Career Advice for an Unhappy Young Doctor?

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Ganacel
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Career Advice for an Unhappy Young Doctor?

Post by Ganacel »

I know some of you are doctors, and I was hoping you could help me advise my cousin, who is very unhappy with her career. I don't know what to tell her to do.

She is 29 years old and just finished residency this past June. Her time in residency was really rough; she wanted to quit all along, and we all talked her out of it, telling her it would get better once she finished. Plus, she has loans to pay, and how else would she be able to pay them? She did finish, which is totally to her credit. She got a job and has been working there since July.

Today she told me that she hates her new job too and she is more convinced than ever that it is medicine, not residency, that has made her so miserable. I know one of the things she hated about residency was the hours. They work 80 hours per week on a lot of rotations and don't make much money during that time. But now she's working like half that much and making a six figure salary, but she says she still feels totally stressed out and unhappy and doesn't want to go to work every day. I asked her if maybe she just needed to change jobs, but she doesn't think it's the job. She thinks it's medicine in general and that she should not have gone to medical school in the first place.

I am guessing that if she stuck it out for about 10-15 years and there was no major bear market, she should be able to afford to completely retire with all her loans paid off. But I don't know if she can stick it out for that long. She's not even sure she's going to make it for one year. The problem is, she is not trained to do anything else. So if she doesn't practice medicine, what else can she do that will realistically allow her to pay off her loans and save for retirement?

Also, is it worth trying to find another job that is less stressful? It sounds like the main things she is unhappy about are that she is expected to see too many patients in too little time, that there is a lot of bureaucracy/paperwork, and that she feels like she is "inadequate" in her job, although I don't think her boss has told her she is inadequate. If I had to bet, I'd bet that is just her being her usual perfectionistic self. But I am starting to think maybe she's right that medicine is not the best career for a perfectionist like her, and maybe we were wrong to push her to stick it out. It's just that I'm not sure what else she could do instead unless she went back to school for something else.

Thanks in advance for any ideas or suggestions.
The Wizard
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Re: Career Advice for an Unhappy Young Doctor?

Post by The Wizard »

I'm not a doctor, but I think it's going to be difficult to give second-hand advice this way.
Encourage her to join Bogleheads and it will be more productive.
It's possible she's in the wrong specialty and might enjoy lab work better, for instance, rather than dealing with patients all the time. But hard to tell from this distance...
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carolinaman
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Re: Career Advice for an Unhappy Young Doctor?

Post by carolinaman »

I am not in medical field but it seems way too soon for her to bail out of medicine after spending 10+ years of education and training. She should give this at least a couple of years to see if she can adapt to the role. She may have had some unrealistic expectation of what her role would be like and now reality has set in. She should talk with some experienced doctors to get their insight and advice on how to deal with her situation. They may have gone through the same issues. Also, more time in her role may give her some insight into different career paths associated with medicine that would be more enjoyable. I am not sure how viable sole practitioner practices are today, but that may be another option. Best wishes to her. I understand that there is a growing shortage of doctors so I hope she stays in the field.
Bigvol
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Re: Career Advice for an Unhappy Young Doctor?

Post by Bigvol »

In what specialty did she train?
Topic Author
Ganacel
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Re: Career Advice for an Unhappy Young Doctor?

Post by Ganacel »

Bigvol wrote:In what specialty did she train?
internal medicine
FedGuy
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Re: Career Advice for an Unhappy Young Doctor?

Post by FedGuy »

It sounds like she's burned out. When did she last take a vacation? I'm not a doctor, but I once felt the same way earlier in my career, and a two week vacation did a world of good.
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Re: Career Advice for an Unhappy Young Doctor?

Post by Jack FFR1846 »

Drug sales

Medical device sales

If she's outgoing, she can do as well $$ wise as she would as an MD. There's still stress, but it's different (making your numbers and other sales nonsense)
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amitb00
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Re: Career Advice for an Unhappy Young Doctor?

Post by amitb00 »

Doctors are employed by pharmacy companies to develop drugs. They can contribute at various stages - like clinical trials. FDA approval , etc. They are also employed by insurance companies to help them cut costs. They are employed by legal firms as well. She can join research labs or academic institutions. She can work at Wall Street analyzing medical companies. She can do MBA and manage hospitals as CEO. So there is lot to do besides direct patient care. Best of luck to her.
dbltrbl
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Re: Career Advice for an Unhappy Young Doctor?

Post by dbltrbl »

I am not a Physician but our son just finished residency past June. She is not alone to get burn out after residency. Our son insisted to future employers that he will not join till October 1st about 3 months vacation traveling national parks on west coast. So that is one option.

I agree that due to insurance industry they must see so many patients an hour not a good way to serve people but if you serve fewer your salary will be reduced some but can be more satisfying.

