Identifying priorities and working with an independent coach or advisor can help physicians reframe their work lives

By Bonnie Darves, a freelance health care writer

It might have taken a crisis — first quietly brewing as niggling individual-physician dissatisfaction and then becoming the full-scale, profession-wide dilemma of burnout — for organizations to get the message that action is needed, fast, to prevent more physicians from leaving medicine and to help them regain professional fulfillment.

The good news is that two positive developments are happening. First, individual physicians are obtaining the input they need, via coaches or mentors or deep personal examination, to identify what’s not working in their professional lives and muster the courage to at least right their ships. Second, a growing number of organizations recognize that physicians must be able to pursue work that matters to them and be supported in that quest if they’re going to retain them. Wellness programs are proliferating, and some organizations are making coaching and other resources available to physicians who want to adjust their work lives or careers.

Physicians who have received coaching on their own or through employer-sponsored programs are using what they learn to reconfigure their professional lives. Some opt to leave medicine, but many are finding ways to adjust their roles and work lives to recapture the fulfillment they once enjoyed.

Sunny Smith, MD, is founder and chief executive officer, of Empowering Women Physicians, a large national company that provides collaborative career coaching and forums with a focus on humanizing the physician experience. Dr. Smith has witnessed the full spectrum. — from physicians who ultimately decide to opt out of practice to those who were on the verge of leaving medicine but instead reframed their careers and went on to become department chairs. “There’s really no wrong way,” Dr. Smith said. The key, she contends, is to “identify the facts” about the dissatisfaction they’re experiencing and then define and pursue the adjustment they need.

Start with self-discovery

Preparing for a career adjustment begins, Dr. Smith said, with an important question that physicians must ask themselves and then answer fully and honestly, “What matters most to me, and what’s getting in the way?”. “It’s about helping physicians who feel trapped realize that they have power and agency — that they can make decisions regardless of their job,” said Dr. Smith, who spent her academic career at the University of California San Diego School of Medicine as a clinical professor of family medicine and public health.

For Gina Geis, MD, an Albany, New York, neonatologist, it was a nagging sense that something was amiss — not full-on burnout — that in part led her to seek a coach. On paper, she was ticking off the up-the-ladder boxes. She completed fellowships in perinatal medicine and bioethics and was enjoying her practice and academic pursuits.

In her bioethics role, Dr. Geis developed a keen interest in the intersection between moral distress and physician burnout and eventually carved out a role as Albany Med’s chief wellness officer and became its first vice-chair for professional development. The coaching experience, in her view, is a prerequisite for wellness officers. It helped her recognize self-imposed impediments to growth. “I discovered that I tended to put limitations on my career growth and to attribute my successes to external factors. And I found that I hadn’t thought about ‘expanding my lane’ outside academia,” she said. “The experience was truly life-changing.” So powerful, in fact, that Dr. Geis decided to become a certified career coach, to help other physicians create more fulfilling careers.

“Even if physicians come in and say, ‘I’m done with medicine, or ‘I want to leave my job,’ I encourage them to learn how to love their job more while they’re still doing it,” Dr. Geis said, or to refocus their work lives on the aspects of medicine that fulfill them. “Sometimes we can create new jobs that didn’t exist before,” Dr. Geis said. The key, in her view, is determining what your values are and leading with them. “When you do this, the world sees you differently,” she said.

The pandemic as a tipping point — and opportunity

The COVID-19 pandemic has revealed two things about medicine. First, physicians will rise to an extraordinary challenge to care for patients in a dire and chaotic environment. Second, that environment laid bare some systemic issues and inefficiencies that delivery and that underlie physicians’ frustration: burdensome, low-value paperwork and ever-rising reporting requirements, poorly performing electronic health record (EHR) systems that don’t readily accommodate workflow, scheduling inflexibility, “hamster-wheel” patient-volume pressures, and a perceived inability to change the system.

