It’s all about the “V” word……


It’ s been over a year since my last post.  Apparently, I am one of the worst bloggers ever.

But you have to admit, it’s a little challenging to have had an active blog about leaving clinical medicine, and then go back to clinical medicine.  It leaves you with not so much to say.  I’ve actually considered stopping the blog altogether, since the entire reason for me starting it has pretty much vanished.

Except that I’ve realized that a) I really like writing, and b) maybe the blog just needs a slightly different focus.  Perhaps a focus on the path out of medicine just needs to be a little broader and include the road back.

So here it is.  I am dusting off some serious cobwebs.

It’s been a year and a half since I came back to medicine.  At first it was very tentative.  I started back at one day a week just to give it a shot, fully expecting that it would be the same misery as before and I would be out within 6 months.  Which is course is not at all what happened.  I’m now at 60% time (with my chairman constantly begging me to do  more) and having to train another provider to help handle my patient volume.  And I actually chose to do this.

I recently finished the longest week of work I have had since coming back to clinical medicine. I had a family emergency and a conference all converge around the same week, and ended up rescheduling two days of missed work into an already full week.  It was long.  It was incredibly tiring.  I was very glad when I finally got into my car on Friday evening to drive home.

And yet, it wasn’t a bad week.  It actually wasn’t even an ok week.

It was a really, really good week.  Yes, I was exhausted and completely ready for dinner out with a self-medicating glass of wine.  But I was just tired from working hard at an unbelievably rewarding job.

I’ve had a ton of time to think about what makes my current situation so ridiculously different from my old job.  I’ve blogged about the concrete differences that make my new life so very different from my old.  It’s very multifactorial, and certainly not simple.

Except that now, having gotten plenty of time and distance from my old job (and really, my old life), it actually is kind of simple.

When I look at all the different factors that are involved in loving my current work, they all have one thing in common.  From a truly exceptional chairman and an outstanding support system and dedicated nurse, to things as simple as having a nice office with plenty of windows and reserved doctor parking in the garage, all these reasons essentially boil down to one simple factor.  At first I thought it was people liking me, but I realized that plenty of people liked me at my old job, and I was a miserable wreck.  I thought it might be that now I am respected, but no, I had plenty of respect where I was too.

Then I realized – it’s the “V” word.

The reason that everything continues to be unicorns farting rainbows where I work a year and half after starting is that, after all this time, I am finally VALUED.


And lest I sound the least bit bitter about not being valued at my previous job, I fully realize how difficult this can be to achieve.

I think it’s extremely easy to confuse being valued with other ideals, such as being liked or respected.  They certainly share certain attributes, and we all feel good when we experience any of them.  I recently drank the Koolaid and read Sheryl Sandberg’s Lean In.  For those of you who have only just joined the human race, Sheryl recently became the COO of a teeny tiny social media company called Facebook.  She wrote a very poignant (and controversial) book about women breaking into and taking on high powered positions in major companies.

Did I agree with her 100%?  Of course not.  And there were definitely parts of the book I didn’t relate to, such as having children and balancing all that out.  Which is clearly an entirely different blog for an entirely different person other than me to write.

But Sheryl’s book was amazing.  Some of those pages felt like she was writing them specifically for me and me alone.  I won’t go into excruciating detail if you haven’t read it….ok screw it, I’m totally going to talk about what I thought was the best part of the book. Sheryl has a chapter on career paths, in which she discusses a phenomenon called “The Tiara Syndrome”.  Yes, it does do some gender stereotyping, which Sheryl is very graceful about addressing in her book.  Basically, women in general tend to function similarly when it comes to their view on success at work.  We roll up our sleeves, put our heads down, and do really, really good work.  And we keep doing good work.  And we do some more good work.  We don’t promote ourselves, we don’t draw attention to all the great things we are doing, we just work.  Because if the work is good enough, and we do enough of it, someone will eventually notice what an amazing, wonderful job we are doing, and come over and plop a tiara on our heads to thank us for all of our efforts.



I was absolutely, positively, 100% a tiara syndrome devotee.  And let’s be honest, half of getting through a clinical medicine residency is picking up your pom poms and cheerleading your way through all the fatigue and the stress and the trauma.  We train for YEARS to roll up our sleeves and put our heads down and work.  And when one of our attendings tells us we did a good job, it’s like winning the lottery.

The problem is that the model for getting through residency is nothing close to the model for having a fulfilling and successful career for the rest of your life.

