As far back as early medical school, Sylvie Stacy, MD, MPH, a primary care physician, realized she probably wasn’t going to be happy spending her whole career in an outpatient setting churning through patients. “I went to medical school because it was a childhood dream of mine; I always wanted to be a doctor. But I don’t think I ever really took the time to think about whether that was a good fit for me,” says Stacy. An introvert, Stacy was surprised to find patient care exhausting and that she needed a good amount of quiet time to be able to recover after making rounds. “I just never thought about how exhausting seeing patients in a clinic or hospital as a full-time job would be for me until I was actually in the weeds doing it during medical school, and then it hit me hard. ‘Oh no, this does not fit with my personality; what are my options here?’” Today Stacy runs an online community focused on helping physicians have fulfilling careers in medicine. Called Look for Zebras after the saying in medicine, ‘If you hear hoof beats, look for horses, not for zebras.’" I tell other physicians that, when it comes to our professional lives, we need to look for zebras.” Make the most of your regrets A recent cohort JAMA study on physician burnout and regret found that 45.2 percent of second-year residents reported burnout, while 14 percent had career choice regret, (defined as whether, if able to revisit career choice, the resident would choose to become a physician again). Characteristics associated with a higher risk of reported regret included being female and having a high level of anxiety in medical school, while those associated with a lower risk of career regret reported lower overall levels of empathy during medical school. Maiysha Clairborne, MD, an integrative family physician and the founder of the website Stress Free Mom MD, has transitioned out of clinical medicine after 14 years. “Over the years I have experienced waves of physician regret, not necessarily for choosing to be a physician specifically, but for the career path I chose as a physician in family medicine.” Medical school remorse? Clairborne classifies career regret into several buckets including taking an unrealistic view about what life as a physician will look like. “As a physician coach who helps other physicians find their career sweet spot (often transitioning from suboptimal jobs), the first thing I tackle is finding out what their “ideal job” would look like.” She thinks many physicians have an idealized career view and make decisions based on money rather than lifestyle. Also high on the regret meter is the system in which physicians often find themselves working. For example, Stacy says, dealing with insurance companies can be tiresome, and there’s tons of paperwork and meeting regulations and requirements for payers like Medicare, which can contribute to career dissatisfaction. The Future of Healthcare: A National Survey of Physicians by The Doctors Company Foundation also found that EHRs and regulations are top causes of physician burnout, and that 7 out of 10 doctors are unwilling to recommend healthcare as a profession. One of the consequences to the growing domination of large healthcare organizations over small private practices, Claireborne says, is that many physicians lose their autonomy in practice. “We go into to medicine to make a difference. It’s very difficult to make that difference when we have insurance companies, hospitals and large medical systems telling us what we can and can’t do,” says Clairborne. Some organizations try to implement a physician wellness culture, but there is still a long way to go. “We have to tackle the mindset of the leadership in these large healthcare organizations and hospitals if we are going to make a difference on this front,” says Clairborne. Which physicians are most regretful? Interestingly, the JAMA study found training in urology, neurology, emergency medicine, and general surgery were associated with higher relative risks of physician burnout and career regret compared to training in internal medicine but further research is needed to determine why. Clairborne and Stacy say they see physician regret both in primary care as well as all specialties. Stacy saysit does seem to be slightly higher in primary care, likely because specialists are more highly compensated, and their focus is usually restricted to a specific problem the patient is having. In contrast, primary care physicians must deal with many different problems. “It’s a minority of physicians that really thrive on doing comprehensive care for patients with multiple comorbidities,” she says. Clairborne thinks primary care has more versatility than some specialties. As a family doc, a physician can practice urgent care, traditional family medicine, women’s health, pediatrics, integrative medicine, hospital-only work, or emergency medicine. “So in some ways regret could be less because of the ability for family and internal medicine docs to pivot.” Resources for physician regret Some hospitals are implementing peer counseling programs where they encourage physicians experiencing burn out or regret to speak up quickly so they can talk to a counselor or therapist, or even restructure their clinical duties. Other organizations offer continuing medical education credits for physicians who take courses in stress management, identifying burnout and substance abuse awareness in hopes of helping ward off these issues. Stacy says the resources organizations put into place, however, are typically focused on retaining their physicians rather than helping with a career pivot. “I think that many physicians who are burnt-out or regret the fact that they went into medicine just stick it out. “I also hear from physicians who are not happy in their current careers and they say, ‘I’m thinking of quitting.’” But her online forum focuses on helping physicians pivot to non-clinical career options while still using their medical training. No regrets Oftentimes, Stacy says, a non-clinical career is an excellent option for physicians who are experiencing regret or feeling burnt-out. Stacy practices clinically part time, does medical writing and works with a managed care company in utilization management and enjoys the mix. Pharmaceutical and managed care companies are probably the most popular options for a physician career pivot, Stacy says, as well as healthcare consulting firms and public health, both local and federal, such as the FDA and CDC. Medical writing is also rife with opportunities for family physicians and specialists, as are organizations who need medical directors, top administrators and chief medical officers who may not practice clinically or have some role in both clinical and non-clinical work. Healthcare tech, software and app companies also seek physicians for a wide variety of positions. “You don’t have to leave medicine entirely if you have physician career regret. There are lots of opportunities to do other things within medicine,” says Stacy. Source
