Your own five-year plan: What do you want to accomplish?

Cover Story

Your own five-year plan: What do you want to accomplish?

What would you like to accomplish—in your practice andon the home front—in the next five years? Judging from our survey, you'reraring to get things done, make a difference, and smell some roses, too.

By Jeff Forster, Editor

The tradition of New Year's resolutions goes way back, at least to Babyloniantimes. In those ancient days, people had all kinds of good intentions aboutreturning borrowed farm equipment. Today, we think a bit more expansively.On the tabula rasa of a new day, we're ready to write the script of a betterlife.

In a fax poll published in this magazine last September and October,we asked you to share with us your personal and professional goals for thenext five years. One of you said, a la Garbo, that what you wanted mostwas "to be left alone."

An understandable response, considering all that you must deal with thesedays, but not a typical one, we discovered. Most of you want to be muchmore engaged—at the office with your patients, and at home with your family.Your responses reflect a strong desire for self-improvement, a deep yearningfor connectedness, and a determination to leave this planet in better shapethan you found it.

At the start of this new year (and any other new epochs you want to embarkon), imagine that you are writing on that clean slate. Judging from ourpoll, most of you don't have wildly ambitious goals or unattainable fantasies;you tilt not toward windmills but seek the sunshine of professional satisfactionand personal serenity. Naguib Farah, an FP in Charlotte, NC, is hoping for"a peaceful, stable, successful, busy practice." And Barbara Loeb,an internist in Downers Grove, IL, wants "to find a niche in medicalpractice where I can work the way I enjoy." Not a bad start on a goodlife.

Here's a look at what your colleagues had to say.

Your professional goals

In the realm of medical practice, you have high expectations for yourself,and an equally high resolve to achieve them. Paul Houston, an FP in Brazil,IN, wants "to continue practicing in the Marcus Welby fashion, so thatafter I'm gone patients will use me as the benchmark by which they judgetheir medical care." He acknowledges the many "distractions andoutside influences" plaguing medicine today but vows, "you mustnot let them get in the way." In much the same spirit, Yves Morency,an FP in St. Petersburg, FL, hopes "to combine all aspects of the healingarts with the best science to truly become a great doc."

Despite all the hassles of practicing in a micromanaged environment,most of you really like your patients. That relationship—and, in many instances,a strong religious faith—sustains you through many a dark day. B. Dan Witt,a urologist in Hoisington, KS, wants to "be kind to my patients, doas little harm as possible, and steal as little time from them as I can."Ditto for Richard Huntley, a GP in Muskegon, MI: "I plan to enjoy mypatients; some have been with me since Day One—1963!" For Jeff Parker,an internist/cardiologist in Baltimore, top priority is "to continueto concentrate on the sufferer as a human."

You also care about preserving the dignity of medicine in the midst ofmarketplace pressures. "I want to maintain my professionalism and senseof self, a belief in doing what is right for the right reason," saysSan Francisco internist Gary G. Kardos. "I want to be truthful andrespectful to my patients for the remainder of my practice lifetime. Ifmedicine is not a profession, there is no medicine, only a trade."

Kardos is nearing the end of his career, but a similar sentiment comesfrom Mary P. Fabian, an FP in Alburtis, PA, who's been in practice for justa few years: her aim is to "continue to provide high-quality, compassionatecare despite HMOs and get patients more involved in caring for themselves."

Some of you don't think you can fully honor your commitment to patientswithout making changes in your practice. For Donald Turner, an FP in Dayton,OH, the answer is to "gear down my volume so I can restore the humanisticside of my practice." Carol Sprague Savage, an FP in Littleton, MA,plans "to maintain my solo practice at a manageable size, avoid beingoverextended, and keep things at the office personal—no computerized answeringservice!"

Neeta Ambe-Crain, who practices in Thousand Oaks, CA, gave up "thecrazy, unpredictable schedule of an obstetrician to concentrate on gynecology.I'm greatly enjoying the opportunity to practice more primary care medicineand basic psychiatry." She also likes sleeping through the night, "andwith a more relaxed schedule, I am hopefully a more attentive and involvedmother, wife, sibling, and friend to those I cherish."

