I had the pleasure this past week to sit on a Physician Careers panel. I'd like to say I doled out crucial career advice, but the truth is I kept my mouth mostly shut – the other panelists were too good to interrupt.
The panelists included a surgical department chair, a regent at a major public university, academic physicians, physicians in private practice, and a retired physician who has written extensively on money management for physicians.
The questions came mostly from first year medical students, but the topics and answers were relevant to physicians at almost any stage of their career.
The advice was eye opening and refreshing – so here's a brief summary. (None of the comments were mine, but they are filtered through my messy memory, so all the errors are mine).
Q. How do you deal with burnout? It seems like with all the training and time it takes in residency and fellowship burnout is a real issue.
Panelist 1: Burnout is a real issue, and you have to learn to balance your career goals and your family. When you're single and committed only to medicine it's a lot easier to spend 100-110 hours a week at the hospital, but even the most understanding spouse isn't going to put up with that long.
This generation has a little bit of a better situation with the 80 hour work weeks during training, but there will always be someone who's smarter or just willing to work harder than you. So work toward a balance.
P2: Don't let the 80 hour work week fool you. While you won't work more than 80 hours during training, once you're out in the world of private practice those limits are off. And especially at the beginning of your practice you can end up working a lot more than that. Balance is the magic word.
P3: It's a lot easier to get a grant rejected or have a paper sent back than watching a good friend go through a divorce. I've never heard anyone say they spent too much time with their kids.
Q. Any advice on finding the right kind of practice or partnership?
P1: Coming out of residency and starting a solo practice is basically impossible these days. That means joining an established practice – or if you're in mid-career starting a practice with a group of partners.
Choose your partners well – it's like choosing a spouse. You want them to share your work ethic and priorities, that's really important.
And while it's good to have partners so you're not on call every night, if the practice gets too big it means you'll be slammed when you are on call. So choose the right size practice.
Q. Do you think we get enough training on running a practice?
P1: Hell no.
P2: We really don't get any training on a running a practice. It's not rocket science, you can run a small practice, but it takes a while to learn the right tricks.
I've run my own practice for several years, but only in the last few have I really started to make money with it. You really need to focus on the patient's experience. It's more important to have the phone answered in a professional way, to have short wait times for your patients, to deal with your patients professionally and properly than it is to set up a practice than can bill the most. If you focus on your patients, reimbursement will follow.
P3: Maybe the fourth year of medical school is the right time to develop a course on this. Let's face it, there's too much baloney in the fourth year.
Regardless, don't worry about this issue in your first three years of med school – learn medicine. That's hard enough.
Q. What kind of mistakes do you see people make when they're choosing a residency?
P1: One mistake is letting other people tell you what you should do: "Oh, you'd be a great ophthalmologist, or you'd be a great surgeon, do that". Figure out for yourself what you like, don't let people talk you into it.
P2: I don't think there's a single specialty that you have to go into. I could've gone into any of several residencies and been happy.
I think the bigger mistake is over-spending while you're young and building your career. Some people need to have that big house and expensive car. Then when they're 50, and they want to go back and revisit their painting interest or just slow down, they can't because their expenses and debt are so high. That's when you see people start to be unhappy, when they have to work harder than they want.
P3: I agree. Since the Revolutionary War the physician has made about five times what the average American makes, but without fundamental money management skills that money disappears. Live below your means. Buy a used three-year-old car. Don't compete with your senior partner on house size. These are the basic rules of money management.
Once your house is paid off, your kids' education is paid for and your retirement is secure, then look at the new cars and big houses.
Physician Career Resources
Netdoc Physician Job Search – thousands of physician jobs in the US and abroad. Permanent and locum tenens positions
Re-evaluating Physician Career Paths – Physician New's Digest article on physician career paths
Physician and Surgeon careers – U.S. Bureau of Labor Statistics
The Physician Career Network – CareerLab
Careers in Medicine – by the AAMC
Alternative physician careers – from the netdoc archive