In medical school, when it came time to choose a specialty, I was kinda fed up with being a student. I decided that training for 2 years to become a family doctor would be the fastest way out. I wanted to stop training for life, and start living it as soon as possible.
Together with a classmate (and good friend), we had planned it all out. We would train together, and eventually open up a joint practice in our hometown.
Unfortunately, we didn’t get the same residency, and I went off to the Maritimes to do my training. I was in a program where I moved around every 4-8 weeks doing different rotations all over Atlantic Canada. My car was my home base and I had 8 banker’s boxes I could squeeze into my trunk with just enough room to slide a suitcase on top.
Then an interesting thing happened. When I was doing my surgery rotation, I loved surgery. Same for cardiology, pediatrics, and emergency medicine. But when I was doing family medicine, I really didn’t enjoy it.
Suddenly, things started to look different. I thought: in five years, whatever I’m doing is what I’ll have to do for the rest of my life. Suddenly a longer residency didn’t seem like too high a price to pay if it would mean that I’d be doing something I really loved.
Right around that time, I was working with a respirologist who suggested to me that I should consider doing anesthesiology. Now, I should say that my very first clinical rotation as a 4th-year med student was 3 weeks of anesthesiology. And I hated every minute of it. It was a bunch of things I couldn’t do, and drugs I’d never heard of.
Nevertheless, he introduced me to an anesthesiologist who invited me to spend a couple of days with him in the operating room. To be completely honest, what appealed to me most was the portability of a practice in anesthesia, and not needing to run my own office. However, I did think it looked cool.
So at the end of the first year, I decided to leave my family practice residency and apply for a training position in anesthesia.
As it turned out, anesthesiology was a much better fit for my interests and personality than family medicine could have ever been. It amazes me to think that the entire trajectory of my life was altered by just one conversation.
I was reminded of the above recently when this sequence was articulated perfectly for me in Clayton Christensen’s book How Will You Measure Your Life?
He says that we are always navigating between our deliberate strategy and unanticipated alternatives that emerge. Neither is inherently better or worse— our circumstances dictate the best approach.
He suggests that job satisfaction is not a continuum, but rather that job satisfaction and job dissatisfaction are two separate and independent variables.
Job dissatisfaction relates to what he calls “hygiene factors”. Things such as status, compensation, job security, working conditions, institutional policies, and supervisory practices. If these factors are managed well, we will experience an absence of job dissatisfaction. I think these factors are responsible for many of our challenges practicing medicine in a post-pandemic world.
However, in order to experience satisfaction with our work, we need “motivating factors”. Like challenge, recognition, responsibility, opportunities for personal growth, and making a meaningful contribution. Now this is beautiful because the practice of medicine has these factors in spades.
If you are feeling a high level of job dissatisfaction, consider giving “equal airtime” to all the reasons why you went into medicine in the first place that are still true. And here’s a tip: what we focus on expands in our minds. So intentionally spend some time every day focusing on what fulfils you in your work.
Christensen says “Depending on your particular circumstances, you should be prepared to experiment with different opportunities, be ready to pivot, and continue to adjust your strategy until you find what it is that both satisfies the hygiene factors and gives you all the motivators.”
I think many physicians forget they have the power to experiment, pivot, and adjust. We have mostly been taught cookie-cutter models of what our work life should look like, and we can fail to recognize how much freedom for self-determination we actually have.
If this resonates with you, and you’d like to explore your freedom to create more job satisfaction, I’d love to help.