Beyond broad-brush goals, many of you have set a specific agenda thatincludes some or all of the following:

•Expanding your horizons. One physician wants to gain a broadereducation in medical economics (here's to you, sir!). A good number resolveto become more computer-savvy (a wise idea). One primary care doc is lookingto improve geriatric skills and thinking about starting an assisted livingor palliative care center.

•Learning more about alternative medicine. Mark Nemiroff, an anesthesiologistin Yardley, PA, wants to become more involved in acupuncture (and less involvedwith managed care). Nalini Dave, an internist in Bryan, TX, has been inpractice for 19 years and now would like "to become well-versed inall different forms of complementary care" and to learn more aboutspiritual healing.

•Staying on top of traditional medicine in your specialty,a marathon race in which the leading edge of knowledge always seems beyondthe crest of the next hill. Thomas P. Ryan, an internist and cardiologistin Fort Wayne, IN, intends to become board-certified in interventional cardiology.In Bellevue, WA, Sam Harrell has his sights set first on getting recertifiedin family practice, then establishing a part-time slot in clinical research.Another primary care doc plans to become board-certified in emergency medicine.

•Just getting better at what you do best. For Mike Vasilomanolakis,a cardiologist in Long Beach, CA, it means being a "more effective,efficient consultant." Joan Flender, a pediatrician in Dansville, NY,plans to "grow my practice, enjoy my patients, and practice the bestmedicine I can. As I get more confident, it gets less stressful, and evenbetter with time."

•Becoming involved in community service. "I hope to continuesetting down roots in my community and begin working as a positive influencefor change," says Kristin Elliott, an FP in International Falls, MN.Neeta Ambe-Crain has found that giving up obstetrics "means that Ican now find time to give lectures to local women's groups. I'm also ona steering committee of doctors to create a surgical specialty hospitalin our community."

•Becoming an activist. For John J. Boyle, an FP in Gainesville,FL, the goal is "to convince doctors to unite and take our professionback." Michael S. Cann, an orthopedist in Glendale, CA, believes that"a revolution is coming in health care, and it will be run by disgruntledphysicians who are tired of the status quo. The public will remain largelyunaware of why this is happening. I don't believe society in general hasa very good understanding of the tremendous stresses medical practitionersare under today."

Seconding that motion is Murad Alam, a dermatology resident in New YorkCity: "I think it's important for doctors to participate in the politicalprocesses that affect medicine," he says. "If we choose to absentourselves, we should not be surprised when other constituencies are moresuccessful in achieving their agendas."

On a more optimistic note, pediatrician Walton Ector in Folly Beach,SC, believes "we seem closer to being able to furnish a true medicalhome for all children in the USA—we must do this!" A veteran of 45years in practice, he's confident that the newest crop of med students andresidents will be up to any such challenge.

•Passing the torch. James Hutchinson, an FP in San Mateo, CA, hopes"to retire with my practice intact in the hands of some young doctorwho shares my ideals and philosophy about medicine." He's typical ofphysicians who have been around for a while and are eager to pass theirknowledge and values to the next generation. For Alan Roberts, an internistat the Medical College of Georgia School of Medicine in Augusta, this means"to teach my students and residents how to care for patients with humanism,humility, and a proper blend of old-time doc and modern technologist."

•Pursuing entrepreneurial opportunities. "Physicians are augmentingtheir incomes by connecting to less regulated lines of business relatedto their specialty—things their patients want to buy," notes GeoffreyT. Anders, president of The Health Care Group in Plymouth Meeting, PA. "Consideran orthopedic practice that anchors an ortho-mall. The complex might includea surgicenter, physical therapy facility, gym, sports equipment retailer,disability services center, pain clinic, and a surgical supply store. Thephysicians could be co-owners of most of the ventures and landlords to themall."

On an individual scale, would-be Thomas Edisons are toiling away bythe light of their own inspiration. Howard Long, an FP and preventive medicinespecialist in Pleasanton, CA, is eager "to market my stereophonic stethoscope,based on its daily revelations of early pneumonia, carotid stenosis, andother conditions."

