Dipping a Toe Back in the Pool

My apologies for falling off the face of the earth for the last few months.  Work has been very busy (hooray!), and quite a bit has happened.  Perhaps most importantly, 2 1/2 years after leaving a career in clinical medicine, I find myself dipping my foot back into the pool to test the medical practice waters.  (WHAAAAAAT????)  This actually comes as quite a bit of a surprise to me as much as anyone else.  Since I left clinical medicine, I have found more happiness and job satisfaction than I ever thought possible.  I had virtually zero intention of getting back into any sort of clinical practice.

So here I am, wondering what happened as I sit filling out a credentialing packet for a major academic medical center that is thicker than War and Peace, and am tentatively scheduled to start seeing patients in a few months.  Like the rest of this career process I’ve been through, I thought it would be helpful to really reflect on what has taken place over the past few months and break it down academically.

First, let me say right off the bat, I am in NO WAY leaving my current career track to suddenly shift back into clinical medicine full-time.  I seriously doubt I will ever let that happen.  I am going to start one day a week, and simply see where it goes.  I cannot tell you how many people have asked me if I’ll be going back to clinical medicine full-time when they find out about my new job.  It’s funny what a reflex assumption that seems to be for everyone.  People, I have drunk the freelance Koolaid, and there is no going back to turning over my schedule to someone else.

Here’s what I came up with when I really looked at what has tempted me back into the world of clinical practice:

1. This is the right department – even though I am trained as a generalist, I’ve actually been hired by a surgical department to function as a consultation specialist with a specific group of patients that I have quite a bit of experience with.  This so far appears to be a much better fit for me than trying to cram my work profile into a general pediatrics department.  I am thrilled at the prospect of leaving the primary care stuff up to my peers (who enjoy it and therefore probably do a much better job of it than I would anyway), so I can focus strictly on the specialist issues.

2. This is the right place – when my husband and I arrived here 2 1/2 years ago, we moved into a neighborhood that just happened to be located almost exactly halfway between two major cities, both with very strong academic medical centers.  I certainly couldn’t tell one from the other when I arrived.  Having worked in both communities over the past 2+ years, it’s become extremely clear which center my philosophies and ethics align with better.  Lucky for me, the one I’m going to be working for is a little closer and has a much better traffic pattern, among other things.  🙂

3. This is the right time – I’ve had over two years to establish myself and build my reputation in the community, as well as make strong connections with other resources.  This job is a natural segue into continuing to build on those connections, and establishing a bridge between the center and the community that currently doesn’t currently exist.  I’ve also had time to recover from the worst aspects of my previous job, and actually miss what I did love about practicing medicine.  This opportunity really arose very organically – I certainly didn’t force the issue when the time wasn’t right.

4. These are the right people – I suspect that this may be the most important factor of all.  The people who have hired me already had an interest in starting up a program, and just didn’t have the right manpower on hand to do it.  They clearly want this to work.  They recruited me (nice dinner with wine included), met all the requests in my proposal, and have already designated support including a dedicated coordinator, dedicated nurse, designated exam room, and corner window office, despite the fact that I have yet to sign my contract.  And just for the record, I signed on for 40% more than I was making at my previous hospital.  I realize it’s not exactly an “apples to apples” comparison since my job description will be radically different, but in the end it’s still me bringing home a paycheck that’s a lot less anemic than before.  My chairman is also very laid back – he’s the kind of guy who hires talented people to do their job and then backs off and lets them do it.  So far everyone I’ve met in the department is a clear testament to this, and have been nothing but lovely.

Of course, it’s still the honeymoon period – we’ll see how I feel when I’ve actually been working for a few months.  But it’s certainly a very healthy start.

More to come…..


Making the Jump: Part 2

It has been several weeks since I posted Part I of this blog – I have been traveling on business quite a bit, and have finally gotten the chance to stop and catch my breath.  And see my husband.  And go to the gym.  No complaining here: I love the work I’m doing now, but I will admit that sometimes is it a bit of a roller coaster, and it’s nice to get off once in a while and just sit on the bench nearby with a sno-cone.

Last I checked in, I had just called my husband to tell him I could not take work one minute longer.  I didn’t want to get into details with him on the phone, as I still had a full afternoon of patients left to see and I didn’t relish the idea of being an emotional wreck for the rest of the day.  I simply said that I really needed to talk to him that evening, so if he could dodge the Friday happy hour at his firm and come home, that would be great.

