Goals, Failures, and Taking Risks: 5 Ways to Improve Your Career

Doctors have different definitions of what success means to them. Some think it would be a high income or a large practice, while others feel it’s more important to earn the respect of their community or peers.

“Some doctors are proud of how many pagers they have, because it tells you they are doing many important things,” says Andrew Wilner, MD, an associate professor of neurology at the University of Tennessee in Memphis and author of The Locum Life: A Physician’s Guide to Locum Tenens. Wilner says it’s better to carve out time when you don’t need to carry a pager.

Many doctors have very basic definitions of success, such as career satisfaction or achieving work–life balance. In a recent Medscape survey of physicians, about half said they would take a pay cut for better work–life balance. But what can really make your work life rewarding is meshing your work life to your deepest inner goals and needs.

Experts give these suggestions for guiding your career to the path that will ultimately bring you to your definition of success.

1. Know What You Want and Like

“Don’t let anyone else define success for you,” Wilner says. “Not your parents or your close friends or your colleagues. The only person who should do that is you, because if you achieve someone else’s definition of success, you’ll end up being very dissatisfied with your career.”

Wilner says doctors often neglect to find out what they want in their career because they didn’t have to do that in its early stages. “Becoming a doctor is all mapped out for you,” he says “You follow a path of academic excellence in high school, college, medical school, and residency. You don’t have to consider which way to go.”

In addition, many doctors choose as career goals objectives that are really just tools to get to a career goal, says Jimmy Turner, MD, an anesthesiologist and teaching physician at Wake Forest Baptist Health in Winston-Salem, North Carolina, who blogs as the Physician Philosopher.

“Making money, earning awards, having a good work–life balance cannot be end-goals,” he says. “Rather, they should be tools to achieve your real goals.”

Lacking insight into what they want, many newly minted doctors pick jobs that aren’t a good fit, Turner says. He points to a survey finding that more than half of new physicians left their first job after 5 years.

Physicians don’t need to limit themselves to a narrow set of jobs, Wilner says. “Your medical degree opens up a vast number of career options. You could join a large group, a small group, or practice in an urban or rural setting, or become an academic. The list goes on and on.”

Determining the job that is right for you requires looking inside yourself and determining your unique strengths and weaknesses, says Peter Moskowitz, MD, founder and executive director of the Center for Professional and Personal Renewal in Palo Alto, California, and an emeritus professor of radiology at Stanford University School of Medicine.

First, he says, doctors need to understand their purpose. “The usual answer is being ‘the best doctor that I can be for my patients,’ but your real purpose should go deeper than that, Moskowitz says. “Your true purpose may be making the world a better place, finding meaning in your work, or being a humanitarian while also taking care of yourself.”

Second, he says doctors should know their personality profile, which can be determined through tests like the Myers-Briggs Type Indicator personality inventory. “Your personality helps determine what sort of work is right for you,” he says. “It can help you can determine your ideal job and even your ideal boss.”

Third, doctors should be aware of their marketable skills, Moskowitz says. “Know what you do especially well and what you love to do. These are two different things, and both of them should match the job you choose. A burned-out physician may do his or her job very well but still hate it.”

2. Keep Learning New Things

Clinical skills are becoming obsolete at a fast pace, so physicians need to astutely choose the medical education courses and other learning they need to take, Moskowitz says. In 2010, medical knowledge was doubling every 3.5 years, according to one estimate. That same assessment, published in 2011, projected that by 2020 medical knowledge would be doubling every 73 days.

“One great way to learn is to teach,” Wilner says. This could involve serving as a volunteer faculty member, writing about a new technique, or just teaching a colleague how to perform a new procedure, he says.

Physicians also need to learn skills they may not have learned in medical school, such as people skills, financial management, and time management. “Doctors need good interpersonal skills because they are more likely to work in teams and need to communicate well with patients,” Moskowitz says.

Moskowitz adds that doctors who want to fill leadership positions may need to go back to school and get a leadership degree. “A master’s degree in healthcare policy will improve your chances of being a success,” he says.

Also, “learning how to deal with personal finances is something many doctors never learn how to do,” says Wake Forest’s Turner, the Physician Philosopher blogger. “If you handle your finances well, you will have the flexibility to do different things, such as having enough savings to leave a job you don’t like.”

