As physicians chew on their professional options when contemplating leaving clinical practice, one of the questions I am often asked is "What other careers are available to someone with a physician's training and skill set?"

The news is good, as I have keep discovering, in my quest to find interesting physicians to interview for my Conversations with Trailblazers Podcast series.

Physicians are morphing into a wide variety of careers in an even wider range of industries.

Here then is my almost certainly incomplete list of possible areas inviting a professional move (and I now know of or have spoken to enough physicians that they span almost all of the categories):

•   Administrative/leadership role
•   Academic role
•   Educational/training role
•   Organizational executive
•   Consultant (area of expertise)
•   Advisor – to foundations, “think tanks”
•   Coach – life, business, executive, health
•   Pharma role
•   Biotech role
•   Information Technology role
•   Medical device role – inventor, patent holder with licenses
•   Business owner/entrepreneur - expert witness, information and other products, services, training, seminars, corporate and other wellness, weight management, cosmetic/med spa, manufacture and sell device/other products, ANY business
•   Media – TV, medical journalism, filmmaker
•   Speaking – motivational, keynote, workshops
•   Medical/healthcare communications (publishing, marketing, market research, advertising etc)
•   Book author, screen writer
•   Entertainment consultant
•   Clinical trials
•   Political role – political office, lobbying
•   Financial/investment – financial advisor, Venture Capitalist, investment banker/advisor
•   Program medical director
•   Real estate – medical and non-medical
•   Public health program/agency
•   Non-profit, public service
•   Executive search, recruiting

Remember, you can dig a whole lot deeper by attending the SEAK Non-Clinical Careers conference in Cape Cod, MA, in October 2008 (disclosure - I will be an unpaid keynote speaker there. And you might just have to come by and say hello, if you go!)

See anything on the list that appeals?

What's missing?

One of the most soul-damaging events for a physician is being sued by a patient with a bad outcome - particularly when the physician cannot think in hindsight how he or she would have done anything differently. I've witnessed the enduring and confidence-shaking psychological trauma up close and personal in physician clients, friends and colleagues!

Another potentially disturbing trend, described in the LA Times a few weeks back in an article titled "Doctor ratings: Is your healthcare hot or not?", is that of public ratings of physicians and their practices. 

Or should we say in some cases public beratings!

"Patients and site operators say the trend is good for consumers and good for healthcare. Thoughtful doctors, they say, will provide better customer service because of the feedback, and the bad ones will no longer be able to hide. And, they add, why should doctors be immune from the trend toward better customer service?

Physicians aren't so sure of such reasoning. Many say the reviews on RateMDs.com, Vitals.com, DrScore.com and other sites are skewed by disgruntled patients and are thus unfair, pushing some doctors to near-ruin after a single post."

The article goes on to debate the rights of patients as consumers to know who they are entrusting their care to (valid point) versus the challenge physicians face when they are criticized unfairly (in their minds) and unable to vent back, for fear of violating patient privacy rights.

I wrote previously about how Zagat has teamed up with Wellpoint to create a physician rating system.

Are these broken solutions for a broken system?

I was glad to see mention made of Medical Justice, a NC company started by Dr. Jeff Segal, whom I had interviewed almost two years ago, when his company was getting off the ground, for Conversations with Trailblazers.

To protect himself, Fischel recently signed up for services with Medical Justice, a Greensboro, N.C., company that provides doctors with contracts and services to guard against frivolous malpractice lawsuits. Last year, the company designed a contract doctors can use asking their patients to "respect their physician's privacy on the Internet" by not participating in online ratings.

If a contract is in place beforehand, a doctor can force a website to take down the offending material, says Dr. Jeffrey Segal, a physician who runs the company.

To a doctor, reputation is everything, Segal says, adding that doctors shouldn't bear the brunt of dissatisfaction with the faltering healthcare system.

"All stakeholders -- consumers, doctors and payers -- are frustrated right now," Segal says. "Because of that there is a lot of finger-pointing and a lot of anger, some of which is unproductive."

(Emphasis mine)

Bravo again to Dr. Segal for standing up for physicians whose professional lives are thrown into turmoil by recognized bad outcomes and frivolous suits.