I thought long and hard on the drive home exactly how I was going to put this to him.  It was no secret that I had been becoming steadily more unhappy over the past few years.  But  thinking about quitting your job and actually doing it are two completely different things.  By the time he arrived home, I had a fairly well-rehearsed speech ready for him.

He walked in the door, took one look at me, and said, “I don’t know what kind of song-and-dance you had prepared to share with me tonight, but if you need to get the f**k out of that place, then just quit.”

This is why I married my husband.  He knows me almost better than I know myself.  He is a gift, and I am thankful for him every day.

I talked with him about giving my department three months notice, even though I was technically only part-time faculty, since it would give them the most time to create a smooth transition for my patients.

Ever the pragmatist, my husband looked at me narrowly and said, “You won’t make it three more months without frying.  Give them two.”

And he was right.  Getting through the final two months once I had given my notice was nothing but an exercise in exquisite torture.  My meeting with my chairman was nothing too terrible.  Perhaps sad and somewhat pitiful, yes.  My chairman was sad to see me go, but knew that he didn’t really have anything to offer me that would convince me to stay (and certainly not any additional money), and he didn’t even try.  it was more of a formality than anything.

No, the worst part was seeing my patients over the next two months and have each one of them react to the news of my leaving.  There was disbelief, tears, and even some anger at the department (which I of course did not encourage but admittedly took some small delight in).  Every day was a soap opera, and it became exhausting.  But eventually, I did get there.  My last day of work, the department threw an anticlimactic little cake and cookie social in the resident lecture room.  I was happy at least to see it was well-attended.

I essentially took the next 6 months off.  Mostly because I could.  My pitiful salary, while welcome, wasn’t exactly dictating our standard of living, and so it wasn’t missed much. Which is why I wasn’t in a desperate rush to run right out and find another job.  I slept.  I worked out.  I slept some more.  I had sex with my husband.  I planted some flowers in front of the house.  It was glorious.

The funny thing is that once you give yourself permission to do something absolutely crazy, like quit your academic physician position after 11 years with absolutely nothing lined up to do after, it creates a bit of a domino effect.  I later learned that four other faculty left my department in the six months after I resigned.

It can also affect your loved ones.  My husband has also been fairly miserable at his big-city firm.  He had a wonderful run there, but had specialized in a part of the law that his firm didn’t really support.  He was respected, but his work was being de-valued, and he felt like he was going through the motions to pull in a paycheck.  He had also been mildly entertaining the idea of joining a small company in the south that had been trying to recruit him for several years.

We were talking one night at dinner.  Having gotten ten hours of sleep and a two-hour workout in, I felt like a goddess.  My husband felt like a doormat.  We talked about how fed up were were having lived in an East Coast big city all our lives, and wouldn’t a change be great?

I looked him dead in the eye and, almost without even thinking, said, “Well, how about that company that’s been trying to recruit you?  We could go there.”

Just like that.  Clearly, I am not a change-adverse person.  Plus, we had entertained the idea several times before, just not seriously.  I was thrilled at the possibility of seeing another part of the country, and even happier at the prospect of moving to a place where winter doesn’t really exist.  I could never see another snowflake in my life and be just fine with that, thank you very much.

And within three weeks, my husband had given his notice, let the new company know he was coming, put our house was on the market, and found a house about 15 minutes from his new job.  Just like that.

The move was even easier.  We sold one of our cars, packed the other with as much of our stuff as it would hold, hired a moving service for the rest, and drove the 1,497 miles to our new life.  We pulled up to our new house the evening of the third day, and were immediately greeted by our next door neighbor, who brought us over homemade dinner.  Welcome to the South.

Within two months of our arrival, just when I had started getting the itch to go back to work,  I got a position as a medical consultant doing peer education and policy development in outreach communities all across the state.  It was uncanny.

I’ve thought a lot about why this move was so simple, when it scared the crap out of many people we knew.  I think it’s because on the surface, it certainly appeared as though we had woken up one morning and had decided to abandon our lives and head for greener pastures.  Certainly, for people who didn’t know us well, that’s exactly what it looked like. The reality is that it had been something we had been talking about and planning for here and there for years before.  When it was the right time, all the pieces fell into place.

If I had to make a list of the things and resources that helped us along our way, I’d start with Kathy Caprino’s article in Forbes: The Five Biggest Mistakes That Career Changers Make.  I actually didn’t find this article until after I relocated, but I had already addressed several of the things she mentions in the article, and I thought it was a nice summary of some of the common pitfalls of career change that are easy to get sucked into.