Is she in a metropolitan area? If she goes to rural area, simply due to demographics she will not need to meet the numbers. Family Physician, Internal Medicine in general low stress than say surgeons.

Another option is to join those urgent care or Little clinics where pressure is low or non existent as there are no appointments of 20 patients a day.

Lastly, if she is truly put off by medicine, she needs to be practical about her loans, so I would suggest work on weekends at Urgent care/little clinics (Walgreen, Walmart, Kroger Etc). This will allow her to something else including explore other options and still allow her to take care of herself and slow payment on her loans as income will be less.

Have her talk to her professors at residency. They can be great help. Trust me our son was ready to quit in medical school and after talking with 2 of the professors he changed his mind.

Good luck.
bluejello
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Re: Career Advice for an Unhappy Young Doctor?

Post by bluejello »

Ganacel wrote:It sounds like the main things she is unhappy about are that she is expected to see too many patients in too little time, that there is a lot of bureaucracy/paperwork, and that she feels like she is "inadequate" in her job, although I don't think her boss has told her she is inadequate. If I had to bet, I'd bet that is just her being her usual perfectionistic self.
She just started her first real job, at the very beginning of what is normally a 30+ year career. Why would she expect to feel anything but inadequate?

Of course a newbie doctor (or newbie anything) is going to feel like she has too much to do in too little time, is unprepared for the repetitive gruntwork (e.g. paperwork), and is generally ill-equipped for her responsibilities. In fact, it's probably the truth that she's not too great at her job right now, but I'm willing to bet that almost every other doctor just out of residency — and every other person at a new job in general — is in the exact same boat.

The point is, she's going to get better and the workload is going to get easier. I'm not a doctor so I don't know how long the learning curve typically lasts, but I would be extremely shocked if she didn't find it easier and easier to handle her responsibilities as the months and years roll by. Instead of thinking about ditching medicine, she should focus on her progress. What are the issues she is struggling with? Can she ask more experienced doctors around her for advice? Were there any cases this week that she handled well (I'm sure there were)? And she should focus on the reasons she got into medicine in the first place.

It may also be the case that she has unrealistic expectations. During all those long years of studying and cramming and testing and sacrificing to become a doctor, the idea of actually being a doctor was always held out in front of her like a carrot, like "this is the amazing prize you're working towards!" And now that she's actually here it's kind of rough, and she wasn't prepared for that. But really, it's wildly unrealistic to have the expectation that you're going to completely nail your job from day 1. She needs to readjust her expectations, and focus on the small daily victories.
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Re: Career Advice for an Unhappy Young Doctor?

Post by VictoriaF »

The Wizard wrote:I'm not a doctor, but I think it's going to be difficult to give second-hand advice this way.
Encourage her to join Bogleheads and it will be more productive.
It's possible she's in the wrong specialty and might enjoy lab work better, for instance, rather than dealing with patients all the time. But hard to tell from this distance...
Alternatively, she should start reading Whitecoat Investor.

I am not a doctor either, but to me it seems that she is depressed and would not be happy in any field until she had recovered from the accumulated stress of the residency. If she could take time off, go on vacation, and completely relax for a month or so, her attitude to her profession and life in general might change dramatically.

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climber2020
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Re: Career Advice for an Unhappy Young Doctor?

Post by climber2020 »

I had a similar experience as a resident. My burnout began during my fourth year of medical school, and I was completely miserable until the day I turned in my ID badge on my last day of residency. I agree with others' recommendations on taking a long vacation; I took 3 months off to travel to various places before I started at my real job and felt completely refreshed after a nice long break.
Ganacel wrote:
It sounds like the main things she is unhappy about are that she is expected to see too many patients in too little time, that there is a lot of bureaucracy/paperwork, and that she feels like she is "inadequate" in her job, although I don't think her boss has told her she is inadequate.
After learning the ins and outs of private practice for a few years, she could always either join or start a cash pay concierge practice. She could still do patient care without all the bureaucratic baggage that accompanies a standard medical practice.

If that doesn't work out, there are plenty of consulting jobs for M.D.s. One of my former classmates got kicked out of medical school before even getting his degree, and he makes a nice living as a consultant.
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Re: Career Advice for an Unhappy Young Doctor?

Post by Grt2bOutdoors »

Ganacel wrote:
Bigvol wrote:In what specialty did she train?
internal medicine
My family doctor practices the same type of medicine - ten years ago he predicted it was only going to get worse - sure enough, he was right and thankfully he's nearing retirement. The amount of administrative paperwork placed on them is just horrendous, jumping through hoops to get tests approved for their patients, you are forced to belong to several networks just to pay rent, etc. It isn't a high paying field within medicine. I'm not a doctor, my sibling is and practices in a similar low paying medical field. See if your cousin might consider after residency joining some governmental job that would allow her student loans to become fully paid off after some amount of time has passed.
She has to get through residency first.........but that can be a real drain on relationships too, if you're always working!
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Re: Career Advice for an Unhappy Young Doctor?

