Like many physicians, otolaryngologists at mid-career may experience some form of burnout and be looking to make a professional shift. Indeed, a study published in the Annals of Surgery last year found that otolaryngologists had high rates of career burnout that paralleled those of trauma and vascular surgeons (Annals of Surgery. 2009;250(3):463-471).
One way for an active clinician to make a change mid-career is to shift from a heavy clinical practice to a more administrative role.
“When someone is well into their career, building a practice may not be as high a priority as defining the nuances of practice,” said Myles Pensak, MD, professor and chair of otolaryngology at the University of Cincinnati. “For a number of physicians, boredom sets in. There’s a routinization, and a mid-career change can invigorate them. It allows physicians to take skill sets from surgery, including timeliness, thoughtfulness, discipline and organizational management, and apply them in systems such as a college of medicine, hospital or health system.”
The key to changing course is to start with the right mentor, Dr. Pensak said. Mentors are often identified as key for junior faculty and otolaryngologists just beginning their careers, but they can be just as important for a more senior surgeon looking to make a change.
The type of mentor you may seek for a mid-career shift can be summed up with one initial question: Can you identify individuals who have already made the change you want to make?
“At the end of the day, most people know one or two colleagues who have gone through a transformative process or thrown out a wider net as to what it is they’re doing,” Dr. Pensak said. “Seek these people out.”
What if you don’t know anyone who’s made such a move? Pick up the phone and make some calls, Dr. Pensak said. Ask colleagues if they know of anyone who’s moved from a predominantly clinical practice to a role in hospital or academic leadership.
Another resource is the Triological Society. “A cornerstone of the society is that you have a group of senior, highly experienced, diversely backgrounded individuals who are available to tap into,” Dr. Pensak said. “Try people within the [American Academy of Otolaryngology-Head and Neck Surgery], and people in your residency programs. If you’re already in an academic medical center, seek out the wisdom of your chair, or the head of your department at your hospital.”
—Myles Pensak, MD
Experience You Need
Taking on a role in administrative leadership at an academic medical center, hospital or specialty society requires more than just a good mentor. It calls for experience beyond the surgical suite and clinical practice. Such experience is actually fairly easy to get if you’re willing to donate your time.
“Most hospitals and medical schools are happy to have people volunteer for management committees; of course, there’s not a lot of pay associated with it,” said Paul Levine, MD, Robert W. Cantrell Professor and chair of otolaryngology at the University of Virginia Health System in Charlotttesville. “It requires real interest in the operation of the institution. Once you get involved you’re like a charity, you get a thousand requests. But when you participate, you learn more about how the clock ticks.”
Similarly, a clinician can garner more practical experience with things like budgets, team building and business planning by getting involved in the administration of one or more specialty societies.
“You can start out as a council member, then become an officer,” Dr. Levine said. “Leadership isn’t limited to the institution at which you work. Any organizational role can help prepare you for an administrative career if it allows you to learn how to make decisions, handle systems efficiently, let people speak up and learn how to make everyone believe they’ve had input, even if the decision you make isn’t in line with what a particular individual wanted.”
It may be easier to get such exposure in an otolaryngology department, where the chair always needs help.
“We have the same amount of work to take on as internal medicine, but we often have fewer people to do it,” Dr. Levine said. “That’s a wonderful place to foster leadership skills: You’re in a small group, and you know your own faculty. Your chair, who has more exposure in the system, will then likely submit your name when there are activities to do on a wider basis.”
What if your goals are loftier, like medical school dean or hospital CEO? “That requires high-level skills in areas like fiscal management which are difficult to acquire informally; you have to seriously educate yourself on the business side, because it really is a shift in careers,” Dr. Levine said.
A number of institutions have graduate business education programs specifically designed for physicians. MBA programs, “mini-MBAs” (short programs that provide an overview of essential management skills, but don’t grant a full MBA degree), and other related coursework can often be pursued online or in intensive short courses. A few examples:
- The American College of Physician Executives (in partnership with the University of Massachusetts, University of Southern California and Carnegie Mellon): acpe.org
- The Alliance for Medical Management Education at the University of Texas: http://amme.utdallas.edu/
- Duke’s Health Sector Management programs: fuqua.duke.edu/programs/duke_mba/health_sector_management/
- Yale’s Healthcare Executive MBA program: http://mbae.som.yale.edu/
There is also Physician Boot Camp, a “comprehensive orientation to physician leadership in hospitals and health systems,” run by a division of the Advisory Board Company (physicianbootcamp.com).
Some physicians pursue career coaching when making this kind of major shift.
“The first thing that I do when I’m coaching someone in this position is to really explore what it is that they want. What’s the legacy that they want to leave in that particular job?” explained career coach Jim Merrell of Ross-Merrell Associates. “What are their specific goals? What are some recurring challenges? What are things in their current position that they’re ‘tolerating,’ and what would success look like?”
Once you’ve defined your successful shift, Merrell said, the next step is to “close the gap” between where you are now and where you want to be and to understand how to ensure success in your new role. A good coach, Merrell said, doesn’t have to be an expert in the field.
“One of the tenets of coaching is that the client has the answers, although he may not realize it. We take you through the process of exploration and discovery so that you can identify those answers.”
And some physicians don’t see the need for coaching. “My career coaches were my prior chairs,” Dr. Levine said.
“If someone is in search of guidance, you need to go out and get it. Most people are really willing to spend time sharing their knowledge, experience and perspective with you, but they’re not going to voluntarily search out mentees,” Dr. Pensak said.