In my old job, I was a total tiara girl.  I started a specialty clinic during my residency and grew it from one family to 5 families to 15 (headdownworkworkwork).  And I stayed on as faculty after I graduated and continue to serve as clinic attending, and taught residents, and published in peer reviewed journals (headdownworkworkwork), and organized conferences, and grew my clinic to 50 families to 100 to 200 (headdownworkworkwork), at which point with virtually NO help and NO support staff and NO meaningful salary, I completely imploded.

Was I liked?  Absolutely.  People LOVED me.  Was my work respected?  Definitely.  The residents gave me teaching awards, students would come back for a second elective rotation with me to learn more, colleagues would proudly laud my achievements to other colleagues.

Was I VALUED?  No.  No sir, I most certainly was not.

Because here’s the thing about being valued.  (And, in general, women tend to do this more than men.)  It’s super easy to confuse being valued with being liked.  We get the warm fuzzies with both being liked and valued.  They can look deceptively similar at first glance.

Here’s the catch.  To put it bluntly, you can be extremely well liked by your colleagues, and still have promises made to you that are going to be broken, be assigned a terrible salary that doesn’t even come close to acknowledging COLI let alone acknowledge the work you do, made to feel like no matter what you do it’s never enough, and be put in a situation with no help and no real way to succeed.  You can be the belle of the ball socially and work can suck suck suck.

As much as we don’t want to admit it, the reality is that it is simply not enough to pat me on the head and tell me I’m doing an exceptional job, and throw me peanuts to survive on.  And for some reason, historically women (in general) have tolerated this much more so than men.

I don’t mean to digress into a gender inequality in the workplace blog (there are plenty of those out there already, and did I mention Sheryl Sandberg’s book?)  This is about recognizing what you need as an individual to succeed.  Personally, it took me quite some time to figure it out.  I need to be truly, honestly, and tangibly valued.

Let me be clear – this is not at all solely about a paycheck.  Ironically, because I’m a generalist who has specialized and am now working in a surgical department, I am BY FAR the lowest paid faculty in the department.  I don’t cut into people for a living (God bless those of you who do and do it well), and my paycheck shouldn’t reflect that I do.  But I will tell you one thing: as an academic clinical assistant professor, I am making a very, very nice salary.  And my chairman is thrilled to give it to me.  It’s like every month, there’s a little subliminal message from my department in my bank account saying “Hey Lumi, you are totally worth it!  Thanks!”

But the salary is the tip of the iceberg.  Ironically it’s the small things that really add up in terms of feeling valued.  When I pass my chairman in the hall and he is talking to someone I haven’t met, it is 100% guaranteed that he will stop me and say, “Oh Dr. St. Claire, have you had the pleasure of meeting so-and-so-chairman-from-blah-blah-department yet?”  And then will go on to completely talk up my work ad nauseam to this poor trapped soul about how special my clinic is and all the innovative things we are doing, etc.  His elevator speech has actually gotten quite good.

Or when my colleagues refer a child to me that they just don’t know what to do with, and tell me how relieved they are that I am here and can help out with complex care coordination that they just aren’t equipped to handle as surgeons.

Or when the medical assistant screening my patient leaves me a little note on the computer in the room that says “Hi Dr. St. Claire – have a super day!”

Or when my colleagues from the community ask me to chair a committee to try to bring resources together to best serve our patients and families.  And then when we have the meeting at 3pm on a Monday, my clinic coordinator naturally assumes I will want it catered, because how on earth am I supposed to host a successful committee meeting without feeding the participants?

Or when our admin sees that I am still in my office on Friday at 5:30pm charting, and runs down to the first floor to bring me a Diet Coke so I can keep working (which may be the reason why I woke up so early this morning thinking about this stuff – caffeine and I are not exactly friends).

I could go on and on with these little encounters that individually could be seen as trivial.  But when every single day at work is FULL of these kind of interactions, you start to feel rather glowy and lovely all the time.  Do I have hard days?  Of course.  Do I occasionally have challenging families or situations that make me sad that I can’t do more?  Absolutely.  But working in an environment where I am not only liked and respected, but valued, makes me finally, finally understand what Confucious was talking about when he said,

“Choose a job you love, and you will never have to work a day in your life.”


I get it now.  I just had to find a job that loves me back.