•Picking up stakes. In some cases, a total change of scenery maybe the only way to attain professional satisfaction. Kenneth S. Wayne, aninternist and pulmonologist transplanted from California to the Midwest,looks forward "to practicing high-quality medical care in my new locationin rural Iowa and recapturing the pride and enjoyment I used to have inmy work." Doctors who have experienced such sea changes are buoyantabout the future, while others continue to look for that escape, like thedoc who is "determined to find a job that does not make me angry."

Other professional goals ranged from "not getting sued" to"reducing my dependence on managed care plans." Whether or notsuch wishes come true, some of you find satisfaction in realizing that lesscan be more. Kishan Agarwal, a pediatric cardiologist in Edison, NJ, expectsto be "working less, making less, but still practicing good, ethicalmedicine without having anybody else tell me how to practice."

In other words, the professional goal can be an essentially personalone. "I'd like to reduce my clinical practice time and have more personaltime," says Margretta Ameigh, an FP in Etters, PA. "Less career,more me." That's a logical segue to . . .

Your personal goals

"Pay off my loans." "Get a pilot's license." "Becomea mother." "Be the best grandfather I can be." "Learnto relax at home." "Stay fit, emotionally and physically.""Write a novel." "Do volunteer work." "Sock awaymore money for retirement." "Successfully launch my kids on careers.""Get a bitter divorce behind me." "Maintain my health, competein several marathons, and see my two oldest kids get through college."

That's a representative sampling of what you shared with us on the personalside. As with your professional goals, the desire for self-improvement coursesswift and deep in your veins. Corrine Santerian, a pediatrician in Buckingham,PA, hopes to "remain humble, not become cynical; be the best motherand wife I can be, and strive for greater patience and compassion with mypatients." An FP in the Philadelphia area wants to "fight cynicism,grow spiritually, emotionally and intellectually, and laugh often."

Actually, you want for yourself the same thing you hope your patientswill want for themselves—to stay healthy, whether that means losing weight,getting more exercise (and fresh air), or reducing stress. The trick isto give yourself the same motivational pep talk you give your patients—andto hope that compliance will be high.

Perhaps more than anything else, you want a good home life. Some of youwould settle for a home life, period. "I'd like to continue makinga difference in every life I meet, to have a happy married life, and tokeep being a good mom. I look forward to being an even better grandma,"says Eleanor DeMoss, a pediatrician in Wichita, KS. Others have more pointedgoals; for pediatrician Joan Flender, it's "to survive the adolescenceof my three sons." Marvin Call, a recently retired FP in Albuquerque,wants "to spend more time with my six grandchildren, and try to transmitcultural and moral values to them." And Rahma Mustapha, a physicalmedicine specialist in Valatie, NY, is giving priority to "bringingup my 10-year-old son as a caring, compassionate, and considerate personwith a high emotional IQ." Jerome Murphy, a pediatric nephrologistin Fresno, CA, would like "to be allowed to marry my gay 'husband'and enjoy the benefits straights save for themselves."

Home is a definite refuge from the storm of medical practice. The pursuitof activities that have nothing to do with medicine seems a form of almostnecessary therapy, whether it be gardening in the backyard or scaling Kilimanjaro."I intend to continue doing what I love most—singing in a championshipbarbershop quartet," says Chuck Strub, an FP and phlebologist in Monroe,WA. Also on his list: climbing Mt. Rainier and shooting par golf. VijayLakshmanan, a pediatrician in Arcadia, CA, has set an agenda that includes"getting in shape and changing my lifestyle to accommodate travel,music, and art a lot more." North Kansas City, MO, cardiologist JohnMiller has an ambitious list of individual goals, including taking partin a triathlon, starting a band, writing a novel, and continuing to hosthis own radio show.