Time management is crucial for doctors, Turner says. “There are so many forces out there asking for your time, so you have to develop a clear idea of what you really need to do and what others can do in your place.”

Turner says managing your time means learning to say no. “Many doctors feel obligated to say yes to serving on a committee or to writing another paper,” he says. “But every time you say yes to one thing, you’re saying no to something else.”

3. Reassess Your Life During Transitions 

Doctors should expect their goals to change as they advance in their careers, Wilner advises.For my first job, I joined a neurology group and was there for over 8 years,” he says. “I was busy but I didn’t like it in the end, because I was so busy I couldn’t do anything new.”

Changes in your personal life may also force you to reassess your career. “I was a single person working very happily in locum tenens, but then in my late 50s, I got married,” Wilner says. “We wanted to have a baby, so the traveling had to stop. I found a great academic job, and now we have a 2-year-old who has changed my life in ways I never imagined.”

“Physicians have to learn to be adaptable,” Turner counsels. “You might have to go through a job you don’t like before you know one you really like.” In a 2020 survey conducted by a physician recruitment company, The Medicus Firm, 1 in 5 doctors planned to make a career change within 12 months.

“Learn to enjoy the journey,” Turner adds. “From time to time you’ll reach an achievement and it will be exhilarating, but afterwards, rather than living happily ever after, you will revert to feeling the same as before. So you need to feel happy while you’re on the journey, not just when you reach your destination.”

Goals change because “successes, failures, and disappointments will reshape your sense of purpose over the course of your career,” Moskowitz says, adding that it’s common for doctors to become disenchanted with their jobs. When this happens, “you need to let go of what’s not working and decide how to make their career exciting again,” he says. “Identify what’s really important to you, your new passion, and refocus your job on that.”

The transition may involve tweaking your existing job by acquiring some new skills and new responsibilities, or you may decide to take on a side gig — such as blogging, coaching, or writing — in addition to your primary job, Moskowitz says.

On the other hand, you may decide to change jobs or even find a whole new career, which can be daunting. “If you are a partner, it may be hard to leave because you’d have to start all over again at a new practice,” Turner says. “But if you really disliked your job, moving on will be worth it.”

4. Learn From Your Setbacks

Every doctor encounters setbacks. “I went from my first job in private practice to an academic job,” Wilner recalls. “My chairman was not supportive, and it was the worst professional experience of my life.”

Wilner left the job and used the setback to propel him in a new direction. “Leaving that job opened up my career,” he says. “I felt like a free agent. I pursued my writing and started locum tenens work. It was a whole new world.”

Turner had a similar experience. “There was a position I wanted that I did not end up getting,” he says. “I beat myself up about it at the time.” But now he’s happy it didn’t work out. “If I had gotten that position, it would have taken all of my time and I wouldn’t be doing the things I do now.” In addition to his academic work, he writes the Physician Philosopher blog and coaches other doctors.

Moskowitz warns doctors not to get mired in their setbacks. “It’s a good idea to assess why it happened and what went wrong, but then you have to let go and move on,” he says. “You can’t obsess.”

Turner says many doctors rule out the possibility of failing, which makes it hard to recover from mistakes. “They want to look as if they’re perfect,” he says. “But if you’re supposed to be perfect, you won’t be able to acknowledge failure and move on.”

Being able to ask for help is crucial, he says, but you need to pick advisers carefully. “Friends can’t help much,” Turner says. “The role of a friend is to commiserate and not to ask the hard questions, which a mentor or a career coach will do.”

5. Give Yourself Permission to Fail

“Doctors don’t want to make mistakes, but the fact is that doctors will fail from time to time, and they will need to find a way to deal with it,” Turner says.

Doctors have to learn how to handle medical errors or any bad outcome, or they will lose their confidence, he says. “Physicians tend to seek out all the ways they might have done it wrong,” Turner says. “But many times, when I repeat the facts back to them and ask them what they would think if someone else did that, they will say it all sounded extremely reasonable.”

