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.




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