How To Endure In Medicine

As an emergency physician, it's a gift being of service to patients on the worst (or last) day of their lives. It's not easy, and it's not for everyone, but it lets me contribute in a meaningful way.

Acknowledging that being an emergency physician provides me a real sense of fulfillment is not enough to persuade me to want to engage in the practice forever. I've written elsewhere of how I came to realize that medicine is a meaningful profession, but not my calling, and I fully expect to exit and move into an Act Two phase of my life (if I have the luxury of additional life years to pursue it).

We recently caught up with friends who are a two-physician household. They are empty nesters, redefining their relationship to work as well as recalibrating their identities now that active, in-person parenting is not a regular part of their day-to-day experience.

Speaking with the female half of this couple helped me realize why, approximately three decades into her career in medicine, she continues to enjoy what she does. Here are a few of the lessons I took from our exchange, summarized in the hope that they might lead to a more sustainable practice of medicine for the rest of us.

She owns her business, and derives pleasure in building and growing it.

In the era of corporate medical groups that tout economies of scale, it's difficult for a new medical graduate to consider that independent practice might be a viable strategy. Being an employee is convenient, and allows you to clock in and clock out, which has understandable appeal to a subset of physicians. Yet building a business involves a certain degree of emotional investment. I always joke with my wife that the side hustle she built into a business that has come to replace her clinical income is like our third child - she is always thinking about how to nurture it, is sometimes distracted by it, and continually derives tremendous pleasure in watching it grow and develop. These intangible entrepreneurship benefits pay intangible emotional dividends - for proof, look no further than [your Silicon Valley guru of choice here] who sold a startup for a life-changing sum of money only to go back and form another startup. It's an addictive high.

Her practice was built to accommodate her family obligations and priorities, making it sustainable.

This is what I've never understood about people who make snide comments about the "mommy track" when female physicians chart an unconventional professional course in order to accommodate family needs - those women are creating a career path that they can sustain by reducing the tensions medicine causes with family life on the front end of their careers.

The men who frequently make such snide comments are typically working full-time medical jobs while their partners are running the household full-time. That's certainly not a problem if the division of labor was part of the plan everyone signed up for. It becomes a problem when a male physician breadwinner checks out completely, sowing resentment in the partner who is left to stamp out the endless small fires.

There are women physicians who have built family-friendly careers by eliminating nights, weekends, or both. How? They started practices that allowed them to do so, or they accepted less pay. 20 years later, those female physicians are now the envy of their once-snickering male colleagues because they have a schedule they can easily continue for the next 20 years.

The only person I knew in academia who got to work no nights, weekends or holidays was the chair of the department. This physician built a practice to provide her the same perks. Not bad.

There's a genuine pleasure in remaining productive.

Some folks are built to produce, and derive a deep sense of pleasure from measuring their contribution to the world through productivity. If such productivity generates a healthy income, all the better.

I find this to be distinct from the case of the person who will never have enough.

Some people are happiest when they are efficient and feel like they are "doing" something. These are folks for whom retirement sounds dreadful by virtue of the lack of productivity and implied obsolescence.

As the senior VP of leisure in our house, I don't suffer this affliction, but I don't begrudge those who do.

Her practice of medicine has not stopped her from pursuing other passions.

Again, owning your business means you set the hours and create the blueprint for how career and life will coexist.

Going back to William Finnegan's memoir, Barbarian Days, the author profiles a physician in San Francisco, Dr. Mark Rennaker, who built his clinical practice and expertise as a patient advocate around a lifestyle that enables him to surf nearly every day.

It's the process of incorporating time for your other passions into the design of your practice that starts out as struggle, but (for those who persist) ends in a career that gives you permission to enjoy what you love by virtue of having protected sufficient time for it.