Post by Professor Emeritus »

If DW had had to practice internal medicine I suspect she she would have cut MY throat. She is introverted and shy. As it turned out she had a brilliant career on the technical side of medicine. Along the way I have met at least a dozen MDs who have had worthwhile fulfilling careers in medicine without the stress that private office practice brings. It just isn't for everyone. Public health, research, biomedical engineering and Health care administration are full of MDs. I taught in a program that gave MBAs in health care administration to MDs. Not to mention the VA kaiser and other "employee" positions that can often be tailored to individual work styles. There are also critical needs ares such as the Indian health service. She has to inventory her own interests and find a fit , preferably one that takes care of the loans.
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Re: Career Advice for an Unhappy Young Doctor?

Post by WL2034 »

Is she practicing outpatient or inpatient (hospitalist) Internal Medicine?
lululu
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Re: Career Advice for an Unhappy Young Doctor?

Post by lululu »

Maybe she should have quit when she first wanted to. Ten years is a long time to waste out of one's life. Everyone seems to be suggesting she keep wasting more of it.

Is there any way to get rid of those loans besides being saddled with them for years?

What other career would she be interested in? Has she thought of that?
scienceguy
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Re: Career Advice for an Unhappy Young Doctor?

Post by scienceguy »

I went to medical school (also a PhD) and found that I really didn't like seeing patients/being a doctor type of person. And I knew I absolutely loved bench science. So, I got my MD and PhD and moved on to a career as an academic cancer researcher (no residency) which I am very happy with. Helped that med school was free (full scholarship MD/PhD student). I think this general notion that has dominated this thread that if she is unhappy being a doctor it must be burnout is incorrect. Some people (probably many people) just don't like the work of doctoring. Fortunately most of those people don't go to medical school, but obviously some do. Sounds like she has already sucked it up for way too long.

Why don't people like doctoring? I can only tell you my experience - here is why I didn't like it. 1) Found it very confrontational. There are always negative power-type interactions in a hospital setting between doctors, nurses, other health workers, and with patients. Very hierarchical, especially in a high powered academic setting. I found that stupid and annoying. 2) Being a doctor is basically about being a service provider - in this case, providing health care services to customers. In many/most cases, I found the customers to be annoying, demanding, and not smart. This is compounded substantially by the fact that they are sick, which brings out the worst in patients and their families. I am happy providing medical advice to my family and friends (and friends of friends). Not interested in providing similar advice as a paid service to strangers.

I would encourage this person to find a job doing non-doctoring activities that relies on an MD. Maybe clinical trial design for pharma. Maybe academic research. Maybe do a research fellowship for a year or two to see if that is fun for her. Yes, being a doctor can be pretty lucrative (and reliable in terms of salary). But what is the point if you are miserable? Of course it is always possible that this person is depressed or generally sad and nothing will make them happy, but I would encourage her to check out some options. Wall street?
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Re: Career Advice for an Unhappy Young Doctor?

Post by VictoriaF »

lululu wrote:Maybe she should have quit when she first wanted to. Ten years is a long time to waste out of one's life. Everyone seems to be suggesting she keep wasting more of it.
By finishing the medical school and residency, the woman has accumulated a significant career capital. The worst thing she could do now is to quit medicine and do something completely different. Branching into a related field where she could capitalize on her achievements is a better approach. I strongly recommend the book So Good They Can't Ignore You: Why Skills Trump Passion in the Quest for Work You Love by Cal Newport that outlines a winning approach to one's career.

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Re: Career Advice for an Unhappy Young Doctor?

Post by fposte »

It's also worth her seeing a health-care professional, which I believe people in health care professions tend to be rather reluctant to do, before she changes her whole career path to avoid a feeling she may bring with her wherever she goes.
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Re: Career Advice for an Unhappy Young Doctor?

Post by staythecourse »

I'm a doc, but it is hard to say what the answer (if there is one) would be without knowing more info., such as: How is her personal life, i.e. current relationship, how is her family support network, how much of this is I don't like seeing patients vs. I feel stressed out seeing a billion pts. per day, how much of this is she happy where she lives, does she have some underlying depression/ anxiety, does she have other career interest she would rather be doing, etc...

Great thing is she is in a great field to have flexibility. She can take some time off, i.e. vacation for 3-6 months and re-evaluate. She can switch to urgent care, hospitalist, locums, etc... that gives her more time off. She can look into joining academics if she likes teaching or research. She can talk to other PRIVATE practice docs who are involved in admin. positions in and outside of clinical medicine to see if this would be the "right" fit.

