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by Tod Stillson MD
You can also find this post at SimpliMD.com
Learning To Work In The Factory
Since the age of 10, I have been working for large corporations. It all began with my first paper route, where I would ride my bicycle around, delivering the local news to the citizens of my quaint little town. I come from a family of factory workers, and during my primary school and college years, I earned paychecks by doing the most challenging job at the factory. That is because short-term and part-time workers in factories often have to take on the “leftover jobs” that no one else wants. I’ve taken on many difficult tasks to earn a few dollars, and some of those dirty jobs in the factory are simply unimaginable. But that’s just how it rolls when you’re starting out in life or working part-time. You simply accept the job, do as you’re told, and remind yourself that it’s all temporary.
The Balm of Payday
The joy of payday momentarily erases all the mental and physical pain that comes with a demoralizing job. For me, working at the factory wasn’t the end, but rather a means to acquire the assets needed to reach the next goal. The demoralizing work could be made tolerable by acknowledging that it was only short-term. On the other hand, long-term factory work was a completely different game that required a higher level of selectivity, patience, time, and luck in order to be promoted to a better shift, machine, conveyor belt, or job. This was demonstrated to me by my dedicated parents, aunts, uncles, and grandparents who faithfully punched their time cards week after week, and then joyfully embraced their time outside of work.
The Job Pool
Ultimately the factories were where the predictable, higher paying, and benefit-laden jobs were located in comparison to retail jobs or small businesses. These large corporations were the go-to locations for employment opportunities. The factory owners had significant control over the job market, making them the default source of work if you weren’t in management, professionally trained, vocationally trained, or owned your own small business.
In a strikingly similar scenario to my factory working days as a non-professional, our tribe as modern doctors are being compelled to select from a limited range of job options that are dictated by large corporations. In the past our status as a professional earned us the power of autonomy and self-determination. For most that included joining the ranks of other small businesses in a community and then delivering a professional service to the free market of patients/citizens in that community.
A Commodity and Corporate Asset
Today, as you transition into the role of an attending physician, you essentially receive a job board that is controlled and manipulated by large employers. These employers, in collusion with recruiters, offer enticing job offers filled with incentives to attract employees to the healthcare factories of America. While they may not be referred to as “factories,” they are commonly known as “health systems. This may sound better than a factory, but essentially, that’s what they are when you become their employee. You are reduced to a nameless, faceless corporate commodity, labeled as “physician labor.” Here, you are treated like a mere machine on their assembly line, where your skills and expertise are exploited solely to generate revenue for others.
By willingly entering the economy as mere employees, we diminish our professional status to a level that is comparable to our non-professional counterparts. Their job opportunities are limited to being loyal employees of someone else’s successful business, and unfortunately, we find ourselves in a similar situation.
In American culture, generally speaking, the more educated and professionally successful you are, the higher the likelihood of gaining the power to be self-employed and function autonomously as a micro-business or service professional.
Unless you are a doctor.
Our conditioned training often leaves us business illiterate, comfortable with being subjugated to the control of others, and accepting of a healthcare system that has been hijacked by the government, big corporations, and insurance giants.
Thus we blindly accept the “safe harbor” of employment because it’s for “our benefit—all the while not understanding the harm that this “safe” space will eventually cause us with a greater than 50% burnout rate.
When we clock in at these healthcare factories, we often find ourselves unaware of the self-imposed mouse traps we enter. It’s amazing what we don’t know about the challenges that lie ahead—always assuming the burnout would happen to someone else.
Industrial Workers In Medicine
Our tribe has transitioned into becoming industrial workers in medical factories operated by large corporations, which have a strong grip on the job market. This has become our primary job pool.
Those of you who are becoming new attendings are overwhelmingly choosing to work in medical factories because it predictably helps you absolve your educational debt. Just like in my younger years, employment offers the essential elements for achieving independence. Many of you aspire to attain a level of freedom that will liberate you from the burdens of debt and working for someone else.
The Trap of Inter-Dependence
However, employment can sometimes feel like a bit of a trap. Once you begin depending on your employer for support, it becomes progressively more difficult to break free, even if the situation is detrimental to you. You will quickly become accustomed to “punching the clock” by fulfilling your contractual hours. This will enable you to enjoy a high quality of life, a predictable paycheck with benefits, and the pleasure of a non-work lifestyle that you can fully define and control. This piece will increasingly serve as your escape valve from work that can sometimes feel soulless, monotonous, and devoid of purpose or meaning.
Don’t let your hope and dream of being the captain of your professional life, making a good living while altruistically helping others, be lost as you become a mere medical machine in your employer’s enterprise.. Don’t limit yourself to seeking control over your life only outside of work. Even in your non-work space, you may find yourself dreaming about a professional change that can bring you the level of autonomy you desire at this stage of your life.
Most of you won’t intend to work at the medical factory for the C-suite executives for your entire life. You see it as a temporary means to an end – a stepping stone towards professional and personal independence. The goal is to achieve autonomy, not rely on interdependence or co-dependence.
