Career Crossroads: Re-evaluating Your Career Path

Moving through the rigors of school and training toward a final destination of MD requires certain personality traits and enormous motivation, not to mention time and money. After all of that dedication, it's no wonder that, as Will Harper, co-CEO of workplace consulting firm Engaged Health Solutions, puts it, "Doctors in particular can feel like they're pigeonholed and stuck in a career that may not fulfill them."

But as some learn along the way, even a life-encompassing career cannot be equated with one's whole identity.

In his role as a business coach specializing in transitioning physicians to new careers, Michael Cassatly says he first helps them realize the fullness of the transition they are in; then how to deal with the identity crisis. For most physicians who undertake major career transitions, however, the results seem to be exhilarating and steadying at the same time.

Cassatly knows firsthand, having transitioned himself after 27 years as an oral maxillofacial surgeon.

"At first, you'll notice a change among the people around you - they were always able to simply refer to you as 'doctor' before, but now it's different. I try to help clients reframe it to see the great opportunity that it is: Now is your chance to choose what to take with you or leave behind."

Harper, a board certified internist, sums up, "Feeling like you're a victim of your own career choice is a cop out. Individuals who go into medicine have incredible capacity. If you want to make a change, you can."

Reasons to change paths

Talk to physicians who've made career transitions and you'll hear several terms used over and over: once-in-a-lifetime opportunity, the feeling that there's a better way to contribute, tough decisions, risky moves, etc. You might come away thinking this is territory reserved only for the bravest and most forward thinking. But individual reasons for shifting gears on the job are quite varied.

In the case of long-time business partners Liz Foley and Judith Hondo, a big reason for remaking their work world was a fairly common one in many industries: more family time.

Each had school-aged children when the established OB/GYNs started seeing a brand new market developing among their patients. The Boston area where they had worked for more than a decade was saturated with obstetric services, but had virtually no phlebology practices.

Foley notes, "OB training really prepared us for the sleepless nights of new parenthood, but your hours are unpredictable. Once our children got into school and extracurriculars, time became more of a conflict. So we wanted to find a way to continue serving our patients yet have time to dedicate to our families."

For some, the desire for change is more a matter of need.

Cassatly started having tingling sensations in one of his hands in 1998 while he was working 80 hours a week to keep up with his booming practice. An MRI revealed severe cervical stenosis with a recommendation that he retire. Now he assists other physicians through their own career shifts.

Adam Regelmann,co- founder and chief operating officer of lab management company Quartzy, may be representative of the new entrepreneurial spirit that moves younger doctors. He graduated with a combined MD/PhD from Columbia in 2007 and completed an internal medicine residency four years later. But in spite of his love for the medical profession, he was drawn even more to the idea that he could be of greater service through Quartzy, the company he created while in residency. It wasn't an easy decision, turning down gastroenterology fellowships at prestigious institutions, but Regelmann believed this wasn't the kind of opportunity that comes around twice.

Ari Levy, the other co-CEO of Engaged Health Solutions, recognized early on that the current medical system, with its typical 30-patient day, was not one in which he would thrive, so he added an MBA to his credentials.

"I love caring for patients, but not within the conventional system. Those who know me would say I'm in the right place now for my skill sets. If I had to label it, I'd say I'm an entrepreneur first and a physician second," Levy remarks.

Finding your footing

A 2011 survey by physician recruiters Merritt Hawkins saw that while jobs are plentiful for new doctors, one in four are ready to jump ship, regretting their career choice while still only in their final year of training. Among the declared reasons: the shifting healthcare landscape, declining reimbursements, and rising costs.

Cassatly recommends a simple exercise to test your commitment to riding the waves of change. First, list your "drivers" - or what he says "jazzes you up" in your current career. Next, list your "stops" - those things that drag you down. Imagine your daily life after the transition.

"Are you taking the drivers or stops with you?" he asks. "Once you define where you want to arrive, then you can map how to get there."

He adds that it's common for career changers to feel overwhelmed by the fear that virtually everything will change. He suggests you expect the unexpected. "It's remarkable, but the things you think will be different (in your next career) are sometimes not as different as the things you think will never change."

More than merely ruminating on what could be career changers eventually move from reflection to action. They frequently mention several must-haves for a successful move:

Personal and professional support

Even in cases where private or household issues are not the primary impetus for change, the ground shifts at least a little bit for everyone in a physician's inner circle, so their support is very important.

Steven Merahn, who started out as a pediatrician, learned as early as medical school that he was intensely interested in parallel business areas. Besides pediatrics, Mehran worked as a medical director and consultant for healthcare business ventures, before becoming chief medical officer at drug information provider PDR Network.

"The greatest ripples [from career transitioning] have been felt by my family. They've had to deal with the occasional uncertainties and insecurities associated with the business world, and the intensity and passion required by entrepreneurs," he says.

Regelmann met and married his wife in medical school and notes her support to a new life. "…Starting a company is incredibly risky, and when comparing that to the incredible job security that a career in medicine offers, it's difficult for her (and me) not to think sometimes 'what exactly am I doing again?'"

Foley says having Hondo for support and as a transition partner made all the difference. "We trained together as OB/GYNs before practicing together, so we're very confident in each others' ability - having that trust in a partner when you're venturing into a pioneering medical arena was crucial for us."

Business savvy/acumen

They may have markedly different personalities, but Harper and Levy complement each other toward their mutual goal of empowering patients to take care of their own health. Part of their unique approach has required expertise on informed and self-managed behavioral change, a relatively new arena for physicians. Rather than focus on the turmoil created by healthcare insurance changes, these partners are looking at the resulting gaps as opportunities to help both companies and physicians provide proactive healthcare to employees and patients.

While they already had long-established medical reputations, Hondo and Foley took the business related steps one at a time. They described the beginning as fairly smooth sailing followed by more recent change that required them to adapt to meet the challenges of an evolving industry and increased competition.

Their advice for tackling the business environment: Llook carefully at the local audience and whether your new venture can succeed there, be flexible when challenges come along, and don't forget the importance of marketing.

Belief in what you're doing

To avoid feeling adrift, career changers must remain true to themselves and use their conviction like a steadying rudder. Even just the proposal of change can be incredibly hard for those around you, so keeping your eyes and ears open for a support network is important.

Regelmann describes how the business world beyond medicine can be a bit like foreign land with harsh realities - for instance, being the "doctor" won't mean complete obedience by others anymore. "You need to be able to convince people of why you're doing what you're doing. The MD will get people to perk up their ears when you talk, but if you're BS-ing, they won't listen long."

But according to Harper and others, risking the loss of automatic prestige is worthwhile.

"…This was a courageous move for me, but I really feel that my future is in helping far more people with greater impact now," Harper says. "This is my destiny, and I'm not letting what was expected of me hold me from it."

Tracy Morris is a freelance writer based in Houston, Texas. She's been a writer and editor for healthcare industry publications and websites, as well as a consulting writer for practices ranging from solo physicians to national corporate networks. She can be reached via editor@physicianspractice.com.

This article originally appeared online in the July/August 2012 issue of Physicians Practice.