For doctors in the dumps about a medical error that may have been their fault, Moskowitz recommends practicing gratitude. “Even in the worst of times, there are things that are wonderful that happen to us and can sustain us,” he says.

He suggests a simple exercise. Place a note pad on your nightstand and, as you wrestle with sleep, write down the day’s events that you are grateful for. “This will help keep you on an even keel,” Moskowitz says.

Wilner views failure as a necessary by-product of trying new things. “Once in a while they’re not going to work out,” he says. “There will be disappointments. Figure out why it didn’t go right and move on.”

Learning from your failures requires a combination of persistence and reflection, according to Turner. “When you fail you have to keep trying, but you also have to learn something from your failures,” he says.

Be Willing to Take a Risk

Making your career progress as you desire requires you to be proactive and to keep refocusing what you want to do, Moskowitz says.

“You have to be willing to take risks with your career,” he says. “You need to look for new opportunities, volunteer your time, or take on leadership roles. If you can do all this, your career will be enriched tremendously.”

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COVID’s Big Impact Made a Fairly Small Dent in GI Earnings

Despite the shutdowns and plummeting patient volumes early in the COVID-19 pandemic, gastroenterologists’ earnings were just 3.1% lower in 2020 than in 2019, according to new survey results from Medscape.

That drop, from $419,000 to $406,000, was larger, however, than the average for all specialists, which slipped just 0.6% in 2020.

“Most gastroenterologists who saw a drop in income cited COVID-19-related issues, such as job loss, fewer hours, and fewer patients,” Keith L. Martin wrote in the 2021 Medscape Gastroenterologist Compensation Report.

Specialties with larger declines than gastroenterology included dermatology (-4%), pediatrics (-5%), and otolaryngology (-9%). Conversely, plastic surgeons saw the largest increases last year, with their average compensation rising 10% over 2019. Oncologists (+7%) and cardiologists (+5%) also did well, the Medscape data show.

For the physicians who did encounter financial hardships, relief came in several forms.

Many turned to “the federal Paycheck Protection Program to help keep themselves afloat; some were able to renegotiate their lease contracts; a large percentage reduced their staff, which reduced their expenses; and those in capitated plans were still getting paid even though they weren’t seeing as many patients,” Michael Belkin, JD, divisional vice president at Merritt Hawkins and Associates, in Dallas, Texas, told Medscape.

One complication on the road to recovery was the furloughs experienced by some gastroenterologists, but work hours for the specialty have largely recovered. The prepandemic average was 53 hours per week, compared with 52 hours for this year’s gastroenterologist respondents, who represented about 2% of the 17,903 Medscape member physicians who completed the survey.

Among the gastroenterologists surveyed who did experience negative financial or practice-related effects from the pandemic, about one third estimated that it would take 2 to 3 years for their income to return to the pre-COVID level, and 14% believe that it will never return to those levels. It is worth noting, however, that 45% of physicians overall reported no such harms last year.

Despite the drop in their incomes last year, more gastroenterologists said that they felt fairly compensated in 2020 than indicated as such in 2019 (55% vs 52%). This year’s higher figure, though, is on the low end of the scale: of the 29 specialties included, only four were lower, and 19 were higher. Five others were the same, according to Medscape’s findings.

In other matters covered by the survey, gastroenterologists found themselves closer to the top. When asked if they would choose medicine again, 81% said yes. Only eight of the 29 specialties were higher; 93% of gastroenterologists said they would choose gastroenterology again. Only four specialties were higher.

The survey was conducted from October 6, 2020, to February 11, 2021, and had a sampling error of ±0.73%. The salary figures were calculated using data for full-time physicians only.

Richard Franki can be reached at [email protected]

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Radiologists’ Earnings Down, and Some Expect Long Recovery

The COVID-19 pandemic took a bit of a toll on radiologists’ earnings in 2020, with nearly half of radiologists reporting at least some decline in compensation and average annual earnings dropping by about $14,000, according to the Medscape Compensation Report 2021.

The report reflects responses from nearly 18,000 physicians in 29 specialties on compensation, work-related issues, and, importantly, how practices fared during the unprecedented challenges of the COVID-19 pandemic.

Although overall, physicians reported little variation in earnings from 2019 to 2020, radiologists reported that their average earnings dropped by about 3%, from $427,000 in 2019 to $413,000 in 2020.

