This week’s post addresses a topic I think about frequently: career longevity. However, the impetus for this post was the White Coat Investor’s October 2021 Newsletter’s “Tip of the Month.”
In this monthly tip, Dr. Dahle reflects on the impact the COVID-19 pandemic had on us 19 months (when that newsletter was emailed out) into it. He offers a list of suggestions for optimizing career longevity. I’ll share his list and offer my own take.
Why We Must Talk About Longevity
Medicine is a marathon. A marathon in which it can feel like all 26 miles are uphill…and the hill only ever gets steeper and steeper.
In this running analogy, the hill is everything that we physicians go through to practice our craft—from our own textbook education to our apprenticeships, and then on to navigating caring for ever sicker, more complex patients—in an opaque, byzantine system that often seems to exist to prevent us from actual caring for those patients!
The hill is the juxtaposition of our idealism and dedication to serving others against that system that not only burns us out but also morally injures us.
I’ve previously detailed this and the other opportunity costs of practicing medicine.
We all deserve to have a career in which we can remain if we so choose. The choice to stay in medicine rests solely with each of us. We can leave whenever we want, on our terms. We don’t need to justify it, feel shame, or apologize. More on this in an upcoming post!
Keeping physicians working because they want to is the goal here.
Elsewhere, I’ve made the case that our career longevity is about more than us—a physician shortage is a public health crisis. Thus, physician burnout is a public health crisis! Heck, I linked charting to healthcare access!
Pilfered from the above linked post.
So what can be done? Let’s first take a look at the White Coat Investor’s tips for longevity.
WCI's Tips
Please note that I cannot link to Dr. Dahle’s writing because it was contained within an email. The only way for you to have had access was to have been a WCI subscriber before he sent out the newsletter.
Here are the 12 suggestions Dr. Dahle listed in his newsletter:
- Take less call
- Work fewer hours per day
- Work fewer days per week
- Work less onerous shifts
- See fewer patients per hour
- Use your vacation time
- Take advantage of sabbatical opportunities
- Take time off between jobs
- Spend a little less
- Use your income to purchase assets, not consumption items
- See a doctor, therapist, coach, or attend a wellness conference
- Prioritize eating well, exercising, and sleeping appropriately
Overall, I like WCI’s list.
The first five are all different flavors of the same idea. Impressively for a finance blogger, only two (#s 9 & 10) are directly finance-related.
I don’t want to spend time critiquing his list just because this post will get too long, and I agree with all that he’s listed. I felt compelled to write this post just to flush out his brief tip and offer some richer context in which to couch the above suggestions.
Finally, before we move on, I just want to call out that he even mentioned coaching! Even he has taken notice of physician coaching!
A Framework
I think developing a simple framework for examining career longevity serves as a useful foundation, even if it cannot account for all the complexity involved.
So here is my simple framework.
To promote physician longevity we must look at:
- Increasing that which brings us joy
- Decreasing that which drains us/wears on our souls
- Doing that which is good for us, even if it doesn’t bring us joy
Told you it was simple!
Increase the Joyful Aspects
Let’s dive in!
What aspects of medicine bring you joy? Hopefully, it includes seeing and helping patients, the constant learning, and navigating the amazing interface of science and art.
I’m projecting, but you should come up with your own. Maybe you love your OR time or guiding patients through end-of-life discussions.
Come up with your list. See WCI’s #s 6-8 above for more inspiration.
Calling an Audible
After you do the above exercise, we’re going to broaden our scope.
So take a pause, step back, and consider what your dream life looks like and how medicine could fit into that. This will help you identify your joy in medicine.
How can you align your reality with what you’re imagining?
The more closely approximated your reality and your dreams, the more satisfaction you’ll enjoy.
What does this designed life look like? Where does medicine fit in?
If this seems like a pipe dream, then you need to lean into this more—you need it!
From here you’ll be better positioned to see how to incorporate medicine, and specifically, the parts that most light you up!
Decreasing the Draining Aspects
What aspects of medicine or your practice make you cringe? For many of my clients, it’s charting, the loss of autonomy, the never-ending stress, and being unable to truly step away. Sadly, for many, this list is longer than the list that brings joy.
And a lot of that is how our brains work. We are hard-wired to emphasize the negative as our brains devote an enormous amount of resources to scanning for dangers. Thus, these things will stand out more.
See WCI’s #s 1-5, in particular, that address decreasing exposure to the noxious stimuli that drive a lot of stressors.
Let's Look at Some Strategies
So what are some ways we can apply these first two parts of the framework?
1. Set Boundaries. What are you willing to do and what are you not willing to do? You can set boundaries to define these. A boundary has two parts: 1) an event occurring, and 2) the action you will take. For example, you may set a boundary that states, “If my call obligations are increased beyond a certain threshold, then I will look for a new job.” Set realistic boundaries and make sure to not make empty threats (e.g., boundaries that you are unwilling to uphold or enforce).
