Good day. This is doctor incorporated. Bring you the truth about employed physicians. I hope it’s been a good day for you as you practice medicine. I know we’re just coming out of a weekend here in the Midwest, and I’m reminded of what physicians do really week after week, month after month. And that is we provide care to our patients.

Whether it be the weekend or the weekday. And I want to say thank you for doing that dedicated work that involves both weekends and weekdays. Many people forget that. Medicine just doesn’t turn off when Saturday and Sunday come, but we continue to press on taking care of patients, doing the right thing, meeting their needs, and taking care of them really Monday through Sunday.

And sometimes people forget that. And I want to just remind you that I’m thankful. And if somebody hasn’t said thank you today, I’m saying thank you today for the work that you did and that extra time in the evenings, the weekends, or the time off that you took care of patients. Been doing this for over 25 years and I’m aware of all the extra time, it takes to really be a caring and a really sincere practice physician in today’s world, which brings me to today’s truth that we’re going to unpack.

Truth: Change is normal

And that is that changing practice environments is normal for physicians as 25 years. I’ve seen this happen over and over again. Both in my life, in the life of my peers and friends. And we’re going to talk today about this truth in a little more detail for physicians.

As you emerge from the pre-med and medical training vortex, that normalizes changes and transitions you after a year, you often find yourself longing for the stability of becoming an attending physician and starting your professional career.

Yes, the bigger paycheck is nice. Yes, unleashing years of delayed gratification feels really good, but in the end, many of you along with your significant other just long for stability. The stability that comes from becoming an attending physician. This is especially satisfying when you get to choose to practice in a self-determined location that is not part of our training. Sweet! Settling down in one location sounds so appealing when you are weary from experiencing changes year after year in your medical training.

This plateau in medicine is a special place where change only happens because you make the choice for it. It is a place filled with expected autonomy and control professionally and personally unlike your training experience.

But today I hate to burst your bubble. It’s in reality, a Mirage.

The Autonomy Bubble Is Burst With Employment

Let me give you six reasons why that bubble will be burst when you reach the attending physician plateau.

1. Change is much more common for today’s physicians
2. Finding a trusted peer in a medical group is elusive
3. Family Life changes are inevitable for doctors
4. Professional maturation leads to discovery about yourself and the world of medicine
5. Financial matters will influence you
6. You will have changing and evolving interests

Employment Makes Life Predictable

When you choose to become employed, you are eliminating many of the unpredictable elements associated with trying to operate a small medical business within a very complex medical world. Through employment you don’t have to manage or operate the practice. Additionally you can contract out predictable clinical hours/work loads. This so called “shift work” is becoming the preferred job structure for Generation Z physicians. It only makes sense due to their preference for work-life balance.  The more predictable your work schedule, the easier it is to find balance. With COVID we have seen the stronger emergence of tele-medicine which also affords a very predictable schedule and deep sense of being off and away when your shift has ended. For many this is very satisfying. 

I am certainly mindful of this option as I am  building a vacation home in another state. I’ve created a suite in this vacation home that’ll allow me to provide tele-medicine from that location so that when I retire from my current primary care job, I’ll be in a position to provide telemedicine when I want.

Employment Makes Transitions Easier

Employment makes job transitions natural and easier overall. Employment contracts have terms that come to an end. At the end, you can easily choose not to resign, and transition to a new job. This is much cleaner and easier than the days when private practice and partnerships ruled the landscape. Again for Generation Z, this is a preferred structure.

Trusted Peers are hard to find

Finding trusted peers in a medical group can be difficult and elusive. I’ve been very fortunate in my career as a doctor to practice medicine with friends and peers and people that for the most part I’ve really enjoyed and really liked. Some of them are my best friends in the world. And some of them are just friends and colleagues that I would consider associates, not not being super close to them. Then there a few have been real pains in the rear. People that I didn’t enjoy being with, or didn’t enjoy practicing with. Fortunately, most of those folks have moved on and moved out, but it’s a difficult thing to find people that you enjoy working with that you want to go to work with every day.

Long-term, finding a close friends or even a spouse can be difficult in medicine. So finding a medical peer that you want to spend all of your days and weeks with is hard. Let me just say, when you find somebody like that, treasure it, enjoy it, drink it up. Even if it’s for a short season t it is a very special relationship and it certainly makes practicing medicine so much more enjoyable when you love going to the office to spend time doing medicine with people that you really enjoy being around. But this rarely lasts because changes that lead to physician movement and thus changes in a medical groups is a normal process now days.

Medical Group Provider Changes are Normal

Every year for the past 25 years has brought a change within the my provider group. Quite simply change is the norm. In contrast, I grew up in a small community in the Midwest. In the primary care medical group that provided care to me as a youth, there were three physicians in that group that literally never changed for never nearly 40 years. Those days are gone now and I suspect this type of longevity will exception rather than the rule.