Like anything else it is hard to figure out the answer without knowing the question. What is making her unhappy? If she doesn't have the answer to this question the first thing is to meet with a psychologist/ psychiatrist who deals with white collar professionals who are stressed out. They likely will be able to provide the avenue to explore the cause of her dismay. What I would NOT do is take it lightly. It is much easier with depression/ anxiety related issues to deal with them early then sweep them under the rug and try to work around them.

Good luck.
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Re: Career Advice for an Unhappy Young Doctor?

Post by greg24 »

Ganacel wrote:she says she still feels totally stressed out and unhappy and doesn't want to go to work every day.
Welcome to the real world.
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Re: Career Advice for an Unhappy Young Doctor?

Post by Valuethinker »

Roles that would capitalize on her medical training:

- consultant eg healthcare at McKinsey etc. The pace of work is very high-- they sweat their consultants to make the partners profit share. You work with amazing people and the projects are constantly changing and (often) interesting. There is a huge travel requirement at least in early years. Typically you spend at least 2 weeks a month away from home. Most people do it for 2-5 years then go into management at a client. Bain or BCG would be 2 other names.

Eventually you might get into the knowledge/ thought leadership area, where you are kind of a consulting academic. Writing papers, speaking at conferences, trying to identify trends. More like normal business travel (ie a lot, pitching to clients etc, but not giving your life away). Give McKinsey (say) mindshare that helps it win consulting contracts.

If I were to stereotype these firms: 'McKinsey is the law firm (professional client centred practice, corporate personality); BCG is the university (intellectually fun, but not necessarily good at managing consultant careers-- partners are there to practice 'knowledge leadership'); Bain is the Marine Corps- -there are 2 ways to do anything, the Bain way, and the wrong way. McKinsey consultants often become corporate VPs at their clients. BCG consultants have become adjunct lecturers at universities. Bain consultants often get involved in turnaround type scenarios, where you have to make decisions quickly and be quite ruthless-- this may lead to managing their own businesses.

There will be other consultancies I don't know about, very strong in health care-- specialist boutiques or other. PWC/ E+Y/ Deloittes will have healthcare consulting practices, by tradition less 'strategic' than the above, but you never know what kind of work they do without asking and interviewing.

Eventually an MBA may be required but executive or part time is an option

- large pharma company managing medical research or sales. Beware this is a 'fat and happy' industry going down the cost reduction route (reminding me very much of IBM, Nortel etc. in the early 80s, before tech got really rough). Medtech company would be similar. Cost pressures from the payers are only going to grow (but it's still a growth industry, given demographics).

- something out of left field. Google will have some kind of medical project going on (using big data)-- just as an example.

- management in a hospital or healthcare delivery company. Adjacent to what she does, but without the clinical angle. People have more normal lives (more normal, the managers work pretty hard). Lots of politics and cost pressures, plus the need to manage staff (make them work harder for no more money, and occasionally sack them)

- university or pharma co research. Don't know much about these. My friends who did Phds in life sciences worked damned hard. More school may be necessary.

There are doubtless excellent roles as a healthcare academic in business schools-- but you'd probably need a Phd in social sciences (ie the study of the field of medicine not actual medicine).

Worth checking what is available at local medical schools/ universities?
Last edited by Valuethinker on Mon Oct 27, 2014 9:07 am, edited 3 times in total.
Valuethinker
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Re: Career Advice for an Unhappy Young Doctor?

Post by Valuethinker »

1. make sure this isn't just burnout from overwork. Potential for a long holiday or sabbatical.

2. see if there is a medical field where she can enjoy herself more. Are there purely salaried medical positions, where you work manager hours (say 50 hours/ week)? Federal government?

3. start to consider options as I outlined in my previous post.

it's really important to identify what exactly is wrong, right now she is probably just feeling trapped by all that education, expectations and those loans. How much is the career and how much the current job conditions?

Only the loans are a real obstacle to a life change. Even that can be managed.
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LowER
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Re: Career Advice for an Unhappy Young Doctor?

Post by LowER »

Hating medicine doesn't necessarily mean that she's depressed or burnt out. 50% of the multiple dozen doctors I interact with regularly are not all that pleased with medicine either, and most are 5 to 20 years out of training, and many are quietly living way below their means and squirreling away money to get out as fast as they can. Doctors all around me are changing jobs like a game of musical chairs - looking for safe cover, when there isn't much left.

She should try to take at least one to two months off (probably impossible at this point after just starting a new job) and not do one lick of anything that resembles medicine, and maybe explore other potential career pathways, pharma or whatever.

Also, there are "job coaches" out there who are usually MDs who help MDs find more meaningful work outside medicine - maybe that would be a place to start.

One thing that should not be overlooked though, is that she may be/probably is burnt out and that's a bad place to be, a really bad place that can ignite all sorts of vicious cycles, for her, her family, and her patients, and coworkers. That is fixable, pretty easily, but it can be difficult to see, especially when it's you. It would be a shame to throw away a career because of burn out, without at least entertaining the possibility.
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Re: Career Advice for an Unhappy Young Doctor?