Those who are charting a path to retirement are excited about the prospectsof having more time at their disposal. "I'm 53, and I remind my partnersregularly that when I hit 60 my nights, weekends, and holidays will be myown," says Charles Davant, an FP in Blowing Rock, NC. But even in retirement,few of you will tolerate "down time" for long. One physician iscontemplating retirement at 60 so that he can go into mission work year-round.And speaking of round, FP Marvin Call has come full circle; he retired fromactive practice a year ago and is now volunteering at the same Indian HealthService hospital in Tuba City, AZ, where he started his career 38 yearsago. "The personal satisfaction of working with others, and the feelingthat you are being of help to people, is worth far more than the dollarsearned," he says. "This feeling has intensified since I starteddoing volunteer work. It's the most exciting time of my life."

Who knows? Maybe you'll find time to live out a fond dream. James M.Donnell, an FP in Wichita, would love to "travel to different universitiesaround the world and study all those things there never was time enoughto learn." After 45 years in practice, GP James F. Gerrits of PortHuron, MI, would love to play the piccolo solo in Sousa's "Stars andStripes Forever." For Jane Hansbarger, a pediatric gastroenterologistin Murray, UT—who undoubtedly speaks for many of her colleagues—the aimis simply " to age without remorse."

Making time for it all

As if you could kill time without injuring eternity.—Henry DavidThoreau, Walden, 1854

Time is on my side, yes it is.—The Rolling Stones, 1964

It's great to have goals; it's even greater to carve out the time toachieve them. More than any other commodity, time seems to the one thatmost often eludes the busy doctor's grasp.

In our pre-millennium fax poll, we asked you to share the single bestthing you do to manage your time. We asked some practice management consultantsto share their views as well.

Michael D. Brown, president of Health Care Economics in Indianapolis,suggests that all physicians conduct a retreat for their staff every year."The physician and key professional team members should sit down andset both vocational and personal goals for the year ahead," he says."Make the goals realistic—difficult, but achievable—and then try,during the retreat, to structure a business plan accordingly."

Brown has another idea about managing time, away from the office. "Ihave two boys, and each year I let each one pick out where he wants to go(within reason) on vacation. I then spend a week with each son, apart fromthe rest of the family. My wife does the same. At the end of the year, wetry to have a vacation for the whole family. This helps us get back to therudimentary values. I have passed this recommendation on to many of my physicianclients and told them to realize what is important in life."

In that spirit, here are some of the ways your colleagues have managedto make time for themselves, in and out of the office. Some have taken adramatic approach, like the doctor whose best time-saving strategy was toup and quit office practice and go to work as a staff physician in an urgent/emergentcare center.

Some of you readily—almost cheerfully—admit to being lousy time managers,but you just as cheerfully rely on others to help you out. "I listento my wife and staff," says Ralph Seligmann, an internist in Scottsdale,AZ. "I am a poor time manager." Says Howard Kramer, an internistin North Andover, MA: "I'm open to suggestions, haven't gotten thehang of it yet." There's a minimalist school of thought: "Don'tplan much, and don't wear a watch," advises Richard V. Liles Jr., anFP in Albemarle, NC. And the "good night's rest" school of thought:"I get plenty of sleep, otherwise I am not efficient," says onephysician. "Oh, yes—and I use a Franklin Planner."

Speaking of Ben, here are the time-saving kernels of wisdom you cameup with:

Be early to rise

"I do the bureaucratic paperwork early in the morning, before Istart seeing patients," says Wallace Rubin, an ENT specialist and allergistin Metairie, LA. He has a soulmate in Miami allergist Michael P. Pacin:"I plan my day first thing in the morning; I keep a day planner inmy computer and review it at the start of each day." For Nalin Mehta,an internist in Albemarle, NC, the secret is starting the workday at 6:30am.

Get to it

"Try to complete tasks and solve issues as soon as they arise. Don'tput off difficult decisions," advises Donald Turner, an FP in DaytonOH. Wayne Strouse, an FP in Penn Yan, NY, agrees: "Don't put off paperwork.Do it now and get it over with. The longer you wait, the longer it takesto do." What helps Donald W. LaVan, an internist and cardiologist inPhiladelphia, is to "handle a piece of paper one time; act on it andget rid of it." He's like the internist in southern Illinois who says,"I use my garbage can liberally, touch things only once, and delegateeffectively."

