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…..

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Guilt is Not a Career Platform

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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.

~lumi

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