“The pandemic has been a huge shift for the planet and for medicine. It has resulted in some physicians saying they’re just not going to take it — all the pressures — anymore,” Dr. Smith said. “Sometimes, when something hits rock bottom, there has to be change.” The pandemic also revealed the extent to which medicine as a profession still primarily operates the way it did decades ago, Dr. Smith said, in how physicians train, the roles they perform, and the hierarchical structures in which they work.

“There is no question that medicine has not kept up with improvement science, and the pandemic shone a light on this and on the high rates of professional dissatisfaction,” said Bryan Bohman, MD, associate chief medical officer for workforce health and wellness at Stanford University.

In Dr. Bohman’s experience working with physicians, the main causes of dissatisfaction he hears are that physicians feel like they’re in a rut, aren’t empowered to control their clinical work, and that their employer organizations are too focused on the financial bottom line. Often, he says, the rut, which he describes as a lag in professional fulfillment, occurs several years into physicians’ careers, because in the early years they’re so focused on getting ahead. Some physicians, however, “get a sense that things aren’t quite right early on,” he said.

Dr. Bohman, an anesthesiologist, experienced his own encounter with impending burnout 15 years ago, when he recognized that the clinical environment “just wasn’t working for him.” That recognition, which Dr. Bohman admits resulted in not only frustration but also admittedly disruptive behavior, led him “take a look at himself” and seek solutions. He got involved in administrative work and eventually helped found Stanford’s WellMD & Well PhD Center, which aims to create cultures and practices that drive professional fulfillment within Stanford. Today, the center shares those learnings broadly with other organizations and professional societies.

Improvement work as antidote and solution

Dr. Bohman contends that physicians who feel stuck might find a remedy by being part of the solution, instead of complaining about what isn’t working. He encourages physicians to propose solutions (or at least offer to explore potential ones) and to carve out a portion of their FTE to work on reframing their clinical environment to address the suboptimal factors.

“Getting involved in improvement initiatives — having the ability and the opportunity to make things better — can actually give you a sense of fulfillment,” he said. “This is where I think a lot of doctors go wrong. They think that by just complaining they can improve things. That doesn’t work. You need to start by identifying what in your job is lifting you up or pushing you down — and go from there.”

—Bryan Bohman, MD, Stanford University

At Stanford, for example, each clinical department has designated improvement leadership roles. Physicians might propose a similar structure or on a smaller scale, Dr. Bohman suggested. Start by conceiving and designing a single improvement project and offering to lead it.

Zero in on what is causing dissatisfaction — before making a career shift

Lena Shahbandar, MD, a physical medicine and rehabilitation physician at Duly Health and Care in Illinois, has long tried to keep a healthy balance in her work and home life. She had a baby in medical school, so she had a balancing-act head start on many of her colleagues.

“It’s been my career perspective that time truly is a nonrenewable resource, and I’ve always been able to structure my career around my children by requesting what I need,” Dr. Shahbandar said. She worked part-time after residency. Later, when she worked full-time and became a department chair, she still took Fridays off. A while back, however, she realized that she was struggling to keep the balance she prized, so she underwent physician coaching. That experience proved a revelation. “I didn’t realize I was burning out, but I was. I learned a lot about myself.”

She realized that she, like many physicians, has led a life tantamount to being transported through a pipeline, in which many decisions are essentially made for them once they sign up. “Medicine is the inverse of so many things in life — you don’t take a step until you’ve studied something and been taught how to do it. Then you still live in fear of making the wrong decision,” she said. That model, she said, finds some physicians inadequately equipped to make life- or career-adjustment decisions.

The coaching experience so buoyed Dr. Shahbandar that she found the courage to pursue a business idea she’d long envisioned, inventing a baby carrier designed to alleviate the low back pain many of her new-parent patients’ experiences. She and her colleague Kate Hoppock, DO, also brought coaching services into their organization and obtained some dedicated time for their wellness-improvement efforts, with good outcomes. One physician initially planning to leave medicine has since become a department chair. Others have reconfigured their work lives to better align with their clinical priorities.