Be there

"I don't allow myself to see patients late. I consider their timeto be as valuable as mine, and I try to see every patient within five minutesof their scheduled time," says Kristin Elliott, an FP in InternationalFalls, MN. Another physician tries to do the same, but within a 15-minutewindow of the appointment time.

Pace yourself

"I work hard, but at a steady pace, and do each day's work as itcomes," notes Gerald W. Roller, an internist in Roanoke, VA. To makethe best use of time, "I try to focus intently on whatever activityI'm involved in at the moment," says Ray D. Howell, an FP in Roachdale,IN. For Tulsa internist Julia Karlak, the secret is to "leave catch-uptime between successive tasks to prevent being late or rushed." And"relax—take things in stride" works for Raphael Schwartz, aninternist in Danbury, CT.

"I try to make priorities in my day and leave nonurgent tasks tobe distributed over time," says internist Barbara Loeb. Jeff Parker,a cardiologist in Baltimore, prefers to "establish a single goal foreach day, and take it all one day at a time."

Learn to say No

"Don't go home until the day's work is done, and learn to say Nowhen you can't do more," suggests internist Gary Kardos, who's beenin practice for 32 years. "I never overcommit—and I get everythingdone every day," notes Janet Harnsberger.

Seek a balance

"Trying to maintain a balanced schedule involving work, family,study and relaxation" is one physician's mantra, a good model to follow."The best thing I do to manage time is not cram too much in it,"says Ed Morris, an FP in Houston. "When I practice medicine, I do it100 percent. When I fish, I do it 100 percent. I have no beeper!" (Hise-mail moniker, by the way is "drtrout.") Patrick Barrett, a family practitioner in Mill Neck, NY, says, "I never panic, and I always take time forme. This creates a nice balance."

Don't go it alone

For Sharon Casazza, a pediatrician in Washingtonville, NY, the answeris to "take on more doctors in the practice to share night and weekendcall." There are now four full-time and two part-time physicians inher group. "I've taught my staff my way of practicing medicine, andI delegate responsibilities," says Elias M. Ghafary, a nephrologistin Gadsden, AL. That also works for Edwin N. Barron Jr., an FP in LittleRock, who suggests, "hire good people, have an office family, and letthem do their job." Consistency and continuity are the keys to timemanagement for Vince Gurucharri, a thoracic surgeon in Columbia, MO: "Iplot my next day the night before—and I've had the same assistant for thepast 20 years."

Make time for you

"I restrict my practice time to 30 to 35 hours a week so I can dothe things I enjoy—reading for pleasure, taking rides in the country, sailingon the Chesapeake, and having quiet time for relaxing and thinking,"says Stephen J. Losben, a dermatologist in Meadowbrook, PA. Another dermatologist,Edward M. Young Jr. of Sherman Oaks, CA, declares, "I do not bringwork home from the office." Similarly, "I realize that I needto leave the office behind, except when I'm on call, and I take time totake care of myself." That from FP Mary P. Fabian.

Avoid time-guzzlers

"The best thing I ever did? I stopped watching TV, and deleted gamesfrom my computer," says an FP in the Philadelphia area. Jerome Murphy,a pediatric nephrologist in Fresno, CA, came up with another solution: "Avoidmeeting with administrators at all costs."

Go electronic

More and more physicians are finding an electronic friend to help managetheir days, hours, and minutes. "The best thing I do," says Houstonpsychiatrist Irvin Kraft, "is make use of my computer (Daily Journalprogram) to keep track of what my brain forgets." David Walker, a radiationoncologist in Webster, TX, finds the solution in hand: "I coordinatemy Palm Pilot with my computer and my wife's computer."

Take a meeting—and walk the dog

For most of you, managing time successfully means finding a way to structureit at work and to unstructure it at home. FP Stewart Kopp of Queens, NY,captures this yin and yang nicely: "I schedule conferences at workwell in advance . . . and I find time to run my dog on the beach at Montauk."

Jeff Forster. Your own five-year plan: What do you want to accomplish?. Medical Economics 2000;1:52.