Post by Valuethinker »

Important point from economics:

- sunk cost fallacy. Whatever is past in time, effort, expectations is past-- what she does with her future is her own issue. None of us can have the past back

- however loans are a real issue because repaying them advances 'freedom day'. Repaying her loans has to be her highest single priority *unless* she finds a 'dream job' (or a step towards it) on the way

So it's important not to confuse sunk cost with the loans. The loans count, the rest of it just does not.
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Re: Career Advice for an Unhappy Young Doctor?

Post by Valuethinker »

LowER wrote:Hating medicine doesn't necessarily mean that she's depressed or burnt out. 50% of the multiple dozen doctors I interact with regularly are not all that pleased with medicine either, and most are 5 to 20 years out of training, and many are quietly living way below their means and squirreling away money to get out as fast as they can. Doctors all around me are changing jobs like a game of musical chairs - looking for safe cover, when there isn't much left.

She should try to take at least one to two months off (probably impossible at this point after just starting a new job) and not do one lick of anything that resembles medicine, and maybe explore other potential career pathways, pharma or whatever.

Also, there are "job coaches" out there who are usually MDs who help MDs find more meaningful work outside medicine - maybe that would be a place to start.

One thing that should not be overlooked though, is that she may be/probably is burnt out and that's a bad place to be, a really bad place that can ignite all sorts of vicious cycles, for her, her family, and her patients, and coworkers. That is fixable, pretty easily, but it can be difficult to see, especially when it's you. It would be a shame to throw away a career because of burn out, without at least entertaining the possibility.

This all feels like very good advice from the perspective of an outsider.
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Re: Career Advice for an Unhappy Young Doctor?

Post by goodenyou »

I would seriously consider looking for a new career pathway. If you do not like the traditional practice of medicine now, chances are you you not like it in the future. Most of my colleagues that felt this way never changed their dislike for medicine as time went on. It actually got worse. It is foolish to take the "what a shame, I worked so hard for this and now I should practice medicine" attitude to work everyday. It is an absolute grind everyday, and the stakes are very high. You have to have a lot of reserve to absorb the unavoidable lows that will happen. I am thankful that I am 20 years into this and on the tail end of my career. I am not encouraging my children to pursue a career in medicine, nor are any of my partners encouraging their children. I would network with other MDs that found alternate pathways and find something that interests you. The sooner the better.
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Re: Career Advice for an Unhappy Young Doctor?

Post by LowER »

lululu wrote: snip Is there any way to get rid of those loans besides being saddled with them for years? snip
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LowER
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Re: Career Advice for an Unhappy Young Doctor?

Post by LowER »

goodenyou wrote:snip I am not encouraging my children to pursue a career in medicine, nor are any of my partners encouraging their children. snip
100% in agreement. And I'm not burnt out, I love taking care of patients. It's EMR, insurance denials (never lost a battle yet but it sure is time consuming and frustrating = denial fatigue), "meaningful use," ridiculous administrative BS, "face-to-face" encounter forms, meaningless and inefficient quality metrics, blah, blah, blah, and etc., et al.... and spending more Saturdays than not doing silly paperwork.
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Re: Career Advice for an Unhappy Young Doctor?

Post by scienceguy »

Fairly new law - federal student loans (ie. med school loans) disappear after 10 consecutive (I think it needs to be consec, not 100% sure) years post-graduation working in non-profit. Virtually all residencies are performed in non-profit academic setting, so not that many more years after that. So, that is one way to make non-private student loans disappear.... Stay in academia.
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Re: Career Advice for an Unhappy Young Doctor?

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Re: Career Advice for an Unhappy Young Doctor?

Post by XtremeSki2001 »

What does she want out of her career that she's missing? Does she have enough experience to know what she wants? She spent the last 12+ years working towards her goal of being a doctor and she wants to quit after working less than 12 months in her role. Something is out of place. Sounds like she needs to give it more time or take some personal time to recover from residency.
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Re: Career Advice for an Unhappy Young Doctor?

Post by White Coat Investor »

I'd say stick it out for two years in clinical medicine while working on an exit plan into a non-clinical aspect. MDs with clinical experience are much more valuable than MDs without it. Lots of career options at that point that are very different from caring for patients.
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Re: Career Advice for an Unhappy Young Doctor?

Post by czeckers »

The first 6-12 months out of residency are quite stressful as this is the first time when you are truly on your own making decisions for your patients. I wouldn't make any changes until after the first year.

If she is unhappy, she needs to figure out what it is about medicine that attracter her to it in the first place, and then figure out specifically what it is that she dislikes about it now.

