Back to Front PageVOLUME 6, NUMBER 4

Treating Physicians' Career Woes

by Jennifer Proctor

Gigi Hirsch, M.D., CEO of MD IntelliNet, has focused her career on counseling physicians dissatisfied with their jobs. Dr. Hirsch started as an emergency-medicine internist and shifted her focus to help other physicians.

Twenty years ago, if a doctor examined his or her career and asked, "What am I doing?" or "Do I really want to practice medicine?" there wasn't anywhere to go for answers.

Things have changed. Today, a growing number of counselors and consultants are aiding physicians dissatisfied with their careers-and they're finding no shortage of clients.

"Career counseling for physicians is a growing business," says John-Henry Pfifferling, Ph.D., founder and director of the Durham, N.C.-based Center for Professional Well-Being. "We help medical professionals find the path of living that causes the least dissonance," Dr. Pfifferling says. "It's primary care for the provider."

Statistics show that Dr. Pfifferling and his colleagues are addressing a burgeoning need. Nearly half of physicians age 50 or older plan to leave medicine within the next three years, according to a survey conducted by the Dallas firm Merritt, Hawkins & Associates. While 38 percent plan to retire, 12 percent will seek jobs in non-medical settings. And only 50 percent of physicians surveyed would choose medicine as a career if they were starting out today.

Dr. Pfifferling says that too often medicine doesn't meet career expectations. Doctors are frustrated by managed care, increasing health care regulation, and faculty and colleagues who provide little in the way of leadership and peer support.

According to Dr. Pfifferling, the rise of the nonphysician health care work force also has contributed to unprecedented levels of physician job dissatisfaction. Nurse practitioners and physician assistants often see less severe cases, while doctors treat sicker patients with more complex illnesses. The gratification from healing a patient is less readily available.

The result is physician burnout. Dr. Pfifferling defines burnout as a stress syndrome, which can manifest itself in a variety of symptoms including insomnia, gastrointestinal problems, rapid breathing, general depression, and cynicism. High turnover, absenteeism, reduced morale, and various illnesses can all be evidence of burnout, Dr. Pfifferling says.

Managed Care Blues

Gigi Hirsch, M.D., started her career in emergency medicine but soon found herself on the verge of burnout. Dr. Hirsch closely examined what she wanted from a job and felt she couldn't dig deep enough into the patient issues that presented themselves in the emergency room. So, she ventured off her foreseen path to explore the psychosocial issues surrounding illness. "I wanted to go back to my roots in psychology," which is Dr. Hirsch's undergraduate major.

She entered a psychiatry residency at Beth Israel Hospital (now Beth Israel-Deaconess Medical Center) in Boston in hopes of helping doctors like herself. In 1992, with $500,000 of grant money in hand, Dr. Hirsch founded the Center for Physician Development. "I wanted to explore the rest of the story," she says. Through the center, she offered individual counseling and studied the impact of the changing health care industry on physicians.

Now, Dr. Hirsch is the CEO for MD IntelliNet, a research and consulting company that specializes in the management of physician human capital. Her tasks still include counseling, and she works to help doctors find career options that fit their personalities and needs.

Dr. Hirsch has found through her research and work that physicians are increasingly unhappy with their careers, as evidenced by both rising physician turnover and disability claims. The Merritt, Hawkins & Associates survey found 56 percent of physicians cited managed care as their biggest professional frustration; nearly 50 percent of doctors indicated that managed care was a "significant factor" or "the single most significant factor" in their decision to change their style of practice.

While many physicians blame managed care for their woes, Dr. Hirsch says it's just the element that tips the scales. A real dollar decrease in physician compensation, heightened fears of malpractice litigation, the growth of managed care, and the rise of dot-com and other lucrative job opportunities have all been blamed for growing job dissatisfaction and a significant decline in medical school applications. "Many doctors are dissatisfied, burnt out, or just plain bored," she says.

Dr. Hirsch has found four general physician career patterns. If a doctor follows a career pattern that isn't suited to his or her personality, conflict and unhappiness can result, she warns. The career patterns are:

• Narrow and deep: A narrow, specific interest is pursued throughout a physician's career. These doctors are likely to become professors.
• Linear: An interest in rising through the ranks of the management hierarchy. These doctors go on to run hospitals and medical schools.
• Spiral: A need to broaden a personal or medical sphere of influence. These doctors are involved in policy and advocacy efforts.
• Transitory: The need for a change every two to three years. Dr. Hirsch admits to falling in this pattern herself. These doctors are best suited as consultants and entrepreneurs.

Shifting to a Better Fit

Experts say doctors are particularly ill prepared to make a career move. Outside medicine, people may not understand the desperation of some doctors, causing physicians to feel isolated. "The culture of medicine tells doctors not to express dissatisfaction since it can be perceived as a sign of fallibility," Dr. Pfifferling says. This lack of communication can leave doctors feeling even more isolated and alone, and can turn their dissatisfaction to distress.