Newton’s Law of Inertia
According to Newton’s Law of Inertia, once you start working in a healthcare factory, it is unlikely that you will change paths.
Newton’s first law of motion, also known as the Law of Inertia, states that an object at rest will remain at rest, and an object in motion will continue moving in a straight line at a constant speed unless acted upon by an external force.
This law has had a profound impact on our understanding of physics and can also be used to explain human behavior.
When it comes to human behavior, Newton’s first law is particularly relevant. People often find themselves sticking to the same habits or routines until they are compelled to break free from them, whether it be through a significant event or the influence of someone else.
For example, when a person is stuck in a rut and unable to find a way out, an external force must come along to break them out of their funk and help them change their trajectory.
Change Becomes Harder
For you this means that making any changes becomes increasingly difficult throughout the span of your 30-plus-year professional career. Your large house mortgage, kids in schools they don’t want to leave, a spouse who doesn’t want to move “again,” and a revved-up lifestyle that strains your finances all make it difficult to make professional changes. Moreover, doesn’t leaving a job look unfavorable on your resume and reflect a sense of moral failure that can be psychologically detrimental to your career?
All of this will culminate in invisible forces that dismantle your dream of independence and transform your interdependence into an unhealthy co-dependent employment relationship. You find yourself in a situation where you can’t live with them or without them.
Coping Mindset: Things Will Get Better When…
As you revisit the delayed gratification mindset that carried you through all the difficult years leading up to your life as an attending, you will remind yourself that you have consistently made successful decisions, demonstrated high-level performance, and displayed an impressive ability to overcome any hardship that comes your way.
Thus being informed by this mindset, you will remind yourself that “things are going to get better, when…” This arrival script will create a futuristic mental escape that will dissipate the current pain.
While this powerful mindfulness technique does work, it may be a little misguided due to the risk of the arrival fallacy.
The arrival fallacy is a cognitive bias that often tricks us into overestimating the ease and speed with which we can achieve our goals. It is a false assumption to believe that once we reach a certain point, things will magically become easier and success will effortlessly follow. This bias can lead to unrealistic expectations, disappointment, and frustration when progress toward our goals takes longer or proves to be more challenging than anticipated. By recognizing this fallacy and understanding its effects, we can become better prepared for the unpredictable nature of life’s journey and learn to appreciate every step along the way.
In medicine, the arrival fallacy is particularly common during the first five years as an attending physician. The feeling becomes especially prominent in years 2-5, as the initial excitement of starting a new job (typically as an employee) wears off and the realization of having limited control over your professional life becomes clearer.
At this point, you can rely on the mindfulness technique that has carried you for years and label the disappointment with your job as a temporary adjustment that will be resolved in the near future.
You can confidently shift and re-formulate your expectations for the next arrival point, knowing that your frustrations will improve when “x” happens in the next 6-12 months.
You will tend to trust yourself to overcome the employment obstacles and inform those close to you that positive changes are on the horizon.
You Must Do Two Things
I am not gonna lie, my wife is tired of hearing me talk about this annually for the first 15 years of my career. Like a giant chess board, I would make adaptations to my employment environment only to feel like my employer simply responded with their next move. Back and forth we went til ultimately I felt backed into a corner by my employer, out of moves—-thus making me feel helpless, controlled, and undervalued.
This reminded me of when I was younger, mindlessly making widgets on the assembly line of the factory—controlled by the time clock and production quotas. I would cope by engaging in mental gymnastics to make the day more bearable, immersing myself in daydreams about what I would do after punching out of the time clock.
Unfortunately, my dream job as a doctor now evokes the same feelings as when I was a factory worker. We are stuck doing someone else’s stuff until we can be set free to autonomously do what we really want to do. Our work just becomes a monotonous job and our meaning & purpose are found in our non-work lives.
You were meant for more, don’t settle for less!
The combination of meaningless work and the loss of professional autonomy are the key ingredients of the most sinister employment consequence of all-burnout.
The paradigm I have described is one of the fundamental reasons our tribe is experiencing significant burnout. It is a systemic problem that requires a solution focused on restoring our autonomy.
But the government and the healthcare systems are not going to do this for you. You have to take responsibility for two things yourself:
1. Do not give up your professional autonomy in the first place.
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This involves creating your own professional micro-corporation as a virtual shield to protect your professional life.
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This involves resisting the urge to follow the herd and blindly signing up to become an employee of a large corporation..
2. Fight to preserve your professional autonomy throughout your career.
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Choose self-employment through our micro-corporation and contract out your professional services, whether it’s for short-term or long-term engagements.
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Take proactive steps to establish yourself as a contractor in the marketplace, and ensure that those who seek your services engage in a business-to-business relationship rather than an employer-employee dynamic.
What should you do with this information, proactively take a step to make yourself micro-business literate by becoming a member of the SimpliMD physician business community.
Go here to download my free e-book “7 Business Hacks For The Modern Physician” which describes more reasons to take this step.
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