Now the practice site is owned by a corporation, but the practice site still exists. However, the providers seem to be a revolving door in that clinic. And that revolving physician door has become the norm in today’s healthcare market. For employers, it’s a matter of filling the provider seat to maintain a market share control over the patients, which is much different than the older model of physicians maintaining a personal presence within the community and vis a vis the patients. In today’s market the alignment is no longer with the doctor and the patient, it is primarily with a corporate brand and the patient. Big business has hijacked medicine in this way.

For doctors this constant provider turnover and change can be disruptive to your sense of peace and professional satisfaction in the outpatient setting and the hospital setting. It tends to diminish deep trusting peer relationships. Communication is rarely verbal between doctors any more, occasionally is electronic within a health system, and more times than not is simply messaged via faxed/emailed/mailed patient charts…left to be deciphered in useless EMR babble.

Family Life Changes are Inevitable

Let me start with divorce. It’s a common and an unfortunate experience, albeit less common for physicians, but yet it is a reality that happens in our physician world. Nothing changes our finances, time, balance, and personal needs more than this change in our foundation of relationship. I know for myself, I I didn’t get a divorce, but I lost a spouse to a cancer a few years ago, and that led me to remarriage. I had a practice partner go through a divorce and remarriage process. Re-shuffling things are home almost always lead to practice changes.

I know the power and importance of how family life experiences lead to all sorts of changes for you professionally. Having children alone affects our lives in dramatic ways. This is especially true to female physicians. Yes children are a special blessing in our life, but they do require time. Ultimately are need for work-life balance shifts with this, as we try to keep up the the demands and responsibilities of caring for and connecting with our kids. Many doctors put off starting their family til after residency, so all of these changes often happen at our first job as an attending.

More than children and your spouse, as a doctor all of these competing time demands often cause you to neglect yourself. Your health needs, your hobbies, and your sense of margin in life all vanishes as medicine and family life ramp up together. It can be very tough and stressful to manage this.

Even personal health needs within your life or your home can lead to practice alterations. As I mentioned earlier, when my first wife contracted breast cancer at age 30 , I lived in Virginia at the time. I thought I was going to practice medicine the rest of my life. But due to her medical needs, we had to move back to the Midwest to be closer to family, for them to help walk through her medical treatments. Personal change leads to professional change.

Maturation leads to Discovery

Then there’s the professional maturation of discovery that happens for us individually as we settle into post-training life. I really think it takes about five years in practice as an attending physician to learn what our own personal preferences are in practicing medicine within our chosen field. From hospital affiliation to employers, to medical group politics, to EMR, to support staff, to preferred procedures, to call arrangements, to clinical and surgical skills. All are sorted out from the land of fanciful thinking to the land pragmatics. As an example I trained to do EGD’s and colonoscopies in addition to surgical obstetrics. What I figured out pretty quickly was that it’s pretty hard to fit all of those things into a busy primary care practice, therefore I had to choose what was most important to me.

Our first five years is a vast web of learning what you prefer and what you like and what you don’t like in medicine. And as you learn about yourself and learn more about medicine it shapes what your interests are. It shapes what you want your practice to look like. And oftentimes that’s not the same as the first practice that you signed up for, or how you envisioned what your medical life would look like.

During this time, you also learned about yourself personally because frankly your own personal interests during medical training were put on hold and really thrust to the back burner. During these five years, you have a journey of self discovery that heavily shapes your futures. As you re-connect with yourself and learn about your own personal preferences and interest. , This all plays out during your first stint as an attending physician. This is in part why only 50% of doctors stay in their first job long-term. The journey of self discovery creates a better self awareness of how you want your personal and professional life to melt together.

Financial matters Influence us

When you come out of a training there are financial forces that influence you. For many, your first job is all about loan repayment and debt elimination. You take a job that promises a good quality of life, but allows you to clear the deck of your debt as soon as possible. You tolerate the less favorable practice location knowing that in 3-5 years you can move. One of my former partners did this by joining us and after her 5 year repayment was up, she darted to another community.

Beyond debt elimination, you may be taking a high paying position that allows you to become financially independent sooner in your career. You tolerate something less desirable in exchange for future independence and possibly FIRE. Taking this route, you will likely be a migratory doctor, taking lucrative contracts for short one to two year stints, moving onto the next one at the end of the contract.

I don’t know to remind you that we’re in a growing physicians shortage, so opportunities abound to financially leverage this shortage favorably towards yourself as long as you’re willing to change locations.

Practice changes are normal for physicians.

In my next blog, I’ll dive deeper into how this truth has played out in my own professional experience. And I will share with you the tale of eight physicians.

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