Here are some other important factors that played into our smooth transition:

1. We moved to a lower cost of living area.  I cannot emphasize enough how awesome it was to move from an expensive city to a not-so-expensive one.  For the money we got for our old house, we bought a house that was 1200 square feet bigger, complete with renovated kitchen and pool, and were able to furnish it too.  Mind blowing.

2. We had no consumer debt.  This certainly was a huge help in allowing me to take the time I needed to find a job I really wanted, instead of taking the first thing that was available that came my way and getting right back into Misery Part II.

3. I am not tied to career identity.  This gets back to really, truly knowing yourself.  I was never exclusively wed to the idea of being a clinical physician, so when another opportunity came up that was related to my field but was something new, I jumped at the chance.  If you are one of those people whose career title is critical to your identity and self-worth, a sudden career change that you have not explored fully can feel like suicide.

4. I had multiple interests that I cultivated along the way.  I did quite a bit of public speaking and advocacy/policy work during my academic tenure, and discovered that I liked them tremendously.  I honed these skills, and was able to develop them into work. This is not something that happened overnight.  I also was fortunate enough to grow up speaking a second language, and had done some informal interpreting her and there for many years.  Part of the time I was between jobs I spent time working with an interpreting mentor and became nationally certified as an interpreter.  I figured that it would be great transition work while I was looking for a new job.  What I never counted on was how quickIy I would develop a tremendous passion for interpreting, and that it would become a significant part of my new working life.

5. I was (and am) willing to hustle.  Functioning as a freelancer with multiple income streams, I have to be willing to work and to travel to do so.  Luckily, this clicks very well with my life, my personality, and my marriage.  If you need a steady income stream, or crave the reliability of a full-time single site job, this way of life is not for you.

The bottom line is that, while people may think we are career nomads floating wherever the wind takes us, my husband and I were very deliberate about the choices we made, and did a lot of work assessing ourselves and what we really wanted out of life.

Go get ’em.


Making the Jump: Part 1

I took this photo from the window seat on a flight I was on last year.  I don’t remember where I was going or why (I fly a lot these days).  I just remember looking out my window and seeing this spectacular cloud line that looked so solid, it was almost like you could step out onto it and not fall through.  Kind of like a leap of faith, if you will.  ( I settled for grabbing my iPhone and snapping a picture.)

I’ve had a number of blog followers at this point ask me to write about my experience in making the jump and leaving clinical medicine.  Which of course prompted me to think about exactly how it happened.  That’s the one thing about blogging – you really have to go back and mentally trudge through the muck again if you want to be able to write about it in any convincing detail.

I think it’s important to say before I start any of this that my story is definitely not some sort of equation for escaping a career that makes you miserable.  I had a very specific set of circumstances (some fortunate, some created very deliberately) that allowed me to make a break from an eleven year career and start over.  While I certainly hope there are pieces of my experience that you may take away that allow you to gain some insight into your own lives, by no means is this a “Lumi Says” advice column.

In thinking a lot about what exactly led me to leave my career, I thought a lot about the factors that went into that decision.  I found myself going way back into much earlier parts of my life – parts that I though wouldn’t necessarily have any bearing on my adult decisions now.  What I realize is that, essentially, my decision to leave clinical medicine boiled down to an absurdly simple math equation:

Past Choices + Present Choices = Future

I know, this is about as satisfying as when the supercomputer at the end of the Hitchhiker’s Guide to the Galaxy, after 7.5 million years of calculation, spit out the Answer to the Ultimate Question of Life, the Universe, and Everything as….42.

I think the reason that this equation is so important to me is that I’ve noticed as a work culture, we put a tremendous amount of stock in our present choices, and woefully ignore the impact of our past actions.  That’s not to say that you can’t escape a terrible childhood and grow up to be a successful adult.  I just think that when we feel stuck, we tend to focus almost exclusively on our present circumstances, and not what led us to this place. Our past, while in the past, has consequences that actively affect us in everyday life, and to ignore this fact leaves us with a very incomplete (and unsatisfying) picture of our life situation.


In my situation, there were two major factors that had a tremendous impact on my flexibility in changing careers.

