Contentment Is At Your Fingertips

Today, Andrew Dombro is the picture of a satisfied physician - sophisticated, graying temples, a ready laugh, and thoughtful eyes. That's not surprising for a man who has found a way to combine two of his great loves - medicine and golf. But for a long time he was miserable.

After two decades in practice, he hated his job. He tried to make it work. He even switched from being a traditional internal medicine physician in a large group to working as a hospitalist. It didn't help.

"It was the day-to-day rat race of seeing as many patients as I could, often more than I felt comfortable with, in a situation where there was a lot of pressure just to churn - to get patients out of the hospital as quickly as possible. That really made me miserable," says Dombro.

And while confident his patient care was good, the threat of malpractice litigation seemed to darken every interaction. "I was waking up every day, to put it mildly, not enjoying my situation."

Dombro knew he wasn't the only one. All around him physicians were grousing about the stress, reimbursement cuts, managed care mandates - all the usual complaints. "Misery is running rampant," Dombro recalls thinking, but none of his colleagues was doing anything to change the situation. Dombro describes it as a strange sort of pressure - everyone else was depressed, too, but they seemed to handle it. And, really, after years of medical school, faced with the expectations of family and a daunting list of monthly expenses, what else can you do?

Dombro eventually grew so despondent he quit outright, with no alternative plan in mind. He responded by rebuilding his career creatively, finding a way to marry his passion for medicine with his affection for golf. He writes health columns for regional golf magazines and consults with Eli Lilly, a PGA sponsor. Soon, he will probably accept an academic post with a medical center in a new city.

Are you fed up, too? Satisfaction is tough to come by in medical circles these days. But that doesn't mean you have to quit, sell the boat, send the kids to community college, and look into a job at the local coffee shop. Investing in a little self-study and making ongoing minor tweaks can make a world of difference.

Dombro overhauled his life entirely. But you don't have to.

Why the griping?

While medicine offers uncommon pleasures - helping individuals, improving community well-being, a lucrative paycheck - it is also a career distinct in its capacity to trap.

David Nissen Kahn is a case in point. After 20 years as a nephrologist, he couldn't take it anymore. "For a number of years I was really very happy, I liked what I did - but over time I found I didn't feel that way nearly as much as I had done before." He thought that maybe nephrology entailed too much time with numbers, too little with people, so he decided to become a psychologist. Accepted by a prestigious psychology program, he was still depressed, but had no idea what else to do.

As a physician, you have put at least 15 to 20 years - and a substantial amount of money - into your education before you even start practicing. Given that investment, it's hard to be critical of the profession. Moreover, you "have gone into something that [most physicians] and that society sees as a calling," Kahn points out.

"You are doing something undeniably important. Doctors don't have the same status as they used to but they still have status." And a good income. "People look at you and say, 'You're on top of the world.'"

That made Kahn feel like he was crazy. "If you're not happy, you feel guilty. You feel like something is wrong with you."

Consider, too, that the early euphoria of being in practice doesn't usually wear off for several years. By then, most physicians are 40 or 50 - with a spouse, kids, and a certain lifestyle in place. It's difficult to fathom ways to improve your satisfaction without immediately assuming the necessary changes will include a pay cut.

Peter Moskowitz, MD, sees it all the time in his physician clients. Moskowitz runs the Center for Professional and Personal Renewal in Palo Alto, Calif. He describes these common symptoms:

"There is a growing sense of boredom with the daily routine.  ...  You wake up not wanting to do the day, wanting to go back to bed. All your journals are still in plastic wrappers.  ... You are irritable a lot at work, get into petty arguments with colleagues, partners, even patients. You find that you are losing your sense of empathy with patients' problems."

At home, dissatisfied physicians prefer to isolate themselves in front of the TV rather than interact with their families. Self-medication is also common - drinking and eating too much, gambling - anything to avoid dealing with the problems.

Moskowitz experienced his own burnout almost 10 years ago. In private practice, working 80-hour weeks, he was separated from his wife, fighting with a teen-age son and depressed. "I thought I was providing well [for] my family financially, but not being the kind of dad or husband [I] might otherwise be because I was spending all my time at work," he says now. "I took a hard look and realized I didn't enjoy private practice. I didn't know what I wanted to do, but I didn't want to work 80-hour weeks anymore."

So he started working less, rebuilt his relationships with his wife and son, and now spends half his time in academic practice as a professor of radiology at his local children's hospital and the other half helping other physicians.

