Jesse Lopez – Career Code Blue Headquarters

There are 8 telltale signs your career and probably life are in full arrest or on life support. If you are like me you entered your medical career with very high expectations. As a youth, I would drive by hospitals at night imaging the miracles and brave acts that took place by heroic doctors and nurses. I had built up the fantasy so much that I didn’t consider any other career. Once I entered medical school I quickly realized my fantasy didn’t quite live up to my expectations. However, I figured I would make the best of it and place all my efforts to make it better. Medicine, however, becomes more and more demanding as you progress through the apprenticeship as the bar of knowledge and practical know-how grows higher and higher. Sometimes as I progressed from Med school to residency to my career, I would forget key elements to care for myself or my family as the work became ever all-consuming. Physicians are burning out at epidemic levels and there doesn’t seem to be an end in sight for this or the ever mechanistic nature of the healthcare system. The growing demands of mandatory compliance of medical treatments, medical records, and continuing education have left many doctors, physicians extenders and nurses ready to quit. I have personally gone through this as have many of my peers and everyone suffers as a result of this key group of people leaving medicine. I like to think of burnout as a career collapse since it impacts everything in our lives and has collateral damage in our circle of influence including friends and family. It is therefore important to recognize the canary in the coal mine before the total collapse and take the necessary steps to avoid total collapse at all costs. Quitting is an option as is letting everything go but often has consequences that are even more grave. I have reached near-total collapse and with the help of my wife, friends and family have begun to reconstruct my life on terms that are more acceptable and self-preserving. I find it akin to the ancient proverb, “Medice, cura te ipsum” or “physician heal thyself.” As a person or healer, we cannot take care of others if we cannot even take care of ourselves. First, we must be healed in order to give it back. Consequently looking in the rearview mirror and actively self-reflecting while taking action to correct course and seek help, I now feel I have the wisdom to help guide others to either reinvent or reconstruct their career or avoid the collapse in the first place. Here are the 8 reasons medical professionals collapse Neglecting Your Personal Life: Physicians are most guilty of this due to our training and educational goals that made us more competitive and self-serving in a zero-sum game of getting into the best medical schools and best residencies. This singular pursuit demands all of our attention and therefore may come at the cost of severing friendships or relationships with loved ones. We end up with a trail of broken relationships which then get replaced with working relationships that don’t address our humanistic needs. In Maslow’s hierarchy of needs, the foundation of physical and emotional needs must be met before personal accomplishment can be fully attained, otherwise it is a house of cards. Personal Health One of my good physician friends always says “There is no health in Healthcare.” We provide mechanistic treatment for people who typically are having a medical crisis. “Health” is something that we must take personal responsibility by taking care of ourselves. This includes having a healthy diet, frequent exercise, have healthy relationships and participate in community activities. If longevity and good health are a marker for personal responsibility we have to be the absolute worst promoters of health since physicians disproportionality lives shorter lives than the entire population. I personally remember eating hamburgers and pizza every day for 3 years as a resident until I was rescued by my very health-conscious wife. If your body is connected to your mind and crisis strikes which person will handle stress better? A healthy grounded person or a doctor? Having a weak foundation One of the advantages of becoming a physician comes in the form of apprenticeship. All medical schools and colleges assign advisors to upcoming physicians. Likewise, mentors are either assigned or chosen depending on research or field of specialty. These mentors excel in teaching how to practice medicine but rarely teach the economics or psychological aspects of medicine. These mentors cannot be blamed since they often practice academic medicine which differs from private practice and they themselves also struggle if they transition out of academics. Therefore starting private practice without any experience leaves the new physician vulnerable to a variety of financial, political or psychological problems that often come during the course of a career. Having a support network in the form of friends, family and finding a personal mentor in the practice is of paramount importance. Without this foundation, any number of small mistakes could have big consequences. One problem that often happens with physicians has to do with ambition. Since we are trained in a zero-sum environment since the beginning of undergraduate medical education, it is not surprising that new practicing physicians take on too much responsibility, workload or leadership positions too early in their careers. Without proper guidance in the form of mentorship or professional advisors, the clinician could develop early burnout which then leads to poor performance and further burnout. This personally happened to me and looking back I set myself up for failure by not having proper professional and personal support. My career went from rocketing to the top of the administrative and professional ranks to just barely hanging on, I didn’t have a firm foundation. Wrong Job or Venue Everyone has a personality based upon the big 5 psychological traits. Unlike other industries where all processes and policies are standardized, medical practices and hospitals tend to operate in silos and rarely have any standardization. Every hospital has medical staff who develops bylaws and policies to keep the hospital in compliance with the health department and IHS. However, everything else such as work hours, operations, processes, leadership, core values, and event profitability is different. Ideally, you will want to work in an environment that either matches your core values and personality characteristics or you find a place that is aspirational or willfully challenging. The opposite would be to work in a place that doesn’t match. For example, some surgeon owned surgery centers have very lofty income goals and focus on production and productivity rather than a friendly workplace or customer service. This type of work could either make you or break you depending on where you stand. Some work environments have challenging patient populations and poor payer mixes. This type of work attracts a very specific type of person who typically doesn’t think agreeableness is necessary for such workplaces and the facilities often lack anything but basic amenities. If nice parking and gourmet cafeteria food are a core value then go elsewhere. It sounds petty but could make or break you in the long run. Choosing the