For most (92%), the decline in earnings was attributed to fallout from the COVID-19 pandemic; however, 19% reported that other factors played a role.

Of note, self-employed radiologists reported incomes 7.5% higher than those who are employees, at an average of $431,000, vs $401,000.

The gap between self-employed physicians and employees was larger among physicians overall, with self-employed physicians earning 17% more — an average of $352,000, vs $300,000 for employed physicians.

Incentive Bonuses Similar to 2019

Radiologists’ incentive bonuses remained nearly the same in 2020 as in 2019. The average bonus was about $69,000, which was 17% of their total annual salary. This was down just slightly from last year’s 18%.

Eighty percent of radiologists reported earning an incentive bonus that was more than three quarters of their potential full bonus. They earned, on average, about 83% of their potential bonus — a bit higher than the 68% reported by physicians overall.

Fair Compensation?

About 65% of radiologists overall reported that they were fairly compensated, which is near the top of the list of specialties. Oncologists led in this caregory; 79% of oncologists reported feeing that their earnings were fair.

At the bottom of the list are infectious disease physicans, among whom only 44% felt that their compensation was fair.

Radiologists’ Workload in 2020

Paperwork and administrative tasks appear to be less of a burden to radiologists compared with other specialists. Radiologists reported spending a relatively low average of 11.6 hours per week on those tasks outside of patient visits, down from the 12.3 hours per week reported in 2019. This placed them third from the bottom of the list. Anesthesiologists were least burdened, at just 10.1 hours per week.

Those with the highest paperwork and administrative burden were, perhaps predictably, infectious disease specialists, who spent an average of 24.2 hours per week on these tasks.

For work hours overall, radiologists reported working an average of 49 hours per week, down just slightly from 50 hours per week in 2019.

The number of patients seen per week dropped by about 7%, from 192 per week in 2019 to 179 in 2020, owing to the fact that patient visits were limited because of the pandemic.

Fifty-one percent of radiologists reported that they expect that 1% to 25% of the reduction in patient volume is likely to be permanent.

Job Satisfaction, Challenges, Legal Worries

In terms of job satisfaction, 43% of radiologists reported that the most rewarding factor of their job was “being good at what I do/finding answers, diagnoses.”

Asked about the most challenging aspect of their job, radiologists most frequently responded, “worrying about getting sued”; 21% of radiologists reported having that concern, which was about three times higher than other specialists.

On average, only about 7% of physicians in other specialties listed worrying about being sued as their top challenge.

About three quarters (74%) of radiologists reported that they would pick a career in medicine again if given the chance, which was only slightly lower than the 78% reported by physicians overall.

That rate places them third from the bottom of the list of specialists in terms of choosing a career in medicine again. Physical medicine and rehabilitation was at the bottom of the list, at 67%, and oncology was at the top, at 88%.

Nevertheless, the rate of those who would choose radiology again is significantly higher — 93%, near the top of the list. That rate was unchanged from 2019.

Gender Gap Still a Concern

In commenting on the survey, Howard P. Forman, MD, professor of radiology and biomedical imaging at the Institute for Social and Policy Studies, of Economics, of Management and of Public Health (Health Policy) at Yale University in New Haven, Connecticut, cautioned that “there are always concerns about surveys that rely on individual reporting and a relatively limited sample.

Dr Howard Forman

“The fact that radiology compensation has dropped and also done so relative to other specialties is not surprising, given the enormous impact of the pandemic across the nation,” he told Medscape Medical News.

“The fact that many individuals think that it will take 5 years to recover is a little surprising to me,” he said.

Among all physicians in the survey, there were nearly twice as many men (61%) as women (36%). Forman noted that there is, in general, a concern about a gender imbalance in radiology.

“Women continue to be a minority within our field, and this has not caught up at nearly the pace that would otherwise be expected,” he noted.

In 2004, Forman and colleagues authored a review in which they assessed why female medical students tended not to choose radiology.

“‘[It’s been] 17 years since I led this review, and we are not making the progress that we should,” he said.