Begin with your values — then set boundaries

Physicians are human, and like most people, they’re susceptible to misreading a situation causing them frustration or resentment. For example, if you’re chronically overbooked in clinic, you might think that you’re underappreciated, Dr. Shahbandar explained. It might be the practice is just trying to get patients seen and isn’t aware the schedule is causing extreme dissatisfaction. “Set a boundary to remove the frustration,” Dr. Shahbandar advised.

Individually, physicians identifying systemic problems affecting their career satisfaction can start by working on a single issue that’s vexing them, such as an overwhelming nonclinical-task load that’s infringing on patient time, Dr. Smith advised. They might be able to reallocate how work is distributed among staff members like medical assistants or to reconfigure how patient messages are handled. “You have to take the pebble out of the shoe while you’re moving the boulder,” she said. “Start by identifying the adjustment that you need and ask your superiors or administration for some wiggle room to experiment.”

All the physicians who shared perspectives for this article mentioned the importance of specifically identifying your own values before eyeing a change. Sometimes, people can quickly list their values — spending time with family, providing high-quality care to patients, being a team player, or taking care of personal health, for example. The telling thing is to examine the extent to which your life reflects those values and identify mismatches. Dr. Shahbandar taught physicians to do the math, via an exercise she used, tallying the time that you spend in pursuit of those values. “This can be very helpful,” she said.

“When you’re clear on what matters to you, you might be able to stop doing some of the things that don’t reflect your values — things you do because you’re afraid to say no,” Dr. Shahbandar said. “It’s OK to say no. You don’t have to explain why, but if you’re pressed, simply say, ‘I’m trying to honor my boundaries.’”

—Lena Shahbandar, DO, Duly Health and Care

Navigating a crisis for new direction

For Jimmy Turner, MD, an anesthesiologist at Wake Forest University in North Carolina, learning to say no was a key component of reframing his career for greater satisfaction. A few years into practice, Dr. Turner recognized he was living a pressure-cooker existence and he was dreading going to work. Instead of stepping back to examine what was causing his distress, he just worked harder. When that only exacerbated his discomfort, and after learning that he had Graves’ disease and acknowledging that he was depressed, he sought coaching. “I think it’s necessary to talk to an objective third party. Sometimes we don’t have the introspection we need, and you need a diagnosis to find the treatment,” he said.

In Dr. Turner’s case, coaching helped him separate external things he couldn’t control from internal ones that he discovered he could manage. “It’s a matter of shifting your mindset. I can choose to have this broken medical system around me,” he said, “without it affecting my job satisfaction.”

Today, Dr. Turner practices medicine happily by saying “yes” only to what matters to him. He also produces a popular, provocative podcast “The Physician Philosopher,” and helps physicians learn how to obtain balance in their lives.

Sometimes, a personal crisis puts physicians on the path to self-discovery and eventually to making their work lives more gratifying. For cardiothoracic surgeon Susan Trocciola, MD, a breast cancer diagnosis in her forties stopped her in her tracks. Like many surgeons, she worked at a breakneck pace. Even though Dr. Trocciola loved her work, she knew there was an imbalance.

“I remember being in the CT scanner and asking myself, why did I work so many hours?” After she recovered, push came to shove when an administrator denied her request to show up an hour late to handle a personal problem, even though, she recalls, “there were enough surgeons to cover.”

After working with a coach, Dr. Trocciola figured out she didn’t want to leave medicine, but she did need to practice on her own terms. She switched to locum tenens practice. The transition allowed her to regained the professional fulfillment previously compromised. “I practice the medicine that I came for. People are happy to see me because they need my help taking care of patients,” she said. “I’ve been offered a lot of jobs, but I do this because it gives me the freedom to work as many hours as I want.”

