or out of the medical realm), or to an outright departure.