There are multiple sources of stress in medicine and it is possible to mitigate some specific stressors in order to achieve a better life balance. For example, if one doesn't like long hours, work part time. If you don't like working weekends/nights, go into a clinic practice as opposed to being a hospitalist. If EMR/billing is a source of frustration, then perhaps joining a large practice that has its own billing/coding specialists may help. If it is the face-to-face interaction that bothers her, then she might consider a different specialty. If the office staff is a source of stress, then changing jobs can help. etc. etc. etc.

Her loan burden is definitely a factor. The greater the burden, the lower the likelyhood that she can leave medicine entirely.

This is about as much as one can give without specifics.

-K
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Christine_NM
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Re: Career Advice for an Unhappy Young Doctor?

Post by Christine_NM »

It could be that she just vents to you feelings that she can't express elsewhere. Doctors do love to complain. They go on about difficult residencies for decades after completion. It seems to be an experience that leaves a mild PTSD effect.

Anyway, does she need more advice or is taking others' advice part of the problem? Surely she can make her career decisions on her own?
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EnjoyIt
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Re: Career Advice for an Unhappy Young Doctor?

Post by EnjoyIt »

She is clearly burned out, and may be depressed. This can lead to a slippery slope of drug or alcohol abuse, negligent patient care or even suicide. The answer to your question is very simple.

1) She needs to take a vacation. Atleast 1 months worth maybe as much as 3 months.
2) She needs to stick this out for another 2 years like Emerdoc says above.
3) She should look for work in a smaller facility out side of a metropolitan area. The pay is less but so are the hours.
4) She needs to pay off her debt ASAP. Even if some of it is low interest. I promise you that the debt is a good part of her stress.

She has many options in internal medicine that are part time such as urgent care or hospitalists. I hire fresh out of residency docs regularly. Almost always they "suck" compared to their experiences colleagues. They are slower and lack confidence. It is normal and most grow out of it rather quickly. I notice it takes about six months to a year to start feeling comfortable in those shoes.

The way I would handle this from today's point is to start looking for a lower pay but less busy job right now. Once she gets hired, she needs to make sure she gets that long vacation in between.

Good luck.
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kingsnake
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Re: Career Advice for an Unhappy Young Doctor?

Post by kingsnake »

Having completed an internal medicine residency, I know that it totally blows. I could not and would not practice general internal medicine, in fact I had anesthesiology apps filled out and ready to go if I did not get the fellowship I wanted. That being said, most of my friends who stayed in internal medicine went on to become hospitalists, for the decent pay, flexible hours, and shift work. I wouldn't quit until loans paid off and exit plan was in hand. Especially wouldn't quit within the 1st one year.
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Re: Career Advice for an Unhappy Young Doctor?

Post by anil686 »

As a fellow internist (and subspecialist), I empathize with her. As others have said - it is often not so clear cut when physicians are not happy. We routinely do surveys in our practice to make sure (annon surveys) that we are happy and if there are any issues that need to be addressed from a physician viewpoint. My personal experience is that it is often several things, not just one, that makes us as physicians seem unhappy with our careers. Sometimes it is "burnout", stress from too many patient encounters daily, stress from finances/debt, stress from relationships that have been strained for far too long based on demanding hours and work schedules. Vacations can temporarily help but may also lead one to see that their life is not "fixable" by going back to a career that may make many demands on them.

I encourage her to stick it out for a couple of years. If she is really unhappy, perhaps a suggestion to seek counseling may help - sometimes expressing inner feelings in a non judgemental environment can help one feel better (or at least less burdened). Other alternatives exist - especially in internal medicine where there are full time hospitalist jobs, part time jobs, locums opportunities, full time outpatient jobs and last, but not least, academic jobs that can combine teaching with less clinical responsibilities with albeit less compensation, but better hours and lifestyle.

On last point, many physicians I know feel burdened by social stigma as well. You must be strong to be a successful physician and not worry about what everyone else does or thinks of you. We discuss this all the time on this board as it relates to money - living below your means. It is true in a career as well. Just because you can make $350,000 being a hospitalist working an insane number of hours and seeing an insane number of patients does not make that a great job. Just because you are not in private practice but rather in academics does not mean that you "can't" do medicine (the old addage those who can do, those who can't teach...) and just because you live in a rural part of the country seeing 20 patients a day may be your cup of tea even if your classmates end up in NYC. She should only care about what she does and do what is best for her - not worry what others who trained with her or know her think (including family). Sometimes, colleagues of mine have not enjoyed the constraints of a traditional practice but really enjoyed the freedom and flexibility of locums - maybe she would enjoy that. Other colleagues love to teach and educate - she may like doing that. Often these other options come at a financial cost - but it is not prohibitive. Many of my friends in academics make low six figures but live below their means and make it work with great retirement plans and insurance plans. Others doing locums make the same but have the tradeoff of not a defined schedule, often with significant travel. But they like that lifestyle since it allows them to travel the country at somebody else's cost...