1. My husband and I have no children.  For those of you who either have no children or have been living under a rock your entire lives, children are a very real responsibility in life, both personally and financially.  If you are considering making a large career change, it is obviously much less risky if you are only accountable for your own expenses than if you are supporting five children under the age of twelve and simultaneously trying to save for college.  That is not to say that it can’t happen.  It just requires much, much more in terms of planning.  And by the way, there is nothing more that I resent than hearing someone scoff at my situation and say, “Well, that’s easy for you – you don’t have any kids.”  Please don’t use your kids as a weapon – it’s disgusting and not very parent-like.  And while we are at it, unless you had an extremely traumatic experience in your life, I seriously doubt anyone held a gun to your head and forced you to conceive a child.  Again, these are past decisions that factor enormously into present circumstances.  More about that in a minute….

2. My husband and I are both very judicious about money.  More importantly, we were long before we ever met each other.  We both attended in-state schools undergrad, which back in the early 90’s meant our parent could actually afford to pay for our education without taking out school loans (I know kids, times have changed.)  We also both attended an in-state school for our graduate studies: him on an educational trust from his grandmother that completely covered his costs since he was an in-state student, and me with an educational grant that I had applied for and won at the beginning of medical school.  What this boiled down to is that neither one of us brought any real educational debt to our relationship when it started.   

Flash forward to out lives now.  I said we were judicious, I didn’t say we were cheap.  The bottom line is that through our entire relationship, we have talked openly about what we want financially in life, and have helped each other to make good decisions all along the way about saving and investing.  Also, while husband loves cars, his “fantasy” car is more along the lines of a Mustang than a Porsche that costs as much as a house.  And I am definitely not one of those girls with a closet full of Jimmy Choo strutters.  It’s just who we are.  Not only are we compatible, we are financially compatible.  So the compounding of 16 years of collaborative good decision-making has left us with a house paid-in-full, two cars paid-in-full, and absolutely zero credit debt. We pay off our credit card balance every month.  This is not all just luck.  This is a combination of fortunate circumstances and hard work.  Our past financial choices have led us to a present that allows us an extraordinary measure of flexibility when it comes to things like career change.

The bottom line is that our past choices were influencing our future long before we ever knew they were.  You of course can try to tell kids this, but they have to figure it out for themselves a they grow up.  I happened to meet a life partner who was extremely sensible about money, and together we made even more sense as a couple.  We’ve made some good financial investments together, and live a very comfortable, debt-free life.  This is not just chance, or something to get angry over if it is not your particular situation.  It is a critical combination of fortune and wise choices.  And it definitely played into my ability to change careers eleven years into the field.


So this is the meat of the story.  Two years ago I decided to leave my position as an academic physician at a well-known University hospital.  At the time, my present day (which was, as we’ve established, an outgrowth of my past experiences) was an interesting amalgam of situations.  I had no children, and while I was a physician, my husband was clearly the primary breadwinner in our relationship, complete with insurance coverage.  Financially, I was certainly in a place where if I needed to make a significant change, I could.

My dissatisfaction with my job had building at a slow burn for several years.  I started bright-eyed and shiny coming out of residency, as most of us do when we finally finish all of our training.  I was working in academic medicine, which I cherished as an opportunity to work with students and residents and have teaching be a regular part of my job.  I had my own clinic, and it grew and grew over the years.

Eventually, though, the shiny wore off, like it does for all of us, and was replaced with a cold dose of reality.  In my case though, I also happened to be working in an extremely dysfunctional system.  All systems, to some effect, put the “fun” in dysfunctional, but my hospital was a really unique place when it came to devaluing its faculty.  The hospital functioned in an “eat what you kill” model, so primary care departments like mine suffered.  The surgical subspecialties were constantly bringing in money hand over foot, and therefore had budget to actually pay their faculty what they were worth (or close to it).  Primary care departments NEVER make that kind of profit – our value lies in that we provide a solid patients base so that the specialists have patients to work with.  But that doesn’t translate into direct dollars for administrators, and so we are left to work with whatever marginal profit is left at the end of the year, if any.  In the six years I was an attending physician at my last hospital, I (along with my department colleagues) received a TOTAL of a 4.4% raise.  There was no cost-of-living adjustment for us.  That was it because that’s all the department had to work with.  Not a really sustainable economic model for retaining staff.  Especially at an institution that already paid us on average 37% less than our colleagues across town (MGMA 2011 Physician Compensation Survey).