11 thoughts on “It’s all about the “V” word……

  1. Awesome post! It’s so great to read about your journey and find out that there can be a happy ending! I think you hit the nail on the head when you say that we all need to be valued. I was in private practice for 18 years when we decided to sell due to the increasing nightmares of reimbursement, EHR, employee issues, etc. We were acquired 2 years ago and I was just having a conversation with my husband yesterday about how our workplace does not value physicians. (We are both family docs in the same office.) He is working there full time and I am paid by the hour for 2 days a week. The rest of the time I have my own private cosmetic practice which I started 10 years ago, I’m starting a coaching practice, and I am one of 12 brilliant physicians in Lissa Rankin’s Whole Health Medicine Institute program this year which mentors visionary physicians to use a more mind-body-spirit approach to our broken healthcare system and create a satisfying work life. Hooray for you and other physicians who have the courage to explore other options and seek happiness!

    • Thank you so much Celedonia for your thoughtful words! It is always inspiring to find my fellow “happiness seekers” in cyberspace, and know that there are many of us out there who are finding alternate paths to career satisfaction. I personally think being valued is underrated, and so the pursuit of it may be as well. Congratulations to you for finding your own path to happiness and success!

  2. Good for you! I have done primary care, stopped, came back in, stopped, and now back in again. Each time it started off ok, but quickly went back to being just a worker bee.
    I spend most of my time now bickering with patients about them wanting a handicapped parking permit, disability, vicodin etc. 🙂
    I think the value we have for patients is less as primary care is a commodity for many? I think the best solution is having control of a career, which you do when one works less than full time. It seems crazy to work 5-6 days just to get one day off. Working full time turns a job into life…

    The best medical job I had was working by the hour when I felt I had control over when, and where I could work.

    • I could not agree with you more, Greencat. I think one of the keys to me having this kind of input and control in my life is that my contract is for 60% time. (It’s worth mentioning that I’m CONTRACTED for 60% time – in reality I work more than that but it’s on things I’m passionate about). Altogether with my consulting work I work about an 80% work week, which leaves two mornings a week for me. Unless I am putting out the biggest fire known to man, I don’t schedule ANYTHING those two mornings that the least bit work related. Making ourselves a priority is really hard, but the payoff is enormous.

      Thanks for posting!


  3. What a good report! I thought about your blog while leaving a comment at The Health Care Blog. The subject was about how doctors are paid and by whom. You clearly have something to contribute, so join in if you care to do so. I’m leaving a link there to your post to make a point. Your experience illustrates a rich and fulfilling alternative to the old ways that medical care has been done for years. Congratulations on finally getting to a place where you are truly, as you say, valued.

    Here’s the link to the Health Care Blog post:

    • Thanks as always, John, for your thoughts! I will definitely check out the Health Care Blog – payment for physician services is definitely a complex issue with lots of facets that are not always (ever?) taken into account. Thanks for the heads up.


  4. I’ve got it even harder. Male, approaching 40’s, and I’ve been dropped from Med school. Second shot, second bite at the cherry. Now, cut away from the rigours of school, I”m completely directionless, because for so many years, prepping and training, relocating to follow the dream of medicine… it’s all lost.

    • Thank you for posting Phil – obviously, your situation is very tough. You clearly have a loss to mourn, and it is a big one. It’s absolutely true that we spend years investing in the path to a medical career, and that pain doesn’t go away overnight. I will say please don’t lose sight of the fact that those years you spent gaining knowledge are not simply wasted. There are so many careers out there that have some overlap with medicine in a non-clinical venue, and you may find an amazing fit for yourself in the future. It definitely takes energy and time to explore what is out there, but when you are ready and receptive, you may find yourself in a place you never expected that is better than you could have imagined.

      All the best-


      • Take care Phil!….Tough situation for you….It is also very tough to finish school, residency and fellowship and find yourself in a soul-sucking job and wishing everyday you had not gone to med school. Take any advantage you can of this event… Perhaps it is not a rejection, but a great opportunity. My days are spent bickering with patients about narcotic prescriptions, and dealing with self inflicted issues of obesity, DM, HTN.

        You have gained great knowledge and can do lots of good in the fire department, police department EMT etc. Try to make energetic progress in the good.

        best wishes.

  5. This just got linked to in a Facebook group called PMG (Physician’s Moms Group about 40,000 strong) so don’t be surprised if you randomly get comments over the next few days! What a wonderful essay and how eloquently put. I had the same experience–liked! respected! but absolutely not valued by the other physician/owner in my practice. I didn’t even realize how miserable I was until I got out and got a new job where the owner of the practice stressed to me that I was valuable and my time was valuable. And I’m enjoying my life so much more, it’s amazing. Transformative. I didn’t have to get out of clinical medicine but I think that so many people, especially women, especially “young” women in their first job out of training fall into this trap. Yeah for you! And yeah for me!

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