Physician, know thyself

As Tiffany Shiau, M.D., neared completion of her medical degree from Sidney Kimmel Medical College, née Jefferson Medical College, many people gave her advice about which specialty to choose. Often, the refrain went something like this: “Hey, I did this rotation in ophthalmology, and I think it would be a great fit for you.”

Shiau knew ophthalmology offered controllable hours and fewer night calls, two of the lifestyle factors physicians covet most. After all, it’s the “O” in the so-called ROAD to happiness: radiology, ophthalmology, anesthesiology and dermatology. But when she finally decided on ophthalmology, she wasn’t just banking on a catchy phrase or her colleagues’ advice. She also considered her own experiences to indentify her ideal work setting.

“At Jefferson, we were affiliated with the Wills Eye Hospital, one of the nation’s top eye institutes,” Shiau says. “Everyone there was amazing. And as a medical student trying to determine what daily routines are like for different specialties—as well as determining how happy people are in their field—I spent time considering whether I could see myself hanging out with these people outside of work.”

After weighing all the factors, Shiau gave a resounding yes to ophthalmology. She assumed it would be a good fit for her personally and began her residency in Buffalo, New York. Four months later, she left the program and switched to internal medicine.

“I came to realize that what other people say is just one input. In the end, it doesn’t matter how people see me unless they really knowme. Only then might they have a better chance of understanding what values are important to me,” Shiau says. “During this soul-searching time, I asked myself a lot of questions: ‘What is my gut sense telling me? What feels like the right thing to do?’”

As Shiau considered those questions, she realized that although she liked the field of ophthalmology and the people she worked with, she didn’t like the procedural part of the work. In ophthalmology, she explains, “You can’t really avoid operating on people’s eyes.”

By the time med students reach their fourth year, they usually know what specialty and practice environment they want to pursue. Most make a straightforward choice and are happy with it, but that’s not always the case.

Shiau took an extended journey from medical school to the start of one residency to a primary care residency in an academic setting. Two and a half years later, she took a full-time clinician job on the West Coast, and she says she doesn’t regret one piece of the circuitous route.

The path from medical school to residency to practice isn’t always a straight line. According to the Association of American Medical Colleges, almost 75 percent of medical students change their specialty choice before residency. Twenty percent of residents and 16 percent of physicians make a change and head in a different direction.

The uncertainty can be daunting for medical students, who are steeped in a culture of perfectionism, accustomed to excelling in academic settings and trained not to show any weakness.

Mirror, mirror on the wall

Taking a long look in the mirror is important for anyone contemplating a new job or career change, but it’s especially critical for physicians. Emergency medicine physician and associate director of an emergency department in Hartford, Connecticut, Joyce Perfetti, D.O., says you can get lost in the job otherwise. She explains: “Doctors love taking care of other people. That’s why we went into this profession. It’s easy to lose yourself in something that you love.”

Self-reflection becomes even more crucial when others are involved in a career decision. “Not only do I need to know what’s important to me, but I also need to know what’s important to my family, my partner,” Perfetti explains, adding that being honest with yourself is imperative during a period of introspection.

“When you are not honest with yourself and you don’t self-reflect on what your priorities are in life and how they balance with your work—whether those priorities are family, travel, health or working out—you are going to feel a loss, and your family might feel that loss as well,” she says. “There are other things important in your life, and you don’t want to sacrifice those. You don’t want to neglect your family, and you don’t want to neglect yourself.”

Not surprisingly, self-neglect is rampant as physicians juggle competing priorities. Often, they put professional obligations above their own needs and push their bodies to do more with less sleep. Physicians have been known to cope with work pressures in unhealthy ways, including consuming excess caffeine or sugar, skipping exercise and even using drugs. The joy of practicing medicine dissipates, and burnout hits hard.

Perfetti says burnout can be prevented by paying attention to mental health and taking time for recreation. “When you start feeling tired and on days off start losing interest in those things that you love, it’s perhaps time to work out, go for a hike with your family or take a much-needed vacation.”

In the long road to career satisfaction, the only constant is change. Your family situation changes. Your circumstances change. Your goals change. Perfetti experienced this herself during residency. Early on, she thought she wanted to work in a demanding environment, but by the time she finished, her priorities had shifted.

“When I went into residency, I thought I’d work in the busiest, craziest ER I could find. I wanted to see it all and be deeply involved in a trauma center. I thought I wanted that for life,” she says. “If I had stayed in that environment, I knew I would face quite a bit of burnout. Although I did love that for training—and I do love the aspect of it in terms of a long-term career—I didn’t think it was the right thing for me at this time in my life.”

Today Perfetti works in a busy community hospital. Although it’s not a trauma center, the emergency department does see some traumas, and that’s enough for her. “Right now, this is the best fit for me, because it allows me to see a lot of pathology,” she says. “I still see a lot of critical care, it’s just busy in a different way.”

Personal think time

Seeking advice from colleagues, family members and mentors can be helpful, but it’s most important to know your own mind. Your career path, specialty and practice environment are personal choices, and you need to consider for yourself how they align with your lifelong goals—not just someone else’s opinion. Digging deep to uncover your values, interests, personality and skills almost guarantees a richer and more satisfying personal life.

Oftentimes, asking yourself good questions is the most challenging part of reflection. You spend more time with yourself than anybody else does, but that time doesn’t always equate to self-knowledge. Unearthing your own preferences and tendencies can be difficult, but it’s the only way to find much-needed clarity.

It will help you identify the ideal practice setting, patient population, specialty and work environment for you. It will also help you find a good fit when it comes to your employer and colleagues.