So as my clinic grew and the department continued to cut staffing more and more, I found my daily job description looking less and less like medicine, and more like administrative work I certainly had not trained for in medical school.  I spent hours arguing with insurers, as we only had one managed care specialist for the entire general and subspecialty clinic.  We switched to a new EMR system that, despite having a tremendous amount of input from the faculty about what they needed, was one of the oldest, cheapest, and inflexible systems available.  I spent many nights charting at home until 11:00pm so that I wouldn’t get too far behind.  Our scheduling system was from the dark ages, and constantly ended up with patients overbooked, bumped, or just dropped from the system.  Angry patients were a given that we walked into work ready to face every day.

I would say I tolerated and tried to internalize this every-growing disintegration of the job I loved for a good two or three years.  After all, guilt and sense of obligation can go a long way, and as physicians we often have an overdeveloped sense of both.  But I was unhappy.  I started resenting having patients on my schedule (wasn’t that the whole point of me being there?)  I would secretly rejoice if a patient didn’t show up for their appointment, as it would free up my schedule for a few blissful minutes.

The day  I decided to resign was one of those days where I experienced what can only be called a shocking moment of clarity.  I was running around as usual, doing things that weren’t medical, getting yelled at by patients that weren’t even mine, and trying to keep my hair from completely catching on fire.  In the midst of all this chaos, I got a message that one of my patient’s parents had frantically called saying that they were at their child’s specialist appointment now, but the authorization form I was supposed to fill out for them hadn’t been sent to the specialist, and now they were in danger of having to pay for the entire visit themselves or lose their spot.

I knew I had filled out the form personally several weeks before the appointment date, and had placed it in our “Stat Fax” box (STAT in this case usually meaning “Some Time After Tomorrow”).  Still I figured a 2 week heads-up would have been enough.  I went to talk to Miss Lucy, who was the staff person who had been working in the department for the past 30 years.  Miss Lucy had essentially been marginalized to running the fax machine as her entire job, rather than develop a plan for her resignation when it was realized that she could simply not keep up with all the technological changes that were happening in the department.

I asked Miss Lucy what happened to the fax I put in the box two weeks ago.  She stared at me blankly.

I asked her again, and let her know that now this had become my problem as I had a panicked parent on the phone at the specialist office right now.

Miss Lucy went over to a three-foot stack of papers on her desk, and started muttering, “I’ll find it for you, I’ll find it for you.”

I’m sorry Miss Lucy, is that pile of papers stat faxes you HAVEN’T SENT YET?!?!??!?!?!

It most certainly was.  Apparently, Miss Lucy’s method for dealing with faxes that needed to be sent out immediately was to move them out of the box and onto her desk, which would at least make it look like something had been done with them.

I nearly swallowed my tongue.  How much other time-sensitive information was in there?

Seeing as how I had no assigned staff to help me, I had to try to coordinate the specialist office sending me another authorization form so I could fill it out on the spot and send it back.  While I was doing so (and getting more and more behind on my patient panel), Miss Lucy suddenly burst out of the back with the paper and a triumphant smile on her face.  “I got it, Dr St Claire, I got it!”

Wonderful.  Give it to me.

“Oh don’t you worry Dr St. Claire, I’ll take care of this for you this afternoon.”

THIS AFTERNOON?!!?!!!?!??  Clearly, despite the numerous conversations I had with her about the time-sensitive nature of this issue, she was going to go PUT IT BACK IN THAT GOD-FORSAKEN STACK OF FORMS.

I told her to please give me the form.

Again, the blank stare.

“Miss Lucy, your lack of organization has made this my problem, and it stops now.  Please give me the form.”

Slowly, she handed it over to me.

I walked over to the fax machine, fuming, punched in the numbers, and sent it myself.  It wasn’t that this task was “beneath” me – I’ve self-faxed more times than I can count because it was just easier and saved some time where it was needed.  This was different.  This was how my clinic ran every single day.  And it was at the expense of its patients and its physicians.  And it was just supposed to be ok with everyone.

I sent the fax, and spent the rest of the day trying to dig out from getting behind on my patient panel.

I then walked into my office, shut the door, and sat down in my chair.

I tried to envision myself working in that system for the next twenty years.  It made me sick to my stomach.  Literally.  I couldn’t even envision myself there for the next two.  How was I supposed to make a career out of this, when I was constantly being punished for the most trivial molehill inadequacies blowing up into mountains every day?  How could I run a clinic that grew and grew every day, and yet my support staff had already become nonexistent due to “budget constraints”?  How could I thrive in a place where my administration really didn’t care if I lived or died?

I sat in my chair for what felt like a long time.

And then I picked up the phone and called my husband….