And by the way, who is taking responsibility of ensuring the fairness and objectivity necessary to make these rating systems useful?

I hope you moms had a special Mother's Day on Sunday. And if you aren't a mom, I hope you felt affection and appreciation for your own mom!

Personal confession: Mother's Day is a particularly poignant day for me as it used to be a day I dreaded. Until I had my own child rather late in life, I endured the day with a sense of shame and even anger that I hadn't become a mom, contrary to all my adolescent expectations and those of my family and friends from earlier times.

Now I cherish the day with a fierce joy and celebration that exceeds my almost-daily feeling of living a miracle.

The reason I'm sharing this highly personal experience is it aligns with an article I came across (thanks to Jeff Cornwall of The Entrepreneurial Mind) by Susan Brown in Tennessean.com, called "When it's all said and done, substance is far more fulfilling than style".

In questioning why we aren't happier than earlier generations despite our obvious material advantages, Brown writes:

"My generation has lost touch with what it means to be content. We equate contentment with home or bank account size. Are we content? I suppose we could ask the psychiatrists and counselors we regularly visit. Alternatively, maybe look at divorce statistics or observe declining church roles while noting increasing doctor visits for stress-related ailments. Maybe interview local pharmacists who increasingly fill prescriptions for sleep and stress disorders or ask a financial analyst to explain the reason behind the increasing debt ratios.

I wish I had clear-cut answers as to why our generation has taken a 180-degree turn from prior generations. Success is good, but a problem occurs when enough is not enough. Our nation is heading down a destructive road unless our values change. Bigger government is not the answer. A diamond's size does not make a lasting relationship. True beauty is not superficial. House size, career title or bank balance does not equal contentment."

Brown refers to values - a big favorite of mine. She calls out "values of yesteryear" such as family, sacrificial love, quality time and contentment.

To that I would add adventure, generosity, passion, creativity and mystery, amongst others.

Take a hard look at what is stressing you at present. Are your stresses a result of lack of style, or of substance?

• If they belong to the latter, how can you choose a life of greater substance?
• If the former, what are you willing to let go of fretting about? Where are you out of alignment with your core values?

For my part, I was blessed with a Mother's Day of substance, far from style. No jewels, flower arrangements or fancy dinner. Instead, it included a call to my mom in South Africa, a photo assemblage of my daughter's year since last Mother's Day lovingly created by my husband; a hand-dabbled Color-me-mine tea mug (replete with 5-year old paw print!) from my daughter with the assistance of our lovely au pair; a day on a foggy chilly beach spent running away from waves and rescuing stranded (dead) jelly fish; a rental movie, and takeout Chinese.

I could NOT have asked for more!

It was curious to spot an article titled "Can you become a creature of new habits?" in the Business section of the New York Times last Sunday. Kind of squishy topic for a business person to get a hold of, don't you think?

Turns out, it's an article on creativity and innovation.

What gave it lustre for me was the neuroscience about neural pathways that I've been increasingly aware of, and that very much pertains to coaching:

'... it seems antithetical to talk about habits in the same context as creativity and innovation. But brain researchers have discovered that when we consciously develop new habits, we create parallel synaptic paths, and even entirely new brain cells, that can jump our trains of thought onto new, innovative tracks.

Rather than dismissing ourselves as unchangeable creatures of habit, we can instead direct our own change by consciously developing new habits. In fact, the more new things we try — the more we step outside our comfort zone — the more inherently creative we become, both in the workplace and in our personal lives.

... “The first thing needed for innovation is a fascination with wonder,” says Dawna Markova, author of “The Open Mind” and an executive change consultant for Professional Thinking Partners. “But we are taught instead to ‘decide,’ just as our president calls himself ‘the Decider.’ ” She adds, however, that “to decide is to kill off all possibilities but one. A good innovational thinker is always exploring the many other possibilities.”'

I emphasize the phrase in the last paragraph to highlight just how our brains are trained to work as physicians. In our quest for a diagnosis, and an explanation for a set of signs and symptoms, we effectively kill of all differential diagnostic possibilities until we get to the One Answer that explains our observations and the patient's experience.