Questions for getting to the core

Expanding on the Greek maxim “To know thyself is the beginning of wisdom,” Socrates taught that “The unexamined life is not worth living.” And it’s true—examining yourself will have a deep personal impact and help you reach your future goals. But self-reflection doesn’t have to be intimidating. There are no right or wrong questions, just different ways to approach the process. One easy way to start is by following this framework.

1 Consider your interests (your hobbies, passions or anything that captivates your attention):

• What activities in my life kindle a fire inside?
• What activities would I miss if I could no longer do them?
• As a child, what types of activities did I do that led me into medicine?
• If I didn’t have to worry about money, what would I be doing?
• What gets me riled up? What problem in the world would I most like to fix?
• What topics do I find myself always arguing against or defending to others?

2 Consider your personal values (your strong beliefs, personal missions and anything else meaningful in your life):

• What is something true in my life no matter what?
• What would I like to avoid in my future career?
• What does quality of life mean to me?
• Which core value can I not compromise on?

3 Consider your personality (your temperament and preferences):

• How do other colleagues, mentors and family perceive me?
• What kind of work environment best suits my personality?
• What work environments would feel restrictive and stifle my enjoyment of medicine?
• What type of colleagues do I like working with?
• What type of patients do I like caring for?

4 Consider your strengths and weaknesses (your talents, abilities, skills and character):

• What are my strengths and weaknesses?
• What is one medical task I love doing even when I’m exhausted and under pressure?
• What do I fear when it comes to practicing medicine?
• What have I done in my life of which I’m most proud?
• Which failure have I turned into my greatest personal achievement?
• Do I have a self-limiting belief, and if so, why do I have it?
• What do I believe is my highest possible achievement in medicine?

5 Consider your family (your partner, spouse and/or children and what they want):

• How will any decision impact my family or loved one?
• Will this new work environment benefit my family—or take anything away from them?
• Do I have the full support of my partner and family with my new job prospect?

By asking probing questions to uncover your deepest personal values and desires, you’ll be more likely to find the right practice environment. And if you’re still struggling to answer these questions, ask yourself one more: “Who knows me well enough to help me decide which work environment is right for me?”

For Shiau, a big part of her decision to trade an academic setting on the East Coast for a full-time internal medicine clinical setting on the West Coast was her desire to connect with people. “Ultimately, when my husband and I decided to move to California, I decided not to stay in academics because my personal values were to provide good, comprehensive, kind care to my patients,” she says. “Two and a half years into my first job, I knew I didn’t want to stay in academics any longer. I wasn’t dreaming up an educational project or anything like that.”

Self-reflection beyond the hire

In the two and a half years since she completed her residency, Stefanie Gilbert Manuel, M.D., has been practicing emergency medicine in Rockville, Maryland. She says that self-reflection becomes even more important as your career progresses. “The self-reflection piece drives the process of finding a job, while also giving a frame of reference or focus for the next steps a physician takes with future goals,” she explains.

Without that introspection, Manuel cautions that it’s easy to get lost in all the different types of residencies and job environments.

Manuel spent time considering both her personality and preferences while searching for her first job. Right out of residency, she looked at a variety of job settings: academic, community-based, mixed, and those with a teaching focus. She then considered her strengths, weaknesses and values, and she evaluated how different settings lined up with these.

“For me, it was important that once I finished residency that I get out on my own and hone my skills, rather than taking an academic setting position where I would be supervising many residents,” says Manuel. “I needed autonomy once out of residency. It was important for me to formulate my own treatment plans and procedures for my own growth development, which would build confidence.”

As she went on to evaluate each employer, Manuel used specific criteria. First, she looked for physicians at each practice with similar backgrounds to hers, reviewed their track records and asked them for input. Next, she considered the makeup of group practice to ensure they embraced diversity instead of just talking about it. Finally, she evaluated the kind of support each employer gave to physicians working their way up to leadership roles

This self-reflection helped Manuel choose her first position. She signed with US Acute Care Solutions (USACS) because the physician-owned group’s values and mission aligned with her own. “In addition to the company being open and receptive to feedback, the group practice has a big push for women in leadership and embraces diversity,” says Manuel.

Now a practicing emergency physician, Manuel carves out time for ongoing introspection. “I have a note on my calendar, set for every couple of months, to go through and update my curriculum vitae. I spend time reflecting on what I’ve done and then line out the next steps and goals I want to consider.”

By prioritizing introspective habits, she finds she’s more able to remember and document her achievements, which will be crucial for future opportunities. Regular reflection also helps her make sure she’s continually stretching herself and gaining clinical skills.

Perfetti also works for USACS, albeit in a different city. Both emergency physicians value the leadership opportunities they’ve been offered. In fact, both recently completed the company’s year-long intensive leadership course, the USACS Scholars Program, which is designed to “mentor and develop acute care physicians with leadership potential into candidates for leadership positions throughout the company.”

The program is helping Perfetti accomplish goals she set for herself during self-reflection. Early this year, she moved into an administrative position and says it’s a good fit. “Prior to entering the Scholars Program, I felt like I was being drawn to the business aspect of things. I love seeing how the hospital works and also learning more about how the USACS works within the hospitals it serves,” she explains, adding that she’s been able to balance new administrative duties with clinical work. “I love emergency medicine, and I never want to leave it. I still wanted to work full-time clinically.”

Whether you, like Perfetti and Manuel, quickly find the perfect job or, like Shiau, you follow a labyrinthine path to career satisfaction, it’s important to set aside time for reflection. Considering your personal values, strengths and weaknesses will help you start your career on track—and continue to lead a fulfilling life. Because you can only know the right path when you truly know thyself.

Marcia Horn Noyes is a frequent contributor to Practice Link Magazine.