After almost two weeks and lots of “chats” with TwitterHelp, my accidental suspension was lifted and I have officially been paroled!  Apparently, the combination of having a new account and simultaneously having my blog go live on KevinMD and getting retweeted by a bunch of other accounts got me mislabeled as a spammer.  Today we are back in business – feel free to tweet me: @lumistclaire

As always, thanks for reading!


Physician Know Thyself

I’ve been thinking a lot about Kathy Caprino’s article that I mentioned in a prior blog post (“Guilt Is Not A Career Platform”). The issue of not knowing yourself really stuck with me. I was actually chatting about it with the hubby the other day, and he asked me, “Well who DO you know in medicine who is really happy with their career and really knows what they want??”

What an outstanding question.

I thought of course I’d immediately be able to come up with a bunch of colleagues that were satisfied and happy in their work. Sadly, as I ticked off the list in my head, I realized that it was much harder than I thought. Most of my friends from my old department were wrestling with a lot of the same things I was, and weren’t winning the battle either.

But finally, it happened.

I remembered the dean of the medical school where I used to work, Gary, who may have been one of the happiest people I have ever met on the planet. This guy literally whistled while he worked. So I asked myself, what was it exactly that he had going on that the rest of us were missing?

And the answer I came up with was that this man took nosce te ipsum to a whole new level.

Gary certainly was as busy as the rest of us, if not more so. In addition to being an extremely active and involved dean (with all of the administration and red tape that comes along with the job), he also still held clinic weekly and carried a regular patient load. Gary had every right to be cranky, put-upon, and unhappy. Except that he wasn’t.

I think Gary had simply found the absolute perfect career for himself.

Gary was the kind of dean who inspired even student he met. He loved to teach. He grabbed teaching moments every chance he got. He personally sponsored an annual award ceremony that acknowledged the best teaching residents in the hospital. Illuminating medical student’s lives was his passion. And he took it upon himself to truly know all of them, every year. They absolutely worshipped him, and he inspired them to become great doctors. But it didn’t stop with his students. He had the same effect on his colleagues. We all wanted to be better doctors because of the way he made us feel. His knowledge and his presence lit up a room.

But medicine was not Gary’s entire existence. He was apparently a real fishing enthusiast too. The only reason I even knew this was because of a random encounter I had with him at the hospital.

I was still a resident, and I had been on call Friday night in the ICU. It had been a really intense call night, and my head had not even come close to touching a pillow. When I was finally free to go home on Saturday afternoon, I stumbled out to the parking garage, squinting in the bright sunlight, to find that my car was gone.

It took me a few minutes in my post-call fog to figure out what had happened, but I finally remembered that I had been forced to valet my car on Friday because the garage had been so packed (this was unfortunately a common occurrence). Over the weekend, that particular garage wasn’t manned, so the valets moved all of the cars over to a central garage where an actual person was working.

I realized I was clear on the wrong side of campus, and started exhaustedly trudging back the way I came, hoping that my car would indeed be in the main campus garage. As I dragged myself back up the hill and passed the Medical School, who should come bopping out but Gary. In full-on fly fishing vest, waders, and floppy hat complete with pinned-on lures.

“Hey Lumi! Where you headed?”

I said I should ask him the same thing.

“Oh, I’m off to go fishing – I go pretty much every Saturday. It’s great just being out there, even if you don’t catch anything!” Truly, the man’s optimism was mildly nauseating.

I asked him what he was doing at the medical school.

“Oh, I like to come in on Saturday mornings if I can, just to get some stuff done. It’s nice and quiet.” (So the man voluntarily comes in on his day off just to catch up on “stuff”.) “So where are you headed? Are you getting out of here?”

I said I was trying, but I hadn’t exactly located my car yet. I told him about the valet situation.

“Yeah, it probably is in the other garage. Hopefully you’ll get home soon – you must be exhausted! But listen, if for some bizarre reason it’s not there, here’s my cell number. Just give me a call and I’ll make sure you get home.”

This is how Gary was every single day. He loved his job. He loved stuff other than his job. And he knew himself. You can’t fake that kind of enthusiasm and kindness for very long without going completely insane.

I drove home from work yesterday after a very long, hard day, and was smiling because I felt so good about my job. For a long time I didn’t realize that you can actually enjoy those really tough, draining days. And maybe you should be able to enjoy some of them. I am knowing myself better every day.

I hope Gary would be proud.