In effect, we are necessarily "anti-creative" in our trained medical thinking.

The challenge for entrepreneurial physicians then is to overcome the tendency to be reductive thinkers. Entrepreneurship demands significant creativity. We physician entrepreneurs need to see more opportunities, not fewer. To generate more ideas, create a greater number of options, or ways to skin a cat.

According to the article, researchers in the late 1960s discovered that humans are born with the capacity to approach challenges in four primary ways: analytically, procedurally, relationally (or collaboratively) and innovatively. At puberty, however, the brain shuts down half of that capacity, preserving only those modes of thought that have seemed most valuable during the first decade or so of life. (emphasis all mine)

We are stuck with how we were encouraged and naturally inclined to think.

The good news is that we can still innovate and create, despite our inherent limitations. It seems the trick is to push ourselves out of our comfort zones.

This interesting article goes on to describe:

"...three zones of existence: comfort, stretch and stress. Comfort is the realm of existing habit. Stress occurs when a challenge is so far beyond current experience as to be overwhelming. It’s that stretch zone in the middle — activities that feel a bit awkward and unfamiliar — where true change occurs."

When we stretch ourselves and expand our possibilities is when we feel truly alive. That belief lies at the heart of a great coaching relationship.

Markova, a PhD executive change consultant and author of "The Open Mind" is quoted as saying:

“You cannot have innovation,” she adds, “unless you are willing and able to move through the unknown and go from curiosity to wonder.”

I couldn't agree more.

What do you think?

Were you the kid who always wanted to be a doctor?

Out of deference to a barely completed conversation with a physician client, and to observing, over the last two days, a truly remarkable discussion on a private discussion board for physicians, I feel compelled to create a new category for this blog - that of "Reflections on being a physician"

What has touched me most about these conversations has been the depth of anguish and struggle for so many physicians about what it actually means to be a physician -- and, more poignantly, what does it say about you if you no longer relish this role?

When I decided to leave clinical practice, I pondered just what this phase of my career had been about. My work to that point had been all about doctoring -- asking, listening, diagnosing, offering possible treatments and following up. And it was unclear just what my legacy was to be if I left practice.

After some deep reflection, I realized my greatest joys as a physician came not from the laying on of hands or a stethoscope, not from removing moles or knowing the right drug to prescribe. Instead they arose out of being a privileged guest, invited into a patient's life to participate in an intimate helping relationship.

At first I thought it was simply being in relationships that sufficed - so I anticipated that being a hospital director would meet that need. After all, that leadership role was mostly about people and fostering great organizational relationships. It was only once I discovered the (then) mysterious career of coaching that I recognized my true love -- the value I placed upon relationships of intimacy and being able to help.

Which brings me back to the question of identity. 

What happens to physicians when they wake up one day and question whether they want to be doctors any more?

From my own experience and the conversations I have overheard and participated in, the very thought seems to shake the foundations on which so much of physicians' lives are built. Families express disappointment, friends are disbelieving ("after all that education, you want to blow it off and walk away! How could you consider that?"), and the physicians themselves are wracked with uncertainty and guilt.

In many situations, they are breadwinners, with years of mortgages and educations ahead of them, or they are done with their biggest financial responsibilities and they have all those years of practice to justify walking away from.

What does it mean if you no longer want to be a doctor?

This nagging question most likely lies at the root of the many dysfunctional statistics that plague physician lives - alcoholism, substance abuse, disruptive behavior, depression, and even suicide.

I don't know the answers as yet.

I had to do my own inner work to permit my separation from my "doctor identity" and, instead, allow my MD to be an expression of certain skills, competencies and experiences. I am NOT a doctor. I am Philippa, who knows how to be a doctor (these days, I'd have to do some serious retraining!) and who has insight into what it is like to work as a physician.

In her fine and extraordinarily revealing book, Finding Your Own North Star, Martha Beck describes our two selves - our Essential Self and our Social Self. I would highly recommend this book if you are struggling with a Physician Identity problem.

The answers probably lie in reacquainting yourself with your Essential Self, and getting exquisitely clear on your core values!

I would love to hear your thoughts on this.