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Early Exposure Key to Solving Pediatric Rheumatologist Shortage

The biggest factors that attract medical students to enter pediatric rheumatology are interest in disease pathology, the patient-physician relationship, and clinical exposure in residency, according to preliminary research shared at the annual scientific meeting of the Childhood Arthritis and Rheumatology Research Alliance.

A shortage in pediatric rheumatology already exists and is expected to worsen to 61% by 2030, noted the authors. About one-third (32%) of current pediatric rheumatologists will retire in the next decade, and less than two-thirds of fellowship slots have filled in the past 5 years.

Katherine Schultz, MD, a clinical fellow in the division of rheumatology at Cincinnati Children’s Medical Center, led the study and said she was surprised that medical school exposure did not play a bigger role in attracting people to the field, but perhaps that’s because too few people received that early exposure.

“If we had earlier exposure, maybe that wouldn’t be definitive for saying, ‘yes, I want to do this subspecialty of pediatric rheumatology,’ but it would open the door, so when you hit residency, you can explore it further,” Schultz said in an interview.

Dr Katherine Schultz

Schultz and her colleagues conducted a survey using the CARRA registry during September-December 2020. Respondents included pediatric rheumatology clinical fellows, early-career pediatric rheumatology faculty with less than 7 years practice experience, and mid- to late-career pediatric rheumatology faculty – those with more than 7 years of practice. They are currently in the process of analyzing additional qualitative data.

Of the 428 clinicians recruited to complete the study, 92 did so, for a response rate of 21%. Most respondents were female and non-Hispanic White. A total of 40% were clinical fellows, 41% were early-career faculty, and 18% were mid- to late-career faculty.

Positive Factors for Choosing the Field

More than 80% of respondents across all three experience levels cited disease pathology as a positive attribute of pediatric rheumatology, something that Schultz mentioned as well.

“The rewarding part of pediatric rheumatology is we take these complex diseases and we help give kids their life back,” she said.

Nearly all the clinical fellows who responded said the patient-physician relationship was important, which early- and mid- and late-career faculty mentioned as well, although to a slightly lesser extent.

Other factors following closely behind disease pathology, patient-physician relationship, and clinical exposure in residency were having a role model in the field – cited by more than three-quarters of clinical fellows and early-career faculty – and having mentorship during residency.

“One of the strengths of our field and one of the things I love about pediatric rheumatology is our community is so close-knit, so kind, and so welcoming,” Schultz said. “If students can have that exposure and they can see the kind of people who are in this field, that’s our greatest power to draw people to our field.”

Low Compensation Is a Deterrent

The least frequently mentioned positive factors were research opportunities and income. In fact, income was by far the most commonly cited negative attribute of pediatric rheumatology, reported by nearly half of clinical fellows and more than a quarter of early- and mid- and late-career faculty.

“We are one of the lowest paid specialties in pediatrics. We often make [income] comparable to or less than a general pediatrician,” Schultz said. One reason for that is the difficulty of doing pediatric rheumatology in private practice. Most positions are at academic institutions, which will nearly always involve lower pay scales, she said. The field is also not a procedure-based one, which makes billing more difficult to quantify.

“If I spend an hour thinking about a patient’s diagnosis and interpreting their labs, how do we quantify that?” she asked. “Our field is so cognitive that it makes it hard to bill in the same manner” as fields who bill more procedures, she said.

Colleen Correll, MD, MPH, an assistant professor of pediatric rheumatology at the University of Minnesota in Minneapolis, was also not surprised to see salary listed as the biggest deterrent to the field.

Dr Colleen Correll

“Unfortunately, compared to other specialties, our compensation is lower, and this can be a real barrier for people who have large medical student loans to repay and for those providing for their families,” Correll said in an interview. She and Schultz both said that workforce advocacy groups are working on ways to compensate for that difference, including loan repayment programs.

The other specialties that respondents considered before choosing pediatric rheumatology varied by generation, but allergy and immunology and endocrinology were among the most cited by early-, mid-, and late-career faculty. Clinical fellows’ responses were more evenly distributed across a range of different subspecialties.