Guilt is Not a Career Platform


Recently, I read a very interesting Forbes.com post by Kathy Caprino, entitled “Why You Remain Stuck in a Career You Hate.” In it, she gives eight outstanding reasons why those of us who are unhappy in our careers remain paralyzed and unable to move. The first reason on her list (“You Don’t Know Yourself”) resonated strongly with me. It took me eleven years in primary care medicine to come to the conclusion that I just don’t like being a primary care doctor. It’s not a good fit for my personality or how I tend to function in a work role. I’m much happier in a “specialist” model – where I can take more time and function in a niche rather than trying to cover a broad range of things in a very limited period of time.

This is just a simple fact I had to learn about myself. It’s not a judgment about the importance of primary care versus other specialities. On the contrary, I have enormous respect for my colleagues who are primary care providers and do it well. I think they have one of the most challenging jobs on the planet.  I just needed to do enough introspective searching to finally admit to myself that I wasn’t in the right field.

But why did it take me such a long time? The immediate obvious answer is that for those of us who spend the better part of our lifetime training for a specific career, it’s a hard pill to swallow to admit that maybe that career isn’t exactly the best one for you. Especially if you are one of those types who was born knowing you wanted to become a doctor/lawyer/etc. But, as I’ve alluded to in some of my other blog posts, I’ve never been one of those people. I’ve also never really viewed being a physician as a critical part of my identity. I am a person first, who practices medicine second. I know that is not the case for everyone, and that’s the point. We are all different.

In really taking some time to figure out what makes me “tick” as a career person, I came to realize something very important in the months leading up to my eventual resignation from clinical medicine. It turns out that I am one of those self-masochists who loves to turn a career’s worth of guilt inward. I was the stereotypical worrier, wondering what would happen to my patients. If I left, who would take care of them the way I did? How would they get what they needed from someone who didn’t know them like I did?” Looking back, these “guilt scripts” held me hostage for years before I finally took a good hard look at what was preventing me from being happy in my work.

It was actually the fiancé of a friend of mine who inadvertently helped me break through the last of my career shackles. My friend was a nurse practitioner in the clinic I worked in, and the two of us developed a friendship borne out of commiseration. We would often get dinner or hit the local bar after clinic was over and just wallow in the injustices of our work environment. We even had our own little book club so we could have some kind of pretense for getting together. We’d talk about the book for about three minutes, and then the conversation would immediately devolve into a first-class bitch session.

One day her fiancé happened to join us for dinner. He listened to us talk about how trapped we were working for an institution that refused to listen to its employees, and imposed all sorts of inappropriate constraints on us. We bemoaned how powerless we were to make change, despite the fact that we were two of the most outspoken faculty in the clinic. We complained about the unbelievable inefficiency and suboptimal level of care in our clinic due to administrative decisions that clinically left our hands tied.

After this went on for about half an hour, he looked at both of us and then asked quite frankly, “So why do you continue to work there?”

My friend and I of course had all sorts of excuses. Our patients needed us. No one else knew the issues our patients faced as well as we did. As I listened to myself spouting off 101 reasons why I couldn’t leave, I realized I had enough career guilt on board to fuel a Catholic mass for three weeks.

His question stuck with me though. He had planted a seed, and over the next several months it germinated into a big, blooming flower. Eventually I had to admit to myself that my patients somehow had found medical care before they met me, and they would after I left . Would it be the same medical care that I provided them? No. Would they get worse care after I left? Possibly. Or maybe someone would come along and do a better job than I had. Regardless, they would not be left lying in a ditch somewhere. Sure, they would miss me. I have several families that I still keep in touch with by email after having left clinical practice, and they do miss me. But they also are very pleased to hear that I am happy and thriving in my new work.

With due deference to Kathy Caprino, I respectfully submit Reason #9 for her consideration: Guilt Is Not A Career Platform. Certainly not for a fulfilling career anyway.



A Good Way to Measure What Works for You

Cheers to a Messy Life

Since I started this blog, I’ve been doing a lot of thinking.  A LOT.  Which has been wonderful, although my brain has decided that it is perfectly acceptable to wake me up like clockwork at 3:30 a.m. so I can sit at my computer and get more thoughts out into cyberspace.  This would be no problem if I wrote for a living and didn’t actually have to get up and work in the morning.

Not that I’m complaining though.  For the first time in a very long time, I can honestly say that I love my job.  Or make that jobs.  Actually, looking at my life from the outside, one could argue that it has become somewhat messy.

