The tendency to look back and impose self-criticism for the past is an all too common human tendency. A more robust strategy involves looking far ahead – not just dreaming, but making a detailed plan after careful analysis of goals, hopes, and reality. What follows are some thoughts and wishes applied through the filter of the retrospectoscope. Father Time The bravado of youth often overlooks critical developments that alter the landscape of life. Decisions made as a single medical or surgical resident or new attending physician are vastly different from those choices when a spouse and children are involved. What once was exciting is now distressing. A string of night shifts as a single, unattached person is vastly different than missing an entire holiday weekend as small children drink in the magic of Santa. The agony mounts as a 12-hour night shift stretches into 14, and exhaustion dominates the day. Mapping out a five, ten, fifteen and twenty-year plan as a valuable exercise is eye opening and can reshape current thinking. Residents should openly discuss how their chosen specialty will impact all areas of life and family. Several physicians left our program as the reality of practicing full time emergency medicine took shape, and the impact on their families played a major factor. Chart A Course Letting dreams interfere with planning and real decision-making is a mistake. Any career has a tendency to go where it is steered. The exertion of focus and effort to achieve results is a much better option than drifting with the current and accepting what comes along. Looking back, I wish a group of senior physicians had shared an honest perspective on what guided their career choices. The issues of longevity, burnout, and balance are often overlooked as resident physicians prepare to leave the nest. Following up with former attendings recently, I was alarmed to learn how many struggled with the same issues and suffered the consequences. More Than Money Although the life at an academic program with its teaching responsibilities and camaraderie had strong appeal, the lure of the private physician group’s offerings was too strong to resist. I admit failing to appreciate the rewards and longevity experienced by my academic physician teachers and mentors. Failing to consider the benefits of working in an environment full of energetic and eager residents has led to many regrets. I look at members of my residency class who continue to enjoy their roles as teacher/mentor and find the teaching environment more sustainable as they age. Outside The Perimeter Residency is a protective environment to a degree. Resident physicians are accustomed to seeing how their supervising physicians live and work. We saw attendings working 15 shifts a month and living great lives. We had little contact with community ED physicians working at smaller hospitals and had no contact with those who chose an entirely different path such as hyperbaric medicine, research or aviation medicine. Knowledge provides options, and I wonder how many of my colleagues would have pursued a subspecialty, myself included. I regret that a component of candidness was lacking during my training. It wasn’t until the chairman of the emergency department abruptly quit and began a hair transplant practice that any of my fellow resident and I saw a chink in the armor. Going into medicine, one assumes the die is cast and the current path will lead straight to retirement in the distant future. Ignoring the possibilities and opportunities is to miss out on the unique skill set of being a physician. While nobody can perfectly predict the future, ignoring risks can lead to dissatisfaction and peril. If I could go back in time, I would do the following: Find a mentor willing to talk candidly about the issues and interplay between medicine, family, and longevity. Finding several mentors with different perspectives is invaluable. Design your life. Create a long-range vision of where you want to be in all aspects of life, including family, career, hobbies and passions. Listen carefully to those who have gone before. Yes, those 14-hour shifts wear you down and quickly lose their appeal. What is easy as a 30-year-old physician becomes arduous as the fifth decade comes calling. Hone your skills. Consider the daily grind as a jack of everything vs. a specialist. Medical knowledge and scientific advancements are rapid and tiring to keep up with; everything is not possible or sustainable. Reassess periodically as the twists and turns of life will undoubtedly reshape your top priorities. Source