For Vivian Sung, MD, MPH, a urogynecologist and researcher at Brown University in Rhode Island, a child’s mental health crisis stopped her abruptly. Her professional life was so tightly wound that she left little room for shifting gears when needed. “I felt like I was going 100 miles an hour in one direction and then 100 miles an hour in the other,” Dr. Sung recalled. “I’d been awarded two large grants and figured out that I actually felt resentful.” She took family medical leave and engaged a coach to help her reset priorities and address the fact that her expectations of herself were enormous — and untenable.

Today, Dr. Sung’s professional life hasn’t changed from the standpoint of her schedule, but her perspective is markedly different. “The burnout I was experiencing wasn’t about the job, it was about my inability to set boundaries and ensure I was doing what I wanted to do,” Dr. Sung said. She has since become the vice chair of faculty development and wellness, a role she proposed to administration, and she is no longer reading charts at 10 p.m. “My experience totally changed my mindset,” she said.

Engaging administration in providing professional fulfillment resources

The extent to which organizations are willing and equipped to enable physicians to spearhead system changes that bolster work fulfillment is variable, physicians interviewed for this article reported. All concurred, however, that physicians need access to resources such as independent career coaching and that they must be integrally involved in designing system changes.

Colin P. West, MD, PhD, professor of medicine, medical education, and biostatistics, Mayo Clinic, who directs Mayo’s Program on Professional Well-being, echoes Dr. Smith’s view that the timing, as the pandemic (hopefully) wanes, is ideal for physicians to push for resources they need and reframe their professional lives.

“There is the notion that physicians have no power to demand an appropriately supportive work environment now — this is what many physicians feel, and it represents a collective failure of the profession to take care of its people,” Dr. West said. “Moving beyond that, the pandemic has increased understanding that things previously considered impossible, such as telemedicine, can be feasible and can actually promote well-being for some physicians by affording flexibility in their practices.”

The objective now should be to build on the knowledge the pandemic has delivered, suggested Dr. West. For example, he proposes extending pandemic initiatives so that physicians can bill for telemedicine care more effectively. “Flexible workdays are another example. We’ve learned that cookie-cutter templates aren’t actually necessary, and that variations on them can balance individual and practice needs for mutual benefit,” said Dr. West, a self-described optimist who has long advocated for “a better world for health care professionals.”

When physicians are viewed as “replaceable parts,” Dr. West said, the flexibility they experience in their job roles lessens. “When physicians are viewed with other employees as the most valuable resource a practice has, it starts to make more sense to leaders to ensure that physicians are well and have work environments within which they can thrive. I suspect we are just entering a bumpy phase in this transition from the current cog-in-a-wheel health care professional experience to a more employee-centered model.”

—Colin P. West, MD, PhD, Mayo Clinic

The extent to which organizations are willing to enable physicians to spearhead system changes that bolster work fulfillment is variable, sources for this article reported. All concurred, however, that physicians need access to resources such as independent career coaching or counseling and that they must be integrally involved in designing needed system changes. “Our leaders are struggling, too, and they’re stressed. They need us on the front lines, but we must be able to say what we need,” Dr. Geis said, “because the energy we bring to our organizations matters.”

Tips for the journey

Sources offered additional advice for physicians beginning or navigating the journey toward a more satisfying career — or life:

Surround yourself with people making changes in their own lives or in the system. Physicians sometimes feel isolated when they’re struggling in their careers, Dr. Smith said. Rather than just toughing it out alone, it can be helpful to identify people who are thriving or making changes, and learn from them, she said.

Don’t just change your circumstances. Switching jobs can relieve immediate stress or get you out of a toxic environment, but don’t count on it being the solution you’re seeking to your dissatisfaction, said Dr. Shahbandar. Physicians should instead commit to rigorous self-evaluation first, either on their own or working with a coach or another third party. “Observe yourself when you’re happy and also when you’re frustrated, to determine the facts,” she said. “Then go from there.”

Keep the faith. In Dr. Trocciola’s view, it’s an ideal time for physicians to ask for what they want because organizations — and the world — need them. “You really can create a career that works for you. People say you can’t be a part-time surgeon, but you can,” she said.