2. Delegate. Can you outsource tasks or shift them to someone else’s plate? Don’t like writing notes? Get a scribe. Can your team help with paperwork? If you’re time crunched at home can you outsource grocery shopping, meals, lawn care, etc?
3. Negotiate. Can you get changes you want codified in your contract? I’m talking number of hours worked, call burden, office locations at which you work, pay, vacation days, OR time, procedures you’re willing to do, etc. Remember the value you bring and your worth to your employer. Also remember that negotiations involve compromise, so where are you willing to give a little to get what you want?
4. More autonomy. Consider working for yourself. Autonomy and control of your immediate microenvironment goes a long way. And yes, solo practices and other private practice setups CAN be profitable, even in this day and age! You just need to be creative and flexible.
5. Avoid toxic situations. Seems obvious and it is, but how many physicians do you know of who work in an abusive environment? If you’re being gaslit, taken advantage of, asked to compromise care or safety, or being put in harm’s way, then it’s time to move on. No Stockholm Syndrome allowed (unless, we’re talking about the song by Muse)!
6. Advocate. How can you promote physician-centric changes in policies, workflows, etc.? Such advocacy benefits not only you but also your colleagues. Maybe you can get your colleagues behind a push for scribes or more nursing help. Maybe you can advocate for malpractice reform on a state or federal level.
These strategies are broad, yes, but I hope you can see that they can be utilized in myriad ways to help make medicine more sustainable.
Forms of Support
The remaining three items I want to explore are evidenced-based forms of support that can also help nurture and sustain physicians careers.
7. Mentorship. There is evidence that formal mentorship can help mitigate burnout. How can you seek out a mentor? They can give advice, serve as a sounding board, and help normalize and validate your struggles within medicine.
8. Peer support. Similarly, peer support has been shown to limit the deleterious impacts of burnout. Knowing that your trials and tribulations are not unique and having outlets to share your common experiences can be tremendously helpful!
9. Coaching. I shared a post a few weeks back on an RCT looking at individual coaching for physicians that showed that the intervention group had decreased emotional exhaustion and burnout and increased quality of life and resilience scores.
Engaging these types of support can help physicians extend their careers.
Myself and other physician coaches are working on just this. If we can systematically tackle some of the biggest pain points in medicine, then we can enable our fellow physicians to have the option to continue in medicine and enjoy their careers more!
Eff yeah!
Take my group coaching program, Charting Conquered. It combines the three above-mentioned forms of support—mentorship, peer support, and coaching—and a lot of the program content invokes the strategies discussed here.
These are two of the main reasons it has been transformational for the 150+ physicians with whom I’ve worked!
The "Roll Your Eyes" Part
You may recall there was a third part to my framework: doing that which is good for us, even if it doesn’t bring us joy.
I lump into here those things that WCI mentions in #12 that not everyone is crazy about or maybe some struggle with. Things like eating healthy, exercising, sleeping enough, meditating, getting regular preventive care, etc.
These are the ways in which we nourish our bodies and souls, rest, and replenish our energy stores.
Notice how hard it may be for you to consistently do some of these because we’ve been trained to just push through and ignore our own needs. Needing to rest and replenish may be viewed as a sign of weakness or an unwillingness to be yet more productive.
For me, it’s staying up late. I’ve always fancied myself a night owl and feel incredibly creative and productive working at night. But that’s tough when I usually wake up around 5:30am.
On a side note: In my ideal world, psychotherapy and physical therapy (for optimizing mental and physical function) would be “regular” parts of well care like seeing a dentist twice a year! And all insurances would cover them!
Meeting these needs and keeping yourself healthy means you’ll function better, and, on average, live longer. Thus, by increasing overall longevity (and quality of life), they can increase career longevity.
Focus on Yourself
As I wrap up this post, I want to call on you to consider your career longevity. How long do you want to work? What impacts that desire, both negatively and positively?
How does your career in medicine fit in with your most perfect life, whatever that looks like for you? You can and should design your ideal life and then take steps towards making as much of that your reality.
So turn inwards. Tap into your needs and wants. It’s not selfish. You get to prioritize you and your loved ones. Let no one shame you, and don’t let yourself feel guilty.
Self care is the best way to ensure you remain in medicine as your best self for as long as you want, instead of burning out prematurely in a blaze of non-glory.
Taking care of yourself enables you to take care of others. It’s a win-win.
I’ll leave you with an airplane analogy.
Flight attendants will always tell you before take-off that in the event of a change in cabin pressure you should always apply your oxygen mask first before assisting others, right?
If you’re succumbing to hypoxia you’re not going to be very helpful to others. Heck, others may perish if you don’t put your mask on first!
The same applies to our careers in medicine. We have to put on our oxygen mask first so there even remains the possibility of being around to help our patients!
What steps are you taking to ensure your career longevity? Let me know in the comments below!
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