Hope your cousin figures it out - please let her know this is not uncommon and for many of us, we felt the same way she does now. However, at least in my case, things changed as I understood myself better. I have left a couple of practices and ended up starting my own practice. There is a reason 75% of residents leave their first private practice job and it is not only money... (source AMA surveys 2009)
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Re: Career Advice for an Unhappy Young Doctor?

Post by staythecourse »

LowER wrote:
goodenyou wrote:snip I am not encouraging my children to pursue a career in medicine, nor are any of my partners encouraging their children. snip
100% in agreement. And I'm not burnt out, I love taking care of patients. It's EMR, insurance denials (never lost a battle yet but it sure is time consuming and frustrating = denial fatigue), "meaningful use," ridiculous administrative BS, "face-to-face" encounter forms, meaningless and inefficient quality metrics, blah, blah, blah, and etc., et al.... and spending more Saturdays than not doing silly paperwork.
I think being a physician in this country is at a crossroads. Many of us became physicians because we saw the generations before us being able to have the control and practice the way they wanted to practice. Medicine, like other professions, are being consolidated into large organizations thus are become much more business driven in its role out. The toughest is on the current generations of docs who feel they signed up for something that is becoming extinct.

The next generation of physicians I think will be much better to cope as they will know what they are getting into as being a physician is becoming like any other job as a rank and file employee. I met a young doc. just out of training who loves being an internist employed by the hospital. He just comes in at x time sees the patients that are scheduled at y time leaves and goes on to enjoy his own life outside of work. he doesn't spend a second thinking about his patients outside of that. If something is not done or fall through the cracks he doesn't care as it is just reported to the admin. If the problem gets resolved great and if doesn't great. He has accepted the role of being a rank and file employee.

The real losers in all of this are the patients. There is no ownership in the patient's care. The doctor is like a clerk at the cashier counter. The large healthcare system doesn't care outside of doing the minimum not to lose the patient which means losing $$$. In the end being a physician in this country will be very similar to watching the movie "Office Space".

Medicine is changing, but all that means is the next wave of phsyicians will/ are changing as well in their expectations. They don't seem to care what happens as long as they get paid for the work they do like any other employee in any other job in life. If the system wants rank and file physicians that is what they will produce.

Good luck.
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gasman
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Re: Career Advice for an Unhappy Young Doctor?

Post by gasman »

There is a tremendous level of unhappiness of physicians at all stages of their careers for multiple reasons.
In no particular order:

Increased production pressure.
Loss of autonomy.
Responsibility without authority.
Quality of care being redefined by corporate and government entities. Only things that can be measured qualify as quality metrics.
Increased time spent on documentation.
Being forced to care about things that are ridiculous.
Dropping salaries.
Lower job security.
Being considered virtually interchangeable with midlevel providers.
Perception of quality of care being as or more important than actual quality of care. e.g., Press/Ganey, HCAHPS.


One docs opinion. Can't wait to cut back to part time.
As far as advice for the OP: Have your friend choose a low stress position, work as little as possible, exercise, meditate, counseling.
staythecourse
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Re: Career Advice for an Unhappy Young Doctor?

Post by staythecourse »

gasman wrote:There is a tremendous level of unhappiness of physicians at all stages of their careers for multiple reasons.
In no particular order:

Increased production pressure.
Loss of autonomy.
Responsibility without authority.
Quality of care being redefined by corporate and government entities. Only things that can be measured qualify as quality metrics.
Increased time spent on documentation.
Being forced to care about things that are ridiculous.
Dropping salaries.
Lower job security.
Being considered virtually interchangeable with midlevel providers.
Perception of quality of care being as or more important than actual quality of care. e.g., Press/Ganey, HCAHPS.


One docs opinion. Can't wait to cut back to part time.
As far as advice for the OP: Have your friend choose a low stress position, work as little as possible, exercise, meditate, counseling.
Great list and agree 100% especially with the responsibility without authority and the perception of quality of care one. It is amazing how different folks think quality has anything to do with real quality of care. Whenever the admin. asks how to improve quality measures I just tell them to buy new marble floors for the lobby, free wi-fi, free coffee, free valet, etc... Sounds sad, but that is what the public seems to like.

Good luck.
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Re: Career Advice for an Unhappy Young Doctor?

Post by dolphinsaremammals »

greg24 wrote:
Ganacel wrote:she says she still feels totally stressed out and unhappy and doesn't want to go to work every day.
Welcome to the real world.
Only part of the real world. There was another thread about job satisfaction, and most of the people who posted there loved their jobs.

OP, my internist works half time as an employee of a practice. Maybe she could find something like that.
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Re: Career Advice for an Unhappy Young Doctor?