right job the first time isn’t easy and statistically, a large percentage of physicians change jobs in the first two years of practice. This is healthy since they haven’t fallen prey to the sunk cost fallacy. On the other hand, finding the correct job the first time should be the goal. Bad Habits Physicians and advanced practice nurses have bad habits just like everyone else in the world. Tardiness, poor work ethics, lack of confidence, poor communication and inability to work well with others can slowly kill a career. Physicians spend years in medical school and residency to earn the best grades, test scores, and evaluations but when you enter a new job on day 1 you start back on the bottom of the pile. Then you slowly crawl back to the top by demonstrating competence and reliability. Unfortunately, given the hierarchical nature of medicine, there will always be someone looking over you waiting for the moment a mistake happens. The stakes are very high since the medical community is very small so a bad habit can be as bad credit and ruin a good career. Evolution What has amazed me over the past 20 years of practicing medicine is all the informational and technological changes. Medicine and the practice of medicine will continue to evolve. Many of my peers continuously fight these changes to their detriment and lose their relevance in the eyes of their peers and patients. Medicine is a business and not a social service. As such the main goal for all private medical companies is to make money, even the not for profits. If a new idea, technique, process, system or platform makes the business more money and you oppose this change, guess who gets left behind? I remember losing several surgery centers many years ago since a majority of my partners could not adapt to a more competitive surgical environment. Private surgeons were building surgery centers and demanded more operating room access with longer hours and expected perfect regional anesthesia and no delays. In response, we said, “this is the way we have always done it.” Now we have one location while those surgery centers made prospered. With less diversification come greater risk. Now we could lose our contract and livelihood with only one employer. Giving Up Life will always have ups and downs. This is true for physicians as anyone else. When faced with adversity, it cannot be stressed any more than surrendering to a problem ultimately make the problem worse. Failures big and small will occur from time to time and are a necessary part of growth. What matters comes from the lessons of those failures. Even getting fired can be a blessing in disguise. Everyone gets fired for a reason and usually happens as a result of a blind spot in our personality, work ethic, knowledge base or something else. Getting fired allows us to take a deeper retrospective look at ourselves and hopefully correct or change that flaw. I often think human resources hurts careers more than helps them when they delay dismissing poor performers in an organization. They deny the opportunity for that person to self-reflect. Giving up after getting fired or some other major setback results in a lack of growth and will cause even more damage psychologically, emotionally and even physically. Bootstrapping the problem can be the solution but to really learn from the experience of getting professional help from a counselor, psychiatrist or career coach will redirect strong emotions and support continued growth. I often read the quarterly medical board newsletter that shows the disciplinary action taken against physicians. The list is typically long and filled with stories that make soap operas seem tame. I wonder how many poor decisions lead these physicians to have such a lack of insight? Not sure but hopefully they have learned some lessons along the way. Don’t give up and seek help early when needed. Financial Literacy The number one reason physician, nurses and most people get into trouble stems from their general lack of financial literacy. Like Grant Cardone says, “The first thing you need to do in your life is to... Get your money right!” I have two kids and both were taught money and currency in first grade since then they have been taught nothing about money. I know they will not learn about this in school since the public school system does not teach personal finance. The same holds true for college or medical school as these are not part of the standard curriculum. Not having financial literacy limits options in a career path. It can lead to early retirement or financial ruin which in some cases cannot be recovered. This includes understanding savings, cash flow, investing, partnerships, contracts, due diligence, homeownership, taxes, liability, retirement vehicles, insurance, trusts, asset protection, student loans, and budgeting. Above all this requires a plan. When I was a medical student, I had one goal, not to mess up and find a good residency spot. It was easy to understand since it had a definite path and ending. Likewise, residency also had a defined set of expectations and milestones to become board certified. Once you enter the medical workforce these well-defined goals and endpoints vanish. Next thing you know you have been practicing medicine for 20+ years wondering where all the time went. The endgame in medical practice is retirement like it or not. Perhaps you could argue academic medicine has predetermined rankings based upon seniority and academic productivity but in the end, the next stage of medical practice is not to practice. I am a fan of the FIRE movement but I don’t think actually retiring early is necessary but this community has the right idea. If you have enough passive income to surpass you earned income as a physician you have the option to do whatever you want. Some people call it FU money but I think of it as freedom from having to worry about my family’s welfare and gives me leverage over my life. Once Financial Independence is accomplished then you get to make all the choices and freedom to take your life in whatever direction you choose. How is this achieved? First and foremost having a plan with a set date and a strategy on how to execute the plan is key. My favorite example is Cory Fawcett who decided to retire from the practice of General Surgery at 56 while still in medical school. He accomplished this by first deciding how much cash flow he needed from his investments and then reverse-engineering the portfolio. He then set benchmarks along the way to make sure he stayed on track. This requires discipline, education, and some risk tolerance. He knew that he would eventually age and realized taking all that demanding call would get old in the long run. Now he enjoys a second career as a writer and speaker and loves every minute of it even though he enjoyed practicing medicine. Money problems only compound other problems so make it a top priority to be on the right track. If none of the 8 signs is a problem for you, congratulations and keep up the good work. If not hopefully you recognize the problem seek to find a solution with the help of others. Physicians have the lone ranger problem and try to solve their problems alone. Without the support of smart advisors and mentors with a loving support network the odds of success going down. Make this the top priority, never give up and let us resuscitate your career.