One of the pieces of advice that I casually dropped in the post about how to start and build your medical business was to “Go where you are needed“. This one short sentence is central to finance and fulfillment in the professional life cycle – one of the main taglines that I use for this site.
This is good advice not only when starting independent practice. It should be considered way before then and throughout the stages of your career. That means medical students, residents, early attendings, mid-life crisis attendings with giant motorhomes, and those in the home stretch. It is vital to get this career thing right because, as physicians, our career helps define us whether we’ll admit that or not.
It may sound altruistic. Really though, it is selfish at its worst or symbiotic at its best.
“Going where needed” is behind much of the success that I’ve had in my career. There has been a great sense of fulfillment in having made a difference, but I am also talking about financial success.
Throughout our careers and lives, there is an exchange when we provide something and receive compensation in return. Sometimes, that balance has been grossly in my favour (selfish) and at others it has been an even exchange (symbiotic). Altruism requires a sacrifice with really little or no benefit in return. That has rarely been my experience. When we give, we almost always receive an intrinsic reward in return. I will share how I have slid around on this spectrum while “going where needed”.
You’ll also get a piece of the Loonie Doctor Origin Story. Wolverine would be a good X-men parallel for me. He has Canadian origins, is pretty badass, has sideburns, and lots of body hair that sometimes obscures the six-pack beneath. In Wolverine’s style, this is also not a mushy post about the warm and fuzzies.
The fact is, I am wealthy compared to most doctors. Not because I have been a great investor or a 100% diligent-tax-optimizing-whiz. I try, but am definitely neither of those things. Making good financial choices as an early attending definitely helped. Luck played a role. However, it is also because I decided to make more money by going where I was needed.
How I Came to Medicine
Prior to medical school, I was on track to become a career high school science teacher. I found that I enjoyed teaching OAC (Grade 13) biology. Teaching grade 9 and 10 science – not so much. A big attraction for pursuing medicine was the opportunity to teach high-level medical science as a faculty member. Of course, I was extrapolating my experience of high school teaching to university faculty. I figured that they must get paid better and still have summers off. Plus sabbaticals. Selfish reasons. I really had no clue!
Most medical students talk about how they want to serve and save the world during their medical school interviews. I can say that, having also been on both sides of the interviewing equation. I did enter medicine because I wanted to have a career where I was helping people. However, that was only one aspect of the decision. My real passion was for teaching patients and doctors, as part of that process.
The Medical Student Years
Unfortunately, once in medical school, I found out that this was a time when clinical teaching was not seen as particularly “academic”. I was called to meetings with University leaders where they told me that they had heard that I had great potential but that I needed to up my game.
I was told, “Anyone can be a decent clinician. Anyone can teach… Only the elite special squad of physician ninjas can do research. To work here, you must join the clan.” Ok, I took artistic liberty with the ninja part. Still, my visions of being a nutty medical professor evaporated because I really had no interest in pursuing a clinician-scientist career track.
In fairness, I agree that the clinician-scientist track is probably the toughest path to pursue in academic medicine. However, all of the cogs in the academic medicine gears need to be valued for the machine to function well.
As you can imagine, that climate translated into a paucity of people gunning to be clinician educators. In fact, they had left in droves leaving big gaps and a few staff carrying a huge load. I wanted to “go where needed” because of my interests. Despite the fact that it wasn’t valued yet. This medical student altruism was probably about as selfless as my “go where needed” mantra gets.
While in residency, there was a major need for people to teach the medical students. This need aligned well with my goals. So, I spent considerable time teaching clinical skills and organizing other teaching sessions. At the same time, there were changes afoot within the University.
The teaching crisis had reached a point by the final years of my residency that there was a new emphasis being placed upon developing clinical educational leadership. I was poised to take advantage of that in getting the plum job that I coveted.
This was when I first received the “Go where you are needed” advice.
To set the backdrop. At this time, resident physician work-hour restrictions were just starting and lifestyle balance had suddenly become all the rage. In my PGY-1 year there were suddenly rules about not doing more than 1 in 4 on-call. By PGY-2 they were being somewhat followed and in my PGY-3 year we were even going home post-call by noon sometimes. This was a major counter-cultural push by my resident peers at the time. Those who didn’t follow all of the rules were frowned upon and the derogatory term “macho-doctor” was applied. Our resident union even had posters in the lounge to shame dissenters.
Within that backdrop, I was chatting with one of my faculty mentor/champions about where I saw my career going. We discussed what I wanted in terms of lifestyle, which types of clinical practice I found most interesting, how I wanted to teach because I enjoyed that. My focus was really on what I wanted out of my career and this line of discussion was a well-worn road from discussions amongst my contemporaries.
He then blew up my smoothly-paved-thought-road by simply saying, “You know. You haven’t mentioned the one thing that we all talked about while at your stage… Where am I needed?” I was left speechless. A rarity.
That shook me up because I had slipped from my altruistic-medical-student-thinking into a self-centered mode.
Neither extreme was optimal. This caused me to recalibrate.
In medicine, a purely altruistic approach of filling needs with little return can be sustained for short periods. However, the need is usually infinite and filling it may, or may not, be valued at a given time or by a given person. Unchecked, that can become medical martyrdom and contribute to burn-out.
A self-centered approach is also ultimately detrimental. You need empathy and compassion to practice medicine well. Further, one of the greatest rewards for practicing medicine is the feeling of self-worth generated by making meaningful contributions. Those who practice medicine for money without empathy or regard for the rewards to their karma don’t last long. Most leave, or if really bad, they get forced out.
What is optimal is a balanced symbiotic relationship. Ideally, “Going where needed” means that you fill a need and have your needs met by doing so.
What did I learn from my early dances with “go where you are needed?”
- Doing work that is interesting or challenging is still often cited when people talk about job fulfillment.
- That work is more fulfilling when it fills a need.
- That need may be undervalued in terms of financial or professional recognition, but those imbalances often right themselves eventually.
A healthy sustainable medical career involves finding symbiosis. To do that, you must not only “go where you are needed” but you must also be rewarded for doing so. We make many choices with consequences that influence our chances of success. Often, we won’t get them all perfect. That is ok. A sacrifice-reward imbalance can be tolerated for periods of time. However, too much altruism leads to a burnt out doctor while selfishness simply makes for a bad one.
In the next chapter of the Loonie Doctor Wolverine origin story, the rubber really hits the road as I move from resident to attending physician.
That one piece of advice from my mentor, “Go where you are needed”, has guided me since.
It has propelled my career to make it richly fulfilling, and well, made me rich. Join me next week to learn how.