Two years ago, I essentially walked away from my previous life.  In all fairness, my husband and I both took a massive leap of faith together.  On paper, we had supposedly been living the American dream.  He was a big-city, big-firm lawyer, and I was an academic physician at a well-known university hospital.  We had the dream house, three cars, and pulled in a half million dollars a year between the two of us.

And we were f**king miserable.

We both hated being smothered by the systems we worked for and had no voice in fixing. We ended up resenting our clients, who were the reason we were employed in the first place.  We grew to loath the suburban Garden of Eden we had bought into.  We drank too much.  We lived to get away for vacation, and then were even more miserable when we came back and it took us a month just to dig out from under the stack of work, charts, and emails that had been slowly breeding while we were gone.

But it took us years to actually figure out that we just really didn’t like how we were living.

We had naturally assumed that we had everything we were supposed to want in life, and something just must have been wrong with us.  Though we’re not quite sure exactly how it happened, eventually we both realized that the things that are supposed to make us happy in life simply didn’t.  We are just not those kind of people.

And then miraculously (you could almost hear the stars lining up in the sky,) in this crappy, terrifying economy, my husband got an invitation to join a small boutique law firm in the south.  Far, far away from our Yankee roots, not to mention both our extended families and life-long friends.  It would mean cutting almost every tie we had, and leaving the place we had grown up and lived in virtually all our lives.  It would mean leaving behind careers and reputations we had spent decades building.

I tendered my resignation immediately.

Some of my colleagues, of course, were horrified.  After all, I was a successful (at least by their terms) physician with a good reputation and a solid academic position.  How could I possibly ditch all that?  And to rub salt into the wound, I had absolutely no job lined up for after we moved.  Terrifying, right?

I actually found it to be incredibly exhilarating.

I have never been defined by my job.  I certainly am not criticizing those who are.  I am just not one of those people who takes a lot of stock in making my M.D. part of my identity.  I am the last person at a party who is going to introduce themselves as “Dr. St. Claire” (especially since people are so uninhibited about asking you grotesquely inappropriate medical advice after they have had some hors d’oeuvres and slugged down a couple of glasses of wine.)  My good friend once described me as “the most reluctant pediatrician I have ever met.”

So for me, I didn’t really view this as a period of mourning.  I had a great run.  I was leaving on a high note.  And I couldn’t wait to see how things settled out for me in our new life. Perhaps I was totally naive (actually, I’m sure I was.)  But honestly, I think it really worked in my favor.  I have discovered several important things in the process of relocating my life:

1. After eleven years in the field, I finally figured out that I just don’t like primary care medicine that much.  I am much better as a specialist and a consultant.

2. I absolutely, positively, love being my own boss.  And my own scheduler.  Although I have on occasion been overheard complaining that I need to fire my scheduler when I’ve really overextended myself.  Thankfully, it doesn’t happen very often.

3. After 37 years of living just outside a northeastern urban metropolis, I have discovered that I really do not like living just outside a northeastern urban metropolis.

4. I like my life messy.

Let me clear – messy does not mean chaotic.  My life is unbelievably scheduled.  I have a speaking engagement I just put on the calendar for April….of 2013.  But this discipline and organization has ironically afforded me the chance to be spontaneous much more than before.  For one, I don’t take call anymore.  I also rarely schedule anything over a weekend.  You can imagine after eleven years of being tethered to a pager and spending a good number of weekends on call or in the hospital, how this has blown open my life in terms of new opportunities.  For the love of all that is holy, I learned to cook after we moved.

For me, messy just means unbound.  I am always open to new ideas, especially when it comes to work.  I was just offered some consulting work in an area that is closely related to my field, but is something I haven’t had the time to focus on until now.  I snapped it up like a bear standing in a river during a salmon spawn.

Sure, it’s unpredictable.  But for me, that’s what keeps it intriguing.  Yes, there are times where money is tight, and then times where I can hardly breathe I have so much work.  It keeps me honest and prevents me from taking my successes for granted.  In my case, leaving clinical medicine simply allowed me to pursue other avenues in life that bring me joy.

Sheryl Sandberg, the current COO of Facebook, said that the best advice she ever got was from Eric Schmidt at Google.  When she was considering turning down an offer she received to be Google’s general manager, Eric told her, “Stop being an idiot; all that matters is growth.”

My life is full of growth.  My life is messy.  I wouldn’t have it any other way.




Leaving Medicine

Women Leaving Medicine

Half of Primary Care Doctors in Survey Would Leave Medicine