Greetings
Greetings! This is Dr. Incorporated bringing you another episode of The Truth About Employed Physicians. I hope it’s been a good week for you in the employed physician world. This week I’ve been reminded of the importance of the work we do every day with patients. A couple of days ago in my office an elderly patient was struggling with shortness of breath. We ultimately determined she was having a heart attack so we of course sent her to the hospital immediately. Upon arriving at the ER she collapsed in cardiogenic shock. She was able to be resuscitated and survived the episode and is coming through at this time. I feel my staff and I saved her life by figuring things out quickly and rushing her to the appropriate care in a timely manner. I’m sure there are a lot of you who have had experiences like that this week. Some of you probably even saved someone’s life. I just want to say thank you. Thank you for all the work you do.
Young Doctor Preferences
This week we’re going to discuss a truth that I realized after talking with my much younger partner at my office. He’s been working with me for a year now. He’s just out of residency and it’s been a joy to have him with me. He’s a great family physician and does a great job at primary care in the rural community in which we live. But in talking with him I realized a truth that exists among younger physicians: the younger you are in medicine, the more you want to make sure your life outside of medicine is healthy and strong. In other words, medicine is not your life, nor does it have to fully define your identity.
Truth – Younger Physicians Value Greater Professional-Life Balance
After talking with him for awhile he somewhat sheepishly and begrudgingly said to me, “You know, I realize your whole identity and purpose seems to be wrapped up in medicine and this community.” Make no mistake about it, he’s absolutely right. I enjoy being an influencer for the health and wellbeing of my community and I don’t mind being known just about everywhere I go.
Enjoy Life Outside of Medicine
As we continued to talk I was reminded of how many things this young doctor enjoyed outside of medicine. He’s a pilot, his wife is expecting their first child in a few months and he’s excited about growing a family, he loves to run–he has a whole host of things to enjoy outside of medicine. He’s already starting to figure out how demanding practicing medicine can be. He’s beginning to flush out what he wants in this field and how much he’s willing to give to it. He sees how much time I spend in the office and how much work I even do outside of the office in the community and he quite honestly told me he doesn’t want to follow that same career path. He wants more balance. I can’t blame him. He is right. That’s not to say that I don’t feel balanced in my own life. Sure, I do a lot of things with my doctor hat on, but I’m still very involved and invested in the lives of my wife and our five children. I love what I do and I love where I’m at. As I reflected on what he said I think there are several reasons for why he values balance. And I also recognize why my “old school” all-in version of medical practice needs adjusted, and can learn some lessons from my younger peer. He and my Millenial & Generation Z peers are moving this needle in the right direction.
Financial Pressures and Economic Forces Influence the Pursuit of Balance
Loan Payback “Fellowship”
Young physicians are always aware of how much money they have to pay back for their prized medical education. With the average medical education debt being north of $250,000 – $300,000, young doctors realize that they need to stay put in one location and begin chipping away at those hefty student loans. Commonly young physicians place themselves in a community that they otherwise wouldn’t choose as their long term practice site. But because there is a loan payback process linked to the position in a specific practice location, they accept a job knowing it likely will be short term until their loan is paid back. This is what I would call the “Loan Payback Job”. It’s a common phase for new doctors coming out residency, and is almost like a “Financial Fellowship.” A place to safely learn how to be an excellent attending physician, while accomplishing the task of wiping away one’s educational debt. This is typically a 3-5 year process. Basically it’s another delayed gratification process for doctors as they prepare for their “dream job-location”.
Debt Elimination
For others of you with less educational debt, the priority might be as simple as making a fair market value contract that results in a predictable paycheck so you can begin paying down that consumer and mortgage debt while taking advantage of the benefit system that includes retirement plans, healthcare, etc. With the student loan resolved, you might have purchased a doctor’s home–with large mortgage payments that weigh you down, and also commit you to staying in that location to pay down the mortgage.
You should make sure you’re doing everything you can to pay your debts down so you can begin living the financially free good life that practicing medicine provides.
I think prioritizing educational loan repayment is the right approach. You need to take advantage of these resources and benefits as you come out of the residency ready to practice as an attending physician.
Knowing that you will be working towards debt elimination early in your career raises the importance of finding personal and professional balance in the process. These early years as an attending physician allow you to develop the necessary habits of well being that stave off burn out. Again, this affirms the value of a balanced practice setting that is prioritized by many young physicians.
Your Work Community Does Not Have To Be Your Living Community
A lot of physicians in the past felt obligated to serve on local committees, or within local service organizations that benefit the community of your practice. . I’m sure young doctors feel this same sense of obligation, but sometimes it’s just not practical to take on all of these extra responsibilities. We work long hours as it is, our profession can be grueling and taxing. Sometimes we barely have enough time to fit in for our families. The last thing you want to happen is to be burdened with things you have to do and not have time to do the things you want to do, at least when it comes to extracurriculars. I love being involved in my church community, our local school system, and I love making a difference in our community through the various civic groups I serve on. If I can help improve my community then it’s not only to my own benefit but to everyone’s benefit. That’s important to me. But I realize it’s because I want to be involved in those things and not because I have to be. When I moved to this community 25 years ago, my predecessor strongly urged me to get involved in the local country club. He thought this would be a great way to build relationships and would make it easier for me to get my foot in the door with certain groups and opportunities. Quite frankly, I was not a country club kind of guy. I didn’t mind golfing, but because I was a young doctor with a family I couldn’t really justify spending 4 hours of my freetime away from my family. Much to his dismay I chose to forego the tee times. My practice still grew and was successful as I found the natural affinity groups that better fit my preferences and values. This is a normative process for all of us.
