Career crisis and advice

Non-investing personal finance issues including insurance, credit, real estate, taxes, employment and legal issues such as trusts and wills.
Dusn
Posts: 217
Joined: Thu Feb 15, 2018 8:59 am

Re: Career crisis and advice

Post by Dusn »

What you’re feeling is extremely common amongst physicians. Unfortunately I don’t have a great solution. For me personally, my solution was to reach FIRE and give up the expectation that I would find a sense of purpose or fulfillment with my job. That freed me to try to find it elsewhere, or most likely, internally.
dcw213
Posts: 261
Joined: Sun Dec 16, 2012 2:04 pm

Re: Career crisis and advice

Post by dcw213 »

I feel for you, OP. While I have not dealt with nearly the same level of stress or grave consequences of errors in my field, I have experienced similar feelings of unhappiness and hopelessness. I will share an anecdote that may or may not be helpful.

About 10 years ago I got promoted to management in my field (finance) ahead of typical schedule and my expectations. At the time I felt very unprepared for this but felt I could not say no or turn down the incremental money in my 20s (seems inconsequential now but at the time it was significant). I struggled for a long time. I feel I am similar to you in having a bit of a perfectionist streak. I could not fathom how my peers could get their work done so quickly and believed everyone around me was half assing it while I gunned for top quality. I found myself in an environment where the approach to quality that got me to where I was could not work at the management level - not enough time allocated to me. I struggled to adapt and was miserable. I focused on reaching financial freedom as my way out.

Interestingly, after about 5 years of hard work and general misery, I did become a true expert and actually started to enjoy it. Things got easier, I became more comfortable with managing people and negotiating with stakeholders. The next 5 years were very rewarding, doing the exact same thing. Ultimately I did reach FI and pivoted my career for family reasons when things became unenjoyable again, but my point is that there may be a chance that you can persevere through your challenges during this 3 year period you are committing to.

I would give it an honest shot rather than already plotting your exit. If 2 years from now you see no progress, I think your plans sound reasonable. Again, I cannot compare my finance background to dealing with human safety and life and death consequences, but looking back I am glad I did not bail despite how badly I wanted to at the time.

Good luck to you.
User avatar
AnnetteLouisan
Posts: 7262
Joined: Sat Sep 18, 2021 10:16 pm
Location: New York, NY

Re: Career crisis and advice

Post by AnnetteLouisan »

I loved the line, “this field is infested with hypocrites and mountebanks...”. 😁🤣

so are many fields... but that is so well put!!!

Read Arrowsmith by Sinclair Lewis. That’s my prescription, doctor. It’s about an idealistic young scientist.

Good luck!!!
User avatar
AnnetteLouisan
Posts: 7262
Joined: Sat Sep 18, 2021 10:16 pm
Location: New York, NY

Re: Career crisis and advice

Post by AnnetteLouisan »

How about joining a naturopathic practice or alternative medicine clinic like Remede Naturopathics or the clinics mentioned in the movie Escape Fire, which mentions a lot of the issues you just did but illustrates practices that are doing things differently?
User avatar
CRC_Volunteer
Posts: 568
Joined: Fri Sep 10, 2021 10:57 am
Location: Southeast USA

Re: Career crisis and advice

Post by CRC_Volunteer »

I have started with a new physician who wanted to get out of the rat race. He started his own practice and is cash only. He lists his prices so you know what you are paying for (EKG: $20). He is thoroughly enjoying himself.

Would this be something you would consider?
"Let me explain. No, there is too much. Let me sum up." (Inigo Montoya) | | 65/30/05 | 53% VTSAX | 12% VTIAX | 30% VAIPX | 5% CASH
helloeveryone
Posts: 1285
Joined: Sun Sep 04, 2016 5:16 pm

Re: Career crisis and advice

Post by helloeveryone »

Markalem wrote: Tue Aug 17, 2021 6:31 am I am an MD with subspecialty training. i have no debt, I am in the mid-thirties, and my net worth is close to 600k.
I am single (never married) and without kids.
I have been in the "real" career pool (ie finished all my training, and started a real job) for 2 years now.
These first few years have been tumultuous, with many (Nonfiscal) disappointments and drastic changes in my life. Due to nasty work politics, I was forced to leave my first job (insecure and sociopath (and corrupt) senior partner, and malignant nature of the institution that values the bottom line more than patient care). I was able to get out of that situation and move to a higher-paying job, which guarantees my salary for the next three years (there was a very generous bonus contingent upon staying for that time). I cannot leave this job (If I had to) until that time (that's out of the question).  
I figured that at the rate I am saving, I will be doing well by the end of these three years, barring a major market crash. Currently, 20% of my net worth is in cash to account for any upcoming surprises. 
This led me to re-examine my goals and what I really want to do. I have been under a lot of stress. The reality of modern medicine is not pink. We are no longer "doctors" but are "providers". Administrators, lawyers, insurance companies, nursing unions, subspecialty physicians, make this environment stressful and less optimal for patients.
The field is infested with hypocrites and mountebanks (like I imagine all walks of life are). Those thrive and get ahead in life not because they are more capable and knowledgeable doctors, but because they are paying lip service for trivial issues just because they are politically "correct".Although this is the case in many many other careers, the stress that life-and-death stakes in medicine is synergistic with this vitriol of an environment that the pressure becomes unbearable. My area in particular involves some high-risk interventions, and this adds pressure to this pressure cooker. 
Although, at face value, I have been successful; graduated from the best training programs, the "practice" has been vastly different from the "theory" and this has caused me great anxiety, discomfort, and an existential crisis. 
I, therefore, sat down to rethink my life. Being in my late mid-thirties without a partner, kids, family, or a dog, I thought that I am in a perfect position to craft the life that might lead to more peace of mind with fewer shackles than others who have more responsibilities face. 
I have not done anything other than clinical medicine (and clinical research) in my life. I have no other skills, although I speak few other languages. I am not tech or finance savvy. However, I need to work on something (badly) to get me out of the shackles of being employed to this environment and allow me the peace to work on my own without having to interface with the environment. In Nassim Taleb's words: to become a Flaneur. In his situation, it is easy to do with a net worth of over 30 million, but I am not sure how I can pull that here. Given my contract, I cannot do any other work (other than my employer's job) in the next 3 years. 