Making matters worse, physicians often don't have access to the career counseling that other professionals do. "The culture of medicine can actually stunt professional growth, because there is a lack of career guidance throughout training, residency, and medical careers," Dr. Hirsch says.

Counseling helps burnt-out physicians modify their careers so they enjoy what they do on a day-to-day basis or even pursue their dream job. For some, it could mean seeing patients only part-time. For others, it could be finding an administrative position within a hospital. Dr. Pfifferling adds that some doctors just need to expand or contract their efforts in medicine, not leave it altogether. For example, a recently married doctor may want to scale back his hours, while a doctor preparing for retirement may want to work more.

Above all, "doctors should ask themselves: 'How do I define medicine in relationship to me?'" Dr. Pfifferling advises. He also instructs new clients to examine their values, what energizes and exhausts them throughout the day, and their definition of a dream job.

Although physicians already short on time may feel hard-pressed to find room for interests outside the realm of medicine, Dr. Pfifferling maintains that hobbies are critical in attaining personal satisfaction. He has a client who is rearranging her practice so she can travel to France and paint in the summer. Hobbies can also help direct a physician to a more individually appropriate career in medicine. One of Dr. Pfifferling's clients who enjoys hiking, exploring, and traveling decided to specialize in research expedition medicine. "Doctors need to redefine medicine in their own image," Dr. Pfifferling says.

Dr. Hirsch adds that early diversification in subjects such as business, public health, and technology can pay off later. "This encourages an open door in other directions." She also recommends that doctors balance the spheres of personal, professional, and organizational life.

Schools Boosting Career Services

Experts are not predicting an end to job satisfaction for all physicians. But, as the world of medicine rapidly changes, the medical community must become more sensitive to the individual career issues doctors face, Drs. Pfifferling and Hirsch agree. Dr. Pfifferling says medical schools and practices can make the environment more open for career discussions by encouraging faculty-student and peer counseling, in which counselors listen carefully, help redefine professionalism, and answer questions honestly.

Dr. Hirsch says she has seen too many doctors enter the job search process uninformed. "You need to know more about yourself than how much money you want to make," she says. "You need to know the kind of environment best suited for your work style." Medical schools can encourage students to think about life after training, she stresses.

And many universities are doing just that-working to help students choose a specialty that fits their personality and making faculty available for career-related discussions. At Tulane University School of Medicine, Paul Rodenhauser, M.D., assistant dean for academic and counseling services, meets with every incoming freshman to discuss personal, academic, and career issues. He says he and many other faculty members also keep an open-door policy, so students may discuss their career paths and personal issues as they progress through medical school.

In addition, Tulane offers third-year medical school students a "career pathways" workshop. "The workshop encourages students to examine themselves and learn to discuss issues with their peers," Dr. Rodenhauser says.

The University of Washington School of Medicine offers many chances for students to glimpse what their future lives hold. For example, first- and second-year medical students have the option of a "preceptorship," in which students shadow a community practitioner one-half day every week.

"We ask students what is important to them and how we can help," says Lisa Hager, a family medicine student advisor for the school. "We offer experiences close to the real thing in as many different ways as possible."

She explains that the school's Family Medicine Department encourages students to participate in its Rural/ Underserved Opportunities Program (R/UOP), a four-week elective between the first and second years of medical school. The program, Hager says, enables students to experience first-hand the work of physicians who care for the underserved in mostly rural regions.

For both practicing and future doctors, Dr. Hirsch admits that examining and modifying job design is not an easy task, but she stresses that, like it or not, it's an issue physicians will increasingly have to face.

And Dr. Pfifferling insists that the most important question a doctor confronting these issues can ask is: "What feels right for me?"

Fast facts about doctors leaving medicine Packing up and moving on: Nearly half of doctors age 50 or older plan to leave medicine within the next three years. 38 percent plan to retire. 12 percent plan to seek jobs in nonmedical settings. Only 18 percent of older physicians plan to continue in their current style of practice. 53 percent of doctors have closed their practice to new patients. Top complaints: 56 percent of physicians cite managed care as first on their list of professional frustrations. Nearly 50 percent of physicians point to managed care as a "significant factor" or the "single most significant factor" in their decision to change their style of practice. 15 percent report Medicare/Medicaid regulations as their primary frustration. Do it all over again? 50 percent of physicians would choose medicine as a career if they were starting out today. 42 percent would encourage their children to choose medicine as a career. 60 percent say "patient relationships" are the single greatest source of their professional satisfaction. Health care quality assessment: 54 percent of physicians indicate that the quality of health care in the U.S. has "generally improved" over the last 20 years. 21 percent of physicians believe health care has "generally remained the same." 24 percent think the quality of care has "generally declined." -Excerpted from "Year 2000 Survey of Physicians 50 Years Old and Older," Merritt, Hawkins & Associates

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