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Non-Clinical Careers for Physicians.
 

Picture The Ideal First Month on Your Next Job, by William S. Frank

When physicians are having trouble focusing on the things that will improve their existing career or make their next one—clinical or not, medical or not—more comfortable, enjoyable and suitable, we discuss their likes and dislikes in previous practices and work situations, and consider results of the Birkman Method, a written career assessment. Next, we compile that data to create a detailed blueprint of the future.

Finally, we have them write their "Ideal First Month in the New Practice," or their "Ideal First Month in the New Job" if they're considering leaving clinical medicine or doing something non-medical—or just don't know. This is a superb exercise for exploring, clarifying, and getting a sharper focus on your future. It synthesizes the exercises you've done before, the "Likes and Dislikes," and the "Career Blueprint." In fact, it's a kind of working narrative for a whole lifestyle, because work and the time, energy and emotion put into it mold the ways everything else in life are conducted, or eliminated.

Physician writing on blackboardMost jobs, especially challenging ones, contain huge variety and vary drastically from week to week, even from day to day, and hour to hour. That's the essence of clinical medicine, whose fixed, predictable feature is unpredictability. That's why we do the "Ideal First Month." The first week you might be off to a medical conference in Atlanta, the second week back in the office seeing patients, the third week at home preparing a manuscript for publication.

Start with day one when the alarm goes off. What time does it ring? Where do you live, what do you see when you wake up? What do you have for breakfast? What car do you drive—or do you walk or take public transit? How far is the office from home? What does your building look like? Or do you work at home?

Eliminate preconceptions as thoroughly as you can. Don't leap to the judgment that an office-based internist can only work in a particular sort of place in a particular sort of way. Or that an anesthesiologist can only be in a surgical suite. Or that a urologist can only . . . . Even if you're dead sure that you are an otorhinolaryngologist who will focus on head and neck cancer surgery until you physically can't stand in the OR anymore—and good for you; it's nice to understand yourself that well—you still have preferences, wants and needs, likes and dislikes about how you work and where. This is your chance to decide what they are.

A nephrologist strongly disliked the cool dusty rose and gray color combinations that have been the darlings of industrial interior designers over the past decade—they made her feel cold and edgy—yet every outpatient dialysis unit she rounded in was finished in those colors. Her colleagues liked the result, or didn't care. Did she dislike dialysis practice? No, she loved it. But she detested the environment she had to work in (there were other factors, too, but this is a big one for her), and she found herself grinding her teeth every time she walked in the door to make rounds. Silly? Not if it's a big deal to you. It doesn't matter what other people think. Here it just matters what you like.

As you write, include a lot of detail. In fact, overkill on detail. Include the color, texture, sights and smells of the surroundings. Describe the people you see. What are they wearing? What are their ages, educations, and personalities?

What does your physical work space look like? Describe it exactly—or better yet, sketch it. If you imagine a clinical practice, be generous with yourself. Give yourself a consulting room that's fitted out, finished and decorated the way you've always wanted. Put in that rolltop desk you've always meant to have. Make your examination and procedure rooms the way you'd have them if they were custom designed and built for just for you. Tear pictures from magazines to help visualize. Don't make your environment too sparse; spend a lot of money on it. If you're a surgeon, design your own operating room. Is it in a hospital or an outpatient surgical center? Want both? You can have them here. Don't stint. Don't forget the waiting room, or any space you may have to be in to do your job.

What if you aren't certain who and what you'll be in your next life? Then you can write two versions of the "Ideal First Month." Or even three. Don't feel trapped by the exercise. Some of our past clients have written several "First Months," and we've combined them into one grand vision.

Look at your activities and describe what you're doing. Are you reading, writing, making rounds, doing procedures, teaching? Are you in an outpatient setting, in a hospital, or a combination? Or something else? Are you seeing patients at all? Be specific. Are you alone or with other people? Are they colleagues or collaborators, or are you doing something for them as patients, clients, or customers?

Don't be practical, logical, or reasonable. This is called "The Ideal First Month," not the "Month I Can Barely Stomach." There are times to be realistic, but this is not one of them. This is the time to be imaginative, creative, and expansive—even outrageous. Especially outrageously positive.

Many doctors have trouble with this sort of open-ended daydreaming. Physicians are universally pragmatists. And, hiding in many of them is a resigned stoic. Medical practice isn't easy, and medicine is a harsh mistress, especially in these times. You wouldn't have reached the point of doing this exercise if your work situation were ideal, after all. But, with the right structure, almost any job, no matter how demanding, can be enjoyable and even downright fun. That's where we're trying to get.

This is the work where everything goes your way, where doors open instead of close, where you can have it exactly how you want it, just like at Burger King. There are no restrictions and no limitations, except those you impose yourself—so don't impose any.

Don't limit yourself by age, education (especially lack of a certain degree or certain kinds of experience), sex, race, geography, or any other factor. In this exercise, there are no limits—everything is possible. That's why it's called "The Ideal First Month"—because it's absolutely perfect and can't be improved.

My guess is that you'll have trouble making it fun and perfect. Most people do. Most of us are accustomed to "reality," and "worst case scenarios." Dealing straightforwardly with them is how physicians spend their days, not only in what they do but where and how they have to do it. Well, scratch that. This is the ultimate "Best Case Scenario." This is your future life. It's worth spending time on; it's worth making it happy.

