By Christopher Guadagnino, Ph.D.

Published August 1999

• React to this article in the Discussion Forum.

PND: You observe that there is professional discontent among physicians. What are its causes and how widespread is it?

KB: There’s a 1998 survey by Levin of 6000 physicians in 22 different cities that revealed that 46 percent of all American clinicians often think about leaving clinical practice. That’s over 300,000 physicians in the United States that seem to be unhappy with the state of affairs. There are other indications about physician discontent that you might not think of readily. The number of disability claims by physicians has increased so much that some insurance companies no longer are writing disability insurance for physicians. Recently the AMA, one of the more conservative organizations of physicians, has voted to form a union. And another example I saw was an article that said that physicians are actually moonlighting by selling cleaning products and herbs out of their homes. So, for a lot of statistical reasons and for a lot of those more soft reasons, it looks like physician discontent is widespread and happens throughout the whole country.

As to content of physician discontent: if you ask physicians, they’ll just say managed care. But I think that’s become kind of a shorthand for a lot of the changes that are happening in society today that frustrate physicians. An article I saw in a family practice journal summarized it by saying that physicians are angry because they’re feeling a loss of financial security, a loss of status and prestige, a loss of physician collegiality, a loss of the physician-patient relationship and a loss of control or autonomy.

PND: What can physicians do to overcome that discontent?

KB: I think there’s a lot of different things physicians can do. I think if you’re of a political bent, exploring ways to be more active in the political process is important. Exploring unionization is a way that physicians can take a look at what they might want to do, although I personally am not sure that joining a union is going to help. I guess the main thing that I would preach would be that physicians need to really take a hard look at what’s happening out there in the world that’s affecting all businesses because of the information revolution and because of the Internet. They need to figure out what they most like to do professionally, and then figure out a new role for themselves either within medicine or outside of medicine that will take advantage of their transferable skills and make them more happy at work.

PND: What are some of their options?

KB: We recently had a continuing medical education conference about how physicians can transform themselves and their careers. What I think they need to do is take a hard look at assessing their own strengths and weaknesses and then decide what niche they want to fulfill. Take a look at me. I was brought here by Sherif Abdelhak to be the Professor and Chair of Pathology at Allegheny, and about a year after that they went bankrupt. So, I sort of had to redefine myself and I’ve been through the whole process. If you look at my transferable skills, I’m a pretty good public speaker, I’m a good writer, I’m a fairly good teacher. And when I went around and decided what I wanted to do, since my family didn’t want to move again, I decided that I best be in the private sector doing teaching and consulting. I had to find a company that would hire me. I created a job that would play to my strengths and then actually had to go out and sell it to an employer.

What one may decide to do is to just change careers within clinical medicine, going from being a primary care physician to maybe an administrator in an integrated delivery system. Another way is to pursue a non-traditional career. At the conference we had physicians who were happy working in the pharmaceutical industry. We had a physician who’s been CEO of several large companies. We had a physician who’s the medical director for Fox TV and radio. I think that physicians can enjoy their work more sometimes by just changing their role within clinical medicine and still seeing patients and providing care, sometimes by switching to administration and sometimes by pursuing a very non-traditional role. We even had a fellow, he’s over at Thomas Jefferson University now, who spoke about being a professional chef at LeBec Fin and compared the positive and negative aspects of being a chef with being a physician.

PND: What are other alternatives for physicians wishing to remain within the clinical setting?

KB: Everybody knows the state of health care is really in flux right now: there’s the Allegheny bankruptcy, with other health systems losing money. I think you can look at that as a negative or as a positive. The positive aspect is that there really are tremendous numbers of new jobs opening up, but they’re jobs that have never happened before. When I was looking at jobs outside of the Delaware Valley after the Allegheny bankruptcy, I looked at large health systems in Seattle, in Chicago, in Indianapolis. Every single job I looked at was a newly-created job for a physician executive. In one case they wanted a physician to coordinate the specialty care at a large university. In another case they wanted a physician to combine a private practice pathology group with a university group. These were all brand new jobs that have never happened before—physician executives were being sought who could provide both a clinical role and an executive role in managing people and managing resources. So, all of the excitement and chaos in medicine creates disruption to our careers, but it also creates opportunities.

As another example, doctors are faced with patients asking a lot of questions based on research on the Internet. What some patients don’t realize is that there’s both very good information on the Internet and there’s really bad information. One of the new roles of the physician is to interpret that information and try to steer the patient in the right direction. But I must say that it sometimes can be a little bit upsetting when the patient is asking about treatments or drugs that the doctor has never heard of. That can sometimes lead to nervousness on the part of the patient or the physician. I think it’s a brand new relationship and that it’s evolving. There’s all these virtual communities on the Internet with people who are concerned about one disease or another: breast cancer, MS, ovarian cancer. Some of them are quite large groups that meet everyday on the Internet. Why shouldn’t some enterprising physician go to one of those groups and offer to become their hired physician to help them deal with third party payers, to help guide them through the good material and the bad material on the Internet, to help them deal with their providers? I bet there’s an opportunity out there for some physician that’s interested in that kind of thing.

As a physician goes through all of this introspection and assessment, he or she may want to do exactly what they’ve been doing and affirm their present role in clinical medicine and continue to see patients. But, having gone through the thought process, they may feel a little less anxious because they know that they’re doing the right thing for their own career.

PND: How can physicians go about evaluating these numerous options to determine what’s most appropriate for them?

KB: There’s always been career counselors that sometimes other executives have used more than physicians have. I know that many lawyers have gone to career counselors and have changed their career. There are a lot of books out there. There’s one that the AMA put together that’s called Leaving the Bedside: The Search for a Non-clinical Medical Career. The American College of Physician Executives offers some programs that are geared toward people who just want to become an administrator, but they’re quite good.