The Second Act Is Coming Earlier

In a recently published survey of primary care physicians, nearly half said they are considering early retirement because of healthcare trends. But, those in the trenches are not the only ones thinking about Plan B.

The other day I sat down with some first and second medical students who, it seems, were having a crisis of faith in their career choices. One had an engineering background and the other was an MD/PhD student and we were discussing how to move forward. Some of the things we discussed included:

1. Whether they could make a difference or get the research support they would need to build a clinical-scientist career.

2. Avoiding the inevitable cynicism and despair that comes with progressing through medical education.

3. An unwillingness to pay their dues and sacrifice in the face of other career options.

4. A sense of guilt and shame that they worked so hard to get where they are and yet are considering abandoning those dreams.

5. Reluctance to tell the truth to authority and about sharing their real feelings for fear of retribution and having a warrior mentality, unwilling to show any cracks in their armor or let anyone see them sweat.

6. Using their entrepreneurial ideas to further check off the boxes to get into competitive residencies, like orthopedics, otolaryngology, and dermatology, instead of identifying an unmet patient need and creating user defined value.

7. A feeling of isolation and being disconnected from local entrepreneurial ecosystems that would embrace them.

8. Grappling with specialty choices given limited exposure, the luck of the draw when it comes to elective rotations, loan repayments, work-life balance and the ability to have time to spend on entrepreneurial endeavors.

9. A lack of mentors or sympathetic faculty support.

10. Dealing with the realities of how all-consuming medical school can be and how it crowds out time for other interests, networks, or families.

The medical workforce is not immune from the changes creating the future of work. As identified recently in an article in The Guardian, these changes include:

1. Workplace structures

Forget the rigid corporate ladder — now the corporate lattice allows free-flowing ideas and career paths.

2. Artificial intelligence

The robots are coming and if the forecasts are correct, they could sound the death knell for millions of jobs.

3. The human cloud

Websites that match employers with freelancers are growing fast — and so is the potential for lower wages and inequality.

4. Workplace monitoring

Bosses apparently worry about the health of their staff and are asking them to wear trackers.

5. The end of retirement

Forget quitting at 65 — everyone is going to have to stay on for longer, but we should exploit older people’s experience

Generational attitudes, in part, are driving how the medical workforce deals with environmental change and stressors. The face of work is changing. Some adapt. Some tough it out, but are grumpy. Others are less persistent and leave.

The key to career success is intrinsic, not extrinsic, motivation. The challenge is to deal with these cesspools of discontent and provide them with the tools and incentives they need to be happy doctors and clinician-scientists. The Sick Care gig economy is here and the smart money will adapt.