Post by hicabob »

I used to work with a couple physicians at a large tech company which had a medical devices division. The docs there much preferred working in an r+d capacity than seeing patients and the MD sticker was a requirement in many phases of bringing the product to market. Of course this requires the doc in question to have an engineering type mindset to be useful but for the right person it seems to be a good career path.
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kingsnake
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Re: Career Advice for an Unhappy Young Doctor?

Post by kingsnake »

I know someone who quit IM residency after year 1 and did urgent care work
could consider doing shift work in urgent care setting, low acuity as anything serious you send to the ED, this is the "doc in the box" type of job.
Last edited by kingsnake on Mon Oct 27, 2014 1:51 pm, edited 1 time in total.
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Re: Career Advice for an Unhappy Young Doctor?

Post by goodenyou »

could consider doing shit work in urgent care setting
Was that some type of Freudian Slip, or just speaking the truth? :D
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Re: Career Advice for an Unhappy Young Doctor?

Post by bargainhuntingking »

Work part time. Consider being a shift worker hospitalist and punch the clock and leave your shifts on time. Save money and accumulate a nest egg so that you can retire early or leave for a more enjoyable job. I know of a doc who's quitting to be a mountain climbing guide. Pick a place to work that isn't full of toxic politics, administrators, nurses and patients; that's not easy to do but ask around and perhaps take a locums position to explore different work environments. No job in medicine is perfect, otherwise we'd all be doing it.Take lots of time off. Focus on outside activities. Plan your escape rationally and methodically; that can make the day to day BS that medicine has become more tolerable.

You are not alone. Most docs I know have various degrees of discontent. The smarter ones who aim to practice quality medicine seem to suffer the most; it may sound counter intuitive, but start caring less about your job. If you internalize the stress, it will eat you. Vent to your friends and other understanding docs. As crappy as medicine may be, there are worse jobs out there, and you could be equally miserable in a much lower paying job, thus be careful to throw in the towel prematurely. Be open to the idea that you could have situational depression, and if it doesn't go away, sometimes medicines can be helpful. Be open to the idea of professional psychiatric help.
Last edited by bargainhuntingking on Tue Dec 13, 2016 5:07 am, edited 1 time in total.
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InvestorNewb
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Re: Career Advice for an Unhappy Young Doctor?

Post by InvestorNewb »

I think many people in new jobs can relate. As the saying goes, the grass isn't always greener on the other side.

I'm in IT and my first year was very stressful. Fast forward seven years and I'm glad I "toughed out" the first year.
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Re: Career Advice for an Unhappy Young Doctor?

Post by StormShadow »

Also just finished my training this past June. Residency sucks. Plain and simple. It drains the life out of everyone. Outside of the work, what especially drove me nuts was having to deal with all of the stupid office politics (residents are effectively powerless and have to kowtow to every jerk attending imaginable... or else risk getting fired and stuck with a ton of debt and no way to pay it off).

I think she should try to finish her initial contract if possible, then look to see if a change of scenery may help. Or if her current situation is intolerable, make the switch sooner. Maybe take an academic position, where she can pace herself in clinic and not have to worry so much about over-booking the clinic to make your quota. Is she at a teaching hospital? Because having residents around to help with the scut makes a difference. Also, for me, having residents and medical students to teach makes my job feel more meaningful.

I also second the advice to seek professional help (i.e. psychiatry/psychology) to see if there is an underlying mood disorder that may need to be addressed.
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Re: Career Advice for an Unhappy Young Doctor?

Post by jellybelly28 »

Hi, do you know what she is interested in doing otherwise? I'm in the field of Preventive Medicine which I think of as the field of "misfits" in medicine. We gain expertise in population and public health. Most folks join after completing a full residency (usually family or internal medicine), but some have quit their residency programs to join Prev Med. In Prev Med, we obtain a Masters of Public Health to gain some biostatistics and epidemiology skills. However, the jobs of Prev Med physicians are not limited to using only these skills. We have folks who work in public health departments, lead research groups at Consumer Reports, and some have their own start ups. It is a fantastic field as it is very flexible and creative.
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LowER
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Re: Career Advice for an Unhappy Young Doctor?

Post by LowER »

StormShadow wrote:I also second the advice to seek professional help (i.e. psychiatry/psychology) to see if there is an underlying mood disorder that may need to be addressed.
This is probably good advice, and therapy (especially when paid in cash) is most always a great pursuit, but being unhappy as a doctor these days is much more the norm than not, regardless of underlying issues, so I do not believe it takes a DSM diagnosis to be unhappy in this field. In fact, I agree to the opposite. She may be more emotionally healthy/emotionally intelligent in her dislike of medicine than most others are.

This young lady needs a rest, a reaffirmation, a reassessment, and an acknowledgement that her career path will not be what it used to be, and then figure where to go from here.

i highly doubt a DSM disorder, though if you look closely enough, really closely enough, we all have many.

I'm sorry if I seem contrarian, I just feel that a dislike of so many things that are now "medicine" is healthy.
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