After working in private practice as a dermatologist, Heather Fork, MD, transitioned to a new career counseling physicians on how to manage their career-related stress and anxiety. Medscape contributor Andrew Wilner, MD, recently spoke with Dr Fork about her decision. You've successfully transitioned to a nonclinical career as a counselor to physicians. What I find really interesting is that you often work with physicians who have just finished their training, residency, and fellowship and now are transitioning to their first clinical career. Can you tell me about some of the problems these new doctors and academicians often face? What often happens is that I'll get a call from someone in clinical practice—a doctor or a surgeon—because they've developed some anxiety that's really starting to escalate. As a physician yourself, you know the difference between that point in your career and being in residency. As a resident, if something is going wrong with the patient, the buck doesn't stop with you; there's always someone senior, an attending or an upper-level, to help you. Even though you're concerned and upset for the patient because you want them to do well, there is still a level of comfort because you're not the one on the spot. That changes when you get out into practice. Say, for example, that you're an ophthalmologist working on the cataract of a patient who maybe has one good eye. All of a sudden, vitreous humor starts leaking out and you're all by yourself. That would freak anybody out, but this really happens in practice. One of the things I like to help these young physicians with is learning how not to have anxiety and have this sort of situation be career-ending, which sometimes it can be if they don't get help. Our discussion can be about what they can do in such moments, when they're already employed and struggling with anxiety. How do doctors typically find you? Often, people find me just by searching online for terms like "anxiety" and "physician." They also find me through an interview I did with a surgeon a while back as a blog post on KevinMD.com. I talk with her about her experience of having anxiety and being able to cope with it through working together. But if they don't find that article, just searching online about "leaving medicine" or "physician coaching" will usually get them to my website, Doctor's Crossing. I think that's great because it's hard to bare your soul to another physician—and certainly to an administrator if you're working in a big organization—about a mistake. That's not really part of physician culture. No, unfortunately it's not. That's an important consideration when you're looking at that new job. You should not just ask about the salary and how your day is going to go with patients, but also about whether you are going to get mentoring and what that support looks like. When something goes wrong, are the partners or administrators going to be supportive of you? Otherwise, it is so much harder to really do your best and be immersed in the learning mode required of young physicians. I do remember having anxiety when I first went into practice. I'm a non-surgeon, so of course the big intervention was—and still is—writing prescriptions. I remember handing them to patients and thinking, "They're really going to take this. I hope I gave them the right stuff." After a while you get used to it, but there certainly is a jump from being a supervised student, resident, or fellow to being out there and practicing on your own. Mid-career Woes What do doctors in the middle part of their career tend to talk to you about? In many doctors, the anxiety doesn't hit until later in their careers, when it often appears to hit out of the blue. That's not unusual. It could happen because there are certain stressors that are going on in their work or personal life, like in anyone. But physician culture encourages a high threshold for suffering; anxiety can be going on for a long time and either managed or suppressed. Then maybe they just hit a breaking point. For these physicians, it can be, "I've managed alright and people can't tell what's going on inside of me, but it's really taking a toll." In these cases, it's about really learning some things to get control of and improve the anxiety, which most of us can do, especially with help. And then there's a small percentage of people who, even if they can improve their anxiety, decide it's just not worth it for them. They say, "I just want to go, sit at a desk, do my work, and not worry about what's going on after hours." Understanding When Issues May Run Deeper Do you ever wonder whether some of this is more of a mental health question than a career-counseling question? That's a really good question. If I feel like someone's anxiety needs assessment by a psychiatrist or they need medication, we certainly recommend that. Some may be seeing a therapist or a psychiatrist concurrently. I think you can tell pretty well, and rather quickly, whether some behavioral modifications—like getting exercise and not using too much caffeine—are having an effect, versus needing more extensive counseling or care. Another point is getting the physician to consider their thinking process. It's very easy for anxiety to get in the driver's seat, where you're doing a lot of "what if" thinking. Maybe you're not even on call but you're having pre-traumatic stress just thinking about your pager going off, or about what kind of case you see next. These are all what ifs. If physicians can start to manage how they're thinking, then they can implement other things in their life that help support being healthier and more relaxed in general. If things don't improve within a month, however, then I think that's an indication that there's probably a deeper problem that's not necessarily situational. So a lot of it is lifestyle modification and expectation modification. I think the best preparation for doing well is your training. The better training you have, the better job you're going to do when you're done. But a lot of other factors are going to contribute to your performance. That's absolutely right. There's not just one quick fix to this challenge. Some of my physicians who have been successful in dealing with anxiety will say, "I do the homework that you give me. I really work with my mind. I got a meditation app. I do mindfulness exercises." And a lot of these things you need to practice when it's not a 9-1-1 kind of situation. A lot of it really is mind retraining. Like you said, much of it is global in terms of how it manifests, but also in how you switch things around to come from a more confident mindset. Concerns Don't Just Go Away Late in Your Career Do you have consultations with physicians toward the end of their career but who are not yet retired? In my own work, I've certainly heard from physicians who don't want 60-hour work weeks anymore. Are there other issues that might come up for these pre-retirement physicians as well? I think some of them worry that when someone looks at their résumé, are they going to seem too old? Are they going to have to deal with ageism? When you've been a physician, you've usually had a lot of respect and esteem and feel like you're really participating in something very valuable and meaningful. Physicians at that stage may question, "What's my value as I get older, and how can I still contribute in a way that's meaningful and enjoyable?" I always ask people, "Are you still breathing? Are you thinking well? Then you're useful; there is a place for you." There's a lot of things physicians can do. Especially the older you get, you have a breadth and depth of experience that younger physicians don't have. Don't discount what you can do. The nonclinical realm is so diverse that I'm sure there's a niche for everybody who really wants to still be contributing. That's a great, optimistic message. Is there anything we haven't addressed that you'd like to mention? You've asked great questions and I'm so glad for this platform to speak about it. I just want to let people know that if you're having any anxiety, you're normal. Everybody has it to some degree. Saying it's very treatable makes it sound like a condition, but it actually can be improved and often reversed very quickly. It doesn't necessarily have to be a really long process, and it's usually not something that will cause you to need to leave your career. And if it does, that ends up being your decision, really. So if it's a problem, don't be embarrassed. Get help. I'm happy to talk to anybody with this. You worked hard to get to where you're at, and we don't want to let career anxiety be a deal breaker for you. Andrew Wilner is a professor of neurology at the University of Tennessee Health Science Center in Memphis and a health journalist. His latest book is The Locum Life: A Physician's Guide to Locum Tenens. When not writing or seeing patients, Wilner, an avid scuba diver, can usually be found underwater in some far-off ocean. Source