What causes career dissatisfaction - and what pushes some physicians over the tipping point? T. Robert Mestas, a former OB/GYN who is now a consultant with Physician Career Network in Englewood, Colo., thinks changes in medicine are to blame for much of it. "We've lost control. It's not really a physician-patient relationship [anymore]. It's become a physician-client relationship. The patient really belongs to the payer," he explains. "Malpractice has escalated to unbelievable proportions. And they can raise the [premiums] overnight," he adds, describing the sense of powerlessness some physicians feel.

Of course, physicians themselves change, too. "Some people have life changes - a divorce, a death in the family, a death of a partner - things of that sort, and all of a sudden they are very, very unhappy." 

Or physicians find they are "not making as much money as they expected to or things have changed in their lives so their income has not kept up with their expenses or their needs," says Mestas.

He thinks such shifts are especially hard for physicians, because they find it hard to discuss their malaise. "Physicians typically can't discuss what they are thinking with other physicians. If there is a problem with our practice, we certainly don't know who to tell that to." You can't tell your practice partner, lest she think you are about to quit, and you can't tell referring physicians, lest they worry about your commitment to their patients.

Even friends and family aren't always receptive. They may not understand how you can be unhappy with an admirable, well-paying career.

Making a change

So, if griping gets you nowhere, what to do?

First step: Take charge.

See yourself as an agent of change instead of a victim of events, urges Carolyn French, a certified professional career coach in Boulder, Colo. "Continually focus on what you can do. It's not about the circumstances." Sure, your partner is a pain, malpractice is sky-high, and your mortgage is so large it makes your knees wobble just thinking about it. "It's all true, but at the end of the day, it's about choices you make," French says. You often can't change circumstances. But you can change your response to them.

"The first step is realizing that you are never really stuck," Dombro explains.

Deborah Brown-Volkman, president of Surpass Your Dreams, a career and mentor coaching company in East Moriches, N.Y., agrees. "You have to believe that you will do it. If you are working toward things on a consistent basis, why wouldn't it work out? People don't reach goals because they stop."

Once you've changed your mindset, figure out what to change about your life. That's more challenging than it sounds.

When you already feel overwhelmed, it can be hard to pinpoint exactly what the specific problems are, let alone how to fix them. A conflict with your staff spirals into disgust with medicine in general; you start wondering what will happen if you can't spend more time with your spouse; you panic about house payments. But you end up back at square one - needing a change, yet not knowing how to do it.

You need to "chunk it out," as French puts it. She draws an analogy to clinical diagnosis. Sure, the body operates as a whole with one system affecting the others, but to diagnose a problem you need to examine one part, one lab result at a time. Looking at the whole thing at once gets you nowhere.

The idea is to force yourself to identify the one thing you could change that would make you feel better. What is it you really need? More time at home? Less time with that annoying nurse? Fewer patients a day?

Feel silly? Well, what do you have to lose? Why resist? If spinning in your tracks isn't working, it can't hurt to try something else.

Make a plan

Once you know what you want to change, you can plan ways to accomplish your new goals.

"It's very difficult to just get fed up one day and quit and go find something else," Dombro says, though that is just what he did. "Knowing that there is something at the end of the tunnel can make it more bearable."

Brown-Volkman urges clients to create a specific game plan, complete with due dates for implementation. "Map out what you want by when and how to get there. It's the same thing [you] did when [you] decided to be a doctor - what classes to take, what applications to fill out - [you] had a plan. Go back to the foundational things that helped you get where you are today."

Once you have the plan, put the steps in your calendar and stick to them. Brown-Volkman says the biggest mistake she sees clients make is "choosing in the moment." Three Wednesdays from now, it may seem more important to squeeze in that last patient, but stick to your plan of instead calling a recruitment firm to start a search for a better practice manager.

Brown-Volkman's physician clients tell her all the time that they don't have time to do her "homework" assignments. In her mind, it's a matter of setting priorities. "If I gave you a million dollars would you have done your homework? They don't believe [changing their professional lives] is possible."

Finally, prepare to constantly reassess your satisfaction. "Life is in constant flux. If you look at your professional life as a pie and cut it into four or five pieces, over the course of your career some pieces will be bigger than others, but in another couple of years it'll swing back. It's a beautiful thing to live your life realizing that things can be in a little bit of flux," Dombro says.

French compares managing your career with riding a bus. Standing as the bus lurches forward or stops, you make constant small adjustments in your position to maintain your balance. That's what people need to do with their lives.

Moskowitz urges physicians to "constantly scout the horizon. Physicians need to be always looking ahead, reading the literature - what are the new trends that are happening in medicine? - [and] updating their skills on a regular basis so that doctors can remain resilient and fluid, adaptable as the medical culture evolves."

Pamela Moore, PhD, CPC, is senior editor, practice management, for Physicians Practice. She can be reached at pmoore@physicianspractice.com.

This article originally appeared in the June 2005 issue of Physicians Practice.