Urban Anonymity
I used to think that physicians who lived in our little community had a greater likelihood of having a successful practice. That was an old model, and now is relatively extinct. Now over half of the physicians practicing in our community and hospital commute in from larger urban areas. In so doing, they find greater opportunities for their preferred life outside of medicine, and find more concrete boundaries between their professional and personal lives. I call this “urban anonymity” and it seems to a preferred practice arrangement to younger physicians.
Medicine Is A Time Stealer
It’s been said that medicine is a demanding lover. There is a lot of truth to this.
Young physicians aren’t as enthralled with overcommitting themselves to things outside of medicine. I fully support and agree with this. I think what happens to physicians is they go through the long, arduous process from pre med to medical school to residency; there’s this whole delayed gratification process that happens. They say no to social relationships, things they want to do that they see their peers doing, they can even delay getting married or buying a house or car. They put everything on hold for the 10-15 year process associated with becoming an attending physician, by the time they get out and start practicing medicine they want to enjoy life. They don’t want to give in to the “powers of medicine” that make them give up on the things their peers and neighbors are busy enjoying. In the training environment you don’t have the luxury of doing anything else. By the time they get out of that training environment they might be tired of all the sacrifices they’ve made to get to this point. They want the option to do what they want with their time. I understand and respect that. I think it’s important to find that balance. Furthermore, I think this is the precise time physicians should figure out that balance and what works best for them.
Young physicians value mobility over longevity
This has changed dramatically over the past 25 years. Back in my day when we got out of residency, it was common to set your roots down and stay in one location forever. The advent of employment options for physicians that aren’t so tied to bricks and mortar provide them with the mobility that comes with being able to start or stop a job at any point to move on to another location or employer. When I wrapped up my training in medicine in southwest Virginia I thought I was going to live in the Appalachian Mountains in Virginia the rest of my life. But through some life circumstances that were connected to my wife’s breast cancer at the time we decided to move back to the Midwest where both of our families were so we could have a strong support system. I then became an employed member of a practice in northern Indiana. Those life circumstances led me in that direction. The value of having mobility and being able to take our practice to a different location can be a great idea. That’s why being an employed physician is such a profound and great place to be in life. It’s probably one of the reasons why you’ve decided to be employed. By going through all of the extensive training, from pre med to your residency and everything in between, we get used to moving. We become kind of nomadic. After some time I think the desire to settle down with your family becomes more and more desirable, but I think that nomadic quality is a big reason why we’re adaptable and capable of moving on to the next opportunity with great resiliency.
Demand For Employed Physicians Creates Opportunity
This is a tremendous place to be; it’s a position of strength. We’re in a physician shortage. If you’re unhappy at your current practice or location, regardless of what exactly you’re unhappy with, you can always find a different job. Let’s face it, we all get bombarded with emails and snail mail pieces soliciting us and our talents.
When I was fresh out of my residency I wanted to do everything. I wanted to practice OB, I wanted to do C-sections, I wanted to do hospital care, I wanted to do EGDs, I wanted to do colonoscopies, I wanted to be a team physician… I wanted to do it all. In fact, in my training I was prepared to do all of those things. But what you begin to realize once you get into practices it’s nearly impossible to do it all. I think it takes about 3-5 years for physicians to sort through what they want in the world of medicine. You might be realizing that your current job is outside of that area of expertise. But as we’ve already determined, the high demand nature of your profession allows you to find a better opportunity that enables you to practice medicine in an arrangement that meets your personal preferences.
Telemedicine Is Growing
The Telemedicine world is bigger than ever and it’s growing at a rapid pace, accelerated by the COVID-19 pandemic. This is really expanding medical care possibilities for physicians. We are now able to provide care to outside communities, states, and even other countries without leaving your office. It’s pretty incredible to witness this transformation. We’ve discussed at length the importance of balance in our lives, and Telemedicine is allowing us to widen our parameters as employed physicians without the stress of traveling and uprooting the lives and careers we’ve made. We can dictate our hours and be “on the clock” at our own leisure. If you want to work 2 days a week, you can. If you want to work 7 days a week, you can do that, too.
It’s almost like “Uber Medicine” for physicians who are all in with telemedicine practice.
The Younger Will Lead Us To Balance
The younger you are in medicine, the more you want a life outside of medicine is an important truth. I think it’s an evolving truth that continues to push people towards the employment model of physicians, and furthermore, will only strengthen that position because of the great opportunities and perks that come with physician employment. This in turn, allows us to fulfill a better balance in our personal and professional life.
I hope you have a great week. I look forward to hearing your thoughts and comments in regards to this as we continue to support each other in this community.
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