Early Exposure Is Key

A large proportion of all three groups, including almost 90% of early-career faculty and clinical fellows, said they received exposure to pediatric rheumatology during residency. However, only a little more than two-thirds of clinical fellows had exposure to the field in medical school, and fewer than that reported medical school exposure among both faculty groups.

Both Correll and Schultz said that early exposure to pediatric rheumatology was key to bringing more people into the workforce.

“I believe that once a medical student or resident has an opportunity to work with a pediatric rheumatologist, they are able to see the many reasons for which this is a great career choice,” Correll said. “Pediatric rheumatologists are seen as positive role models. We love what we do, we have great patient-physician relationships, and we see interesting disease pathophysiology on a regular basis.”

Although earlier exposure to the field is primarily an institutional issue, clinicians can play a role as well.

“For the individual practitioners, the biggest way they can make an impact is to make themselves visible,” Schultz said. Although the subspecialty is stretched thin, she encouraged pediatric rheumatologists to do med school and resident lectures, volunteer to do feedback sessions, offer residents opportunities to rotate with them, and generally make themselves more visible. “It’s going to take the community to really make the change we need,” she said.

She and Correll both cited the American College of Rheumatology and CARRA pediatric residency programs as helpful, but there’s more to do. Other ways to increase exposure to the field include creating medical student rotations in pediatric rheumatology, working on case reports or small research projects with new learners, and requesting that pediatric rheumatology be a mandatory rotation in pediatrics training, Correll said.

“We absolutely have a responsibility to promote our field because if we don’t, the workforce supply issue will continue to worsen,” Correll said. “We already have a workforce shortage, and models show this shortage will only worsen if we don’t improve recruitment into the field, especially with many pediatric rheumatologists coming up on retirement. Once we are able to expose medical students and residents to the field, I think they easily see our passion and our love for the field, and it’s easy to recruit them.”

The research was funded by CARRA, which receives funding from the Arthritis Foundation. Schultz and Correll had no disclosures.

This article originally appeared on MDedge.com, part of the Medscape Professional Network.

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Insurance Regulator to Issue Warning on Virus-Test Billing

Editor’s note: Find the latest COVID-19 news and guidance in Medscape’s Coronavirus Resource Center.

SANTA FE, N.M. (AP) — New Mexico’s top insurance regulator is putting medical providers on notice that people cannot be charged for coronavirus testing after reports that residents have been required to pay for coronavirus rapid-result tests.

Insurance Superintendent Russell Toal said Wednesday that his office is preparing an administrative bulletin to ensure testing costs are not passed directly on to consumers, as state health officials push for robust testing to track infection rates and new strains of COVID-19.

Toal said the Office of the Superintendent of Insurance has received reports and complaints of people being charged in excess of $100 for testing services that should be free. The extent of the improper billing is unclear.

“We’ve got some providers out there that are charging individuals for so-called rapid tests,” Toal said. “The new guidance from the federal government makes it really clear that those federal tests are to be covered without a charge to the patient.”

The Biden administration in February issued guidance on 2020 emergency pandemic legislation that restricts cost-sharing with patients for coronavirus testing under a broad range of circumstances.

New Mexico officials this week described steep declines in new confirmed infections, hospitalizations and deaths because of the virus. Still, state Human Services Secretary David Scrase said they are monitoring variants and stressed the importance of testing as a way to keep tracking the virus.

The seven-day rolling average for tests administered is hovering around 11,800 — well above a benchmark of 5,000 per day set by the state for re-opening the economy.

New Mexico health officials say more vaccine doses are needed from suppliers if New Mexico wants to meet a new mandate for applying at least one shot to all teachers by the end of March.

Many New Mexico school districts have opted not to dramatically increase in-person learning despite approval from Gov. Michelle Lujan Grisham. Some have opened on a limited basis, allowing students to attend in-person based on the availability of teachers who volunteer.

Citing the limiting factor of vaccine supply, Lujan Grisham said in a statement that she was hopeful Biden’s directive on schools reopening was an indication that the federal government would be sending more support to the states to get schools opened safely on a faster timeline.

New Mexico is leading the nation when it comes to the percentage of vaccine doses used, having administered more than 94% of its doses. It’s the second-fastest state for administration with nearly one-quarter of residents partially vaccinated and nearly 13% fully vaccinated.

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