Are You Having A Career ALTE?

crispydoc Uncategorized 6 Comments

Alternate Title: The Father, The Son And The Holy Crap!

Careers in medicine have evolved over time. It’s always been a hard path, but previously, you knew what you were getting when you signed up.

Recent changes have eliminated significant autonomy and prestige from a medical career. Increased debt conspires with decreased satisfaction until we unexpectedly encounter an Apparent Longevity Threatening Event (ALTE), an inflection point where we acknowledge that continuing to practice medicine as we currently do is no longer sustainable.

To illustrate, let’s take a hypothetical father and son who entered medicine a generation apart (Word to the ladies: Both physicians are males because this better fit my alternate post title. No offense intended.).

The father’s career in medicine went like this:

  1. Work, work, work through school. Becoming a doctor is your sole passion project and your calling.
  2. Work, work, work through your career because your patients come first. Since you identify as a capital “D” Doctor, you love your work and choose this life.
  3. Moms walk up to you on the street and thank you for saving their baby, who just got a full ride to Harvard and wants to become a doctor because junior always looked up to you.
  4. Your spouse accepts that she comes second.
  5. Your son is proud from a distance, and in hopes of emulating you decides to pursue medicine.
  6. Work until you turn 90, die two weeks after you retire. (This, incidentally, was the path actually taken by my great uncle).

His son’s career in medicine went like this:

  1. Apply to medical school as a great candidate leading an interesting and multi-faceted life engaged in numerous passion projects.
  2. Work, work, work through school.
  3. Allow medical training to whittle you into a uni-dimensional shadow of your former self.
  4. Graduate owing more than your grandparents from the old country earned in their lifetime.
  5. All that time in medicine detracts from your relationships with the important people in your life. You have no time for passion projects.
  6. Buy those people a house, car and lifestyle to make up for your absence. Spend more time away from them to afford it.
  7. Work, work, work through your career because you are a slave to debt.
  8. Grow depressed. Drown your sorrows in more stuff.
  9. Resent your impotence in choosing how to allocate your time. Lose your sense of purpose.
  10. Find yourself burning out by 40, in what should be the prime of your career.
  11. Experience an ALTE, your personal Holy Crap! moment where you realize you can’t do this any more.

Many of us proceed along a son (or daughter’s) path until we unexpectedly encounter an ALTE.

An ALTE threatens to cut short the medical career we envisioned we could practice for life.

We have a kid and want to spend more time with him. We find a spouse or partner, and want to spend more time with her.

An important relationship falls apart, and we find our lives untethered and lacking meaning without the foundation that person provided.

We feel stuck in medicine.

It hurts to admit we don’t want to be this kind of doctor any more, although (if we are honest) it can also feel extremely liberating. You mourn the loss of your fantasy of medicine, and then you make difficult decisions.

You reduce your spending.

You re-prioritize your time.

You reduce your clinical commitment accordingly, expecting it will be a matter of time before you leave medicine completely for greener pastures.

Suddenly something amazing and totally unexpected happens. Working less time, more humanely revives your mojo for medicine.

You become the plague victim in a Monty Python movie: You realize your love for medicine is not dead!

Now things get interesting. If, as Socrates once proclaimed, the unexamined life is not worth living, your newly examined life means everything is on the table for discussion.

You re-engage with life with a newfound zeal.

Life becomes a series of philosophical questions which only beget more questions.

What is my purpose? How can I pursue it with fewer distractions?

What do I need to be happy? How can I strengthen the signal and eliminate the noise?

How can increase my sense of connectedness to those I care about?

What is it others value in their relationship with me, and is that what I’d like them to value about me?

How do my financial expenditures support or jeopardize these goals?

How can I bring them in line with my values?

In the best case, an ALTE leads you to pivot in order to redesign your life.

This often leads you to re-engage with medicine with a newfound excitement.

What type of practice would replenish me more than it depletes me?

What can I contribute to reduce my patients’ suffering and increase their well-being?

What subset of patients am I best able to assist? How can I leverage my skills for maximum impact?

An ALTE can motivate you to subtract the aggravations and focus on the meaningful aspects of your medical career.

When it’s no longer about the money, it’s far easier to align your career with your purpose.

Don’t fear the ALTE.

Comments 6

  1. An ALTE definitely causes a lot of people to have a financial epiphany. When you realize that you can no longer envision a continued career path as is, then there become a need to make a change in your life.

    It is sad that most have to be taken to the depths of burnout before they see the writing on the wall. For some it is too late which can explain the periodic newsflash of another physician suicide.

    I think there is promise as the millennial doc generation seem to have gotten it far earlier than the previous generations and are more focused on lifestyle.

    1. Post

      I see great blogs like Reflections of a Millenial Doctor and I have to think they are reaching a turning point away from the mistakes we’ve made.

      It definitely gives me hope, Xrayvsn.

  2. Thank you for your sensitivity to us ladies 😃. And I enjoyed the Blue Oyster Cult flashback! Seriously, though, interesting views you’ve presented.

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  3. There exists a mathematical concept called the inflection point. It is best defined as when the second derivative goes from positive to negative or vis versa. Retirement is such a point. Accumulation goes to deflation. Graduating residency is such a point. Being broke turns into abundance. You can also think of it when a growth curve goes from concave up and turns concave down. The thing about concave down is it can still grow for quite a while, just at a slower rate. Trying to maintain concave up after inflection is the definition of burnout. You literally have to change the curve into a different curve. A better tact: Instead of trying to make the curve match your fantasy, make your reality match the changing curve. You don’t have to fall off the curve, just embrace the change in growth.

    My example I went from a full time hospital practice with a full schedule of nights and weekends, to same day surgery 3.5 days a week no nights, no weekends, no emergency! emergency! At some 7 year later date I went from a 5 day SDSC schedule (we grew!) to GONE FISHING. I forgot to burn out, I was having too much fun. I looked in the mirror one day and said DAMN I’M OLD! Think I’ll go fishing.

    1. Post

      If you haven’t already, might be worth reading Norman McLean, A River Runs Through It. Beautifully written prose, great fishing scenes, and – here’s where I’m going with this – WRITTEN AFTER HIS RETIREMENT.

      Damn you’re old just means you get to be productive on your terms, whether reeling in the fish or typing the fishing scenes into a keyboard.

      Keep typing, my friend. We’ll keep reading.

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