Therefore, I wanted to see if any of you have career suggestions or skills I can try to obtain during these coming three years. I am very passionate about getting out of this situation. Should I study for an MBA? a CFA? specific courses? Accounting? What can mesh my clinical medicine skills (and they are not to be underestimated) and a life AWAY from this nasty aspect of clinical medicine? I need options and coaching so badly given the level of despondence in my life currently. Some may say my empty life (no family, partner, etc) is the source of my depression. I thought about that, but that's not it. Going to work every day fills my heart with heaviness and anxiety as to: What is the next disaster that I have to prevent, and what confrontation do i have to deal with. I am not sure how a girlfriend or kids would mitigate that.
Sorry for this long diatribe, but I had to vent and ask for help from a smarter and wiser crowd. If you can give me thoughts regarding a plan that i can implement during the upcoming period (three years of work) I will make sure to explore it and implement it.
Sounds like you have had two bad jobs...either that or perhaps you have the wrong perspective and need a mentor (perhaps reach out to one of your residency or fellowship institutions and talk it out). Some people hang up a shingle and practice medicine that way....they set their own rules, you can focus on patient care and accept less annual salary but enjoy medicine the way you would want to. It'll be difficult up front but once you've got your practice running with a good team you may enjoy what you've built.
JDonaghy
Posts: 36
Joined: Thu Aug 06, 2015 5:48 am

Re: Career crisis and advice

Post by JDonaghy »

humblecoder wrote: Tue Aug 17, 2021 9:48 am Here are some thoughts for what it is worth. I am not a physician so please take that into consideration.

When young people decide upon a career, sometimes they have an idealized version of what that career will be like. However, the reality of the career can be different from the perception. I call this "reverse nostalgia". Nostalgia is where you idealize the past whereas this is where you are idealizing the future.

I went into computer science as a career. The idealized version is that you are writing software all day, figuring out the optimal way to structure the code so that it is maintainable, extensible, etc, solving thorny technical bugs, trying out new technologies to see how you can apply them, and so forth. If you are a techie, this is heaven for you. However, the reality of the job is that oftentimes you are asked to rush out code to meet some economic deadline, or spend half your day sitting in on requirements meetings, or working on documentation, or explaining to your boneheaded manager items which are simple to you but rocket science to them. In other words, the reality isn't as glamorous as what you imagined from reading the glossy brochure.

It sounds like you are coming to a similar realization with your own career choice.

I'll be honest with you. I believe that you and many of the respondents are going down the wrong path with their suggestions. If you follow this path, you are going to end up in the same position you are now. Medical informatics? Pharma? Academics? It seems you are again idealizing these careers. You think that academics doesn't have its warts? Have you heard the term "publish or perish"? From what I can tell, the academic world is also about publishing papers so that you can secure grant money for your next set of papers? Can't get grants? Then no tenure for you regardless of how good of a professor you are.

You think Pharma is going to be more "pure" and have less BS than clinical practice? Really?

And medical informatics, electronic record keeping is just another commercial venture where the pressures of profits will override purity of purpose.

If you go down these paths, I wouldn't be surprised if you are back here in a few years posting about all the BS that you have to deal with in the academic world, or the Pharma world, or the software world that you don't want to deal with. Sorry for the tough love, but as they say, the grass isn't always greener once you get to the other side of the fence.

Here are some suggestions that I have:

1. Think about WHY you went into medicine in the first place. Presumably it was to help people. Focus on that aspect on try and block out the BS.

2. In every field, there are jobs which have more BS and others that have less BS. Keep looking for the one that minimizes the BS where you can focus on patients and less on numbers.

3. Start your own practice so that you align it with YOUR values. It is possible that, in three years, you'll have the seed money. If you don't want the overhead of starting your own traditional practice, can you be a relief doctor where you can have more self-determination? Also, I know some doctors have completely broken away from the insurance "networks" and built a practice around high quality medicine without the shackles of dealing with third parties. Not sure if this is an option in your specialty, but perhaps this would eliminate another source of BS for you.

4. Have a goal to be financially independent and then volunteer with one of the many medical charities that are out there. I'm sure the Red Cross, Doctors Without Borders, etc probably have their own BS, but at least you won't have to deal with insurance, financial pressures, etc, and you can have more focus on the rewarding aspects of medicine.

Whatever you decide, I wish you all the best!
Well said, concur. Have been in similar situation - reverse nostalgia in both military and business world. Military was stressful. Humans and our institutions are imperfect. That's what makes me admire some of the really top people i have met along the way who someone can rise above, be awesome at their job, keep the faith and manage the noise.

Im not sure what the corrective action is, but recommend OP buy the book "Designing Your Life"
User avatar
F150HD
Posts: 3926
Joined: Fri Sep 18, 2015 7:49 pm

Re: Career crisis and advice

Post by F150HD »

TimeTheMarket wrote: Tue Aug 17, 2021 8:07 am Don't switch careers and throw the MD out. It's just worth too much money.

I'm aware of positions at bioscience companies that involve things like data analysis or device development that also require an MD. This means they will pay well, there won't be a ton of people applying for the positions, and you still leverage something that few people have.
^^ this
Post Reply