How long should the written exercise be: five, ten, or fifteen pages? There's no proper length, just the length that's right for you. I prefer to see it longer and more detailed, but a one-page summary would do, if it were extremely well focused. Once you allow yourself to get in the spirit of the exercise, one page will probably seem hardly enough.

One person completing this exercise wrote, "The first day on the new job I get up in the morning, I do what I do, and I go home. The second day, I get up in the morning, I do what I do, and I go home." Obviously, not much help.

The heart of the exercise is "The Six File Folders." The first day on the job they key person employing you (your new boss, partner, physician executive, or practice administrator, or client) comes in, hands you six file folders, and says, "Susan, these are the major disasters, problems, and challenges I want you to tackle in the next year." The exercise is to describe what's in the file folders—the projects, problems, and wildly exciting challenges that get your blood boiling—clearly, precisely, and in great detail, as before. This works even if you will be self-employed. If working for yourself, you essentially hand yourself six daunting (but fun) tasks.

The paradox I often see is that writers fill their folders with dull, lifeless activities and situations. When I look at them, I have to say, "These are really boring, not exciting at all. This sounds like a terrible new job, not the slightest bit interesting. There's no point in describing a job you don't want. Put some fun into it. This isn't a life sentence, you know . . . it's supposed to be fun." Here's what a sample file folder for an M.D. might sound like:

    "I get on a plane and fly to all the major metropolitan centers in the country to interview key senior executives in leading-edge medical device companies about the new technologies they employ. I go into their homes and meet their families. I shadow them for a week, participate in all their perks, and eavesdrop on their confrontational, stress-filled meetings. Then I return to my laptop and write a feature article on my impressions of their business model and their technology. My new employer, a brand name mega-company with outrageously deep pockets, pays $187,000 for the story, and gives me pats on the back and more far-out assignments. Naturally, all accommodations along the way are first class, expenses aren't questioned, and my invoices are paid within 7 working days."
Now that's fun! That's an example of a file folder that means something. It contains excitement and adventure, and some clue to what makes the writer tick, and while not all of it is attainable, perhaps parts of it might be.

Doctors don't think this way. Every day is different, even in practices that non-physicians might think stable and predictable, even staid and stale. They don't move from project to project, and most problems are much more open-ended than in business. But those truths don't prevent idealizing the perfect setting to work in. And, if you don't know what you want to do, you still know how you like to do things.

Here's an "Ideal First Month" an internist made. It was at a difficult time in her career. She was a contemplative, careful, methodical practitioner who liked to talk with her patients and felt that she accomplished more for them by understanding them and their environment. She needed time to think about problems, and she liked to customize solutions to people. The primary care practice she was in with three other doctors was busy and rushed, with appointments every 15 minutes and a huge Medicare and HMO commitment. She had young children and active sports interests. Here's what she wrote:

    "I'm a sports medicine specialist in Boulder, Colorado. I work with all sorts of athletes, but my special interest is endurance sports, especially women athletes. I consult with the track and field teams of the University of Colorado. My husband and I are avid mountain bikers. A number of mountain bike racers, both men and women, see me for their medical care. Because of my interest in psychology, I work with a sports psychologist to improve distance runners' performance. I'm a target shooter and a Nordic skier, and many biathletes consult with me to improve their results, both in skiing and in shooting, and for their general care as well. I do what they do.

    I'm getting paid—not much insurance here—to talk about things and do things I'd do free if I had the time. I take as long as I need with each visit, and I have whatever equipment I want. There isn't much on-call, because I'm not really a primary care doc, and I can refer problems I don't want to deal with to excellent consultants who do. Sometimes my kids stay in the clinic with me. And my husband can see me for lunch. I know what I'm going to be doing every day, and I know that I won't be still running at top speed when everyone else is at home or skiing."

A physician executive named Terry completed this exercise at a difficult time in his career. He had been thrown into the job market after a layoff, there were no openings in his field, and he had sunk part of his life savings into the wrong business venture.

Terry completed the Ideal First Month on the New Job exercise, and as a result, he clearly saw what he wanted to do and realized it was already possible. Several months earlier he had turned down a challenging job offer, declining because of geography. The exercise caused him to reconsider, because his File Folders matched the job description perfectly. Terry re-approached the employer, and was hired overnight during a time when there were "no jobs for physician executives."

The results aren't by coincidence. Your mind is a tool you can program. The important lesson is to program it for the results and outcomes you actually want. Writers and "creative types" do very well with this exercise, but some others don't. If you're having trouble, you may want to approach the exercise differently:

Begin listing everything you want in the new job one thought at a time. List each thought inside a small circle on the paper. Continue drawing circles and filling them with thoughts until your mind suddenly feels like taking off and writing a narrative. Don't judge or plan the narrative, simply record whatever comes out. Write with great passion as fast as you can. Sooner or later you'll get a sense of completion. Write until you feel finished, then stop and take time to reflect on your work. You'll be pleased and surprised at the outcome.

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"Nothing happens unless first a dream." —Carl Sandburg


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