The Bigger Picture: Finding Your Bliss

"There are many meetings I go to where I am the only physician smiling in the room," says Daniel Maison.

What makes Maison so special?

"It really is about choices," he says. Maison decided to make a trade-off in his career. Rather than practicing straightforward internal medicine, he went into hospice care. Sure, he makes a little less money than he might have otherwise. "But I have a job that I love with very reasonable hours," explains the vice president of medical services for Treasure Coast Hospices in southeast Florida.

How many careful, conscious choices have you made regarding your career? Did you go into medicine because it's what someone else expected of you? Do you accept every lousy managed-care plan in the universe because you think you have to? Do you put up with belligerent staff because you don't see any other options? So many physicians I speak to are frozen by their own limited expectations. Few act.

Maison is a rare example of a physician who refused to adhere to the status quo.

The result? He loves his practice. While some of his time is consumed by administrative tasks, full-time clinicians at his organization see five to seven patients a day - maybe as many as nine, tops. They spend a full hour or more with each patient, not six to 10 minutes. They gain a sense of their patients' lives, talk to their families, and provide holistic care. "You really get to be an important part of their lives and provide great relief in terms of pain and symptoms," explains Maison. "You get invited into their homes. There is a real sense of collaboration."

Maison has been recruiting more physicians from outside the hospice world to join him. "These days, lots of primary-care physicians are coming in to get out of [the] pain[ful] situations ... where they are. People coming in from office-based practices say they enjoy the work more and remember why they became physicians to begin with," he says. Maison's hospice system even recently recruited a neurologist who was tired of being battered by groundless lawsuits.

Maison also likes the way hospice helps physicians who still work in office-based practices. "We are a completely value-added service to them. When they refer to hospice, they can stay as involved as they want. ... These are the sickest patients in a physician's practice," he points out. They create a lot of uncompensated, high-pressure work in the form of fielding phone calls from family, coordinating care, and managing prescription refills. "They are the ones who are going to have the problem at 2 [o'clock] in the morning and repeat admissions to the hospital," says Maison. Hospice physicians relieve much of that burden, he explains. And hospice helps avoid emergency calls and admissions because clinicians can foresee upcoming crises and take steps before problems get out of control.

I hardly think hospice is the route everyone should take. The point is that you should actively choose or even create a career path that works for you - no matter what it is.

Tired of heart surgery? Go train in plastic surgery. Tired of 40 patients a day? Cut back to 15. You'll have to fire staff and maybe sell a car or even get a smaller house. But so what? At least you'll have actively chosen the path you want instead of being miserable every day to support a lifestyle that - when you really think about it - may not be all that important to you.

I, for one, would love to see more smiling faces in the room when I'm with a group of physicians.

This article originally appeared in the November/December 2006 issue of Physicians Practice.