Physicians & Lifestyle Design

By Greg Bledsoe MD MPH

Over on Freelance MD, I've posted a couple of articles about taking responsibility for yourself and "building your own ship" , and we've also gone through a few common reasons why physicians aren't the best at career modification.

In this post, I'd like to spend a little time introducing you to the idea of "lifestyle design," something that has become a bit of a buzz-phrase in the business world but as far as I can tell hasn't penetrated the world of medicine just yet (for a lot of reasons).

I'll begin with a personal story...

When I jumped off the academic track in 2006, I wasn't exactly sure what I wanted to do as a career but I knew I wanted something unique.  My idea was to design a career that was flexible, fun, adventurous, and meaningful, all the while paying my bills and being a responsible spouse and parent.  Simple, huh?

I spent months thinking about how to do this as a physician.  I searched websites and blogs.  I spoke with mentors and colleagues.  I read the literature, all to no avail.  There seemed to be no conversation about a career like this in medicine.  I mean, there were a few articles about volunteer opportunities or non-traditional careers, but nothing really like what I was trying to create.  

What I found, though, was that while the medical community was silent about how to develop a very non-traditional and interesting career, the business world had already awakened to the idea.  Within the world of business, the idea of becoming a "free agent" and overhauling your career through "lifestyle design" was beginning to pick up steam. 

Around this time I picked up a copy of the book Free Agent Nation by Daniel Pink.  I'm not sure how I found this book, but it became a sort of manifesto for me.  In this book, Dan explains how more and more individuals were escaping their cubicles to become independent free-lancers and living their lives with increasing flexibility and empowerment.  It was a great read and it hit me at a very important time.  Through this book I realized that I was not alone in my desire for more autonomy, and that a lot of workers who had already yanked themselves off the grid were thriving.  I was hooked.

The second book I read was a book that has become a bit of a cult classic already, Timothy Ferriss' text, The 4-Hour Workweek .  This book is a basic introduction to how Tim built a stream of residual income and then used his extra time and money to explore his interests and live a more interesting life.  It was Tim's book that introduced me to the term "lifestyle design," and while the phrase might seem a bit hokey, it's a very powerful concept.  Basically, what Tim discusses in his book is the idea that it is possible to live an incredible life if you prioritize correctly, live frugally, and develop your entrepreneurial side.  Some have criticized the book recently, explaining that no productive person-- not even Tim Ferriss himself-- really only works four hours a week-- but I would argue that that's not really the point.  The catchy title sells books, but it's the mindset Tim describes that is the reason why the book is an important introduction for individuals who feel helplessly caught in a hamster wheel at work.  Tim's point is that you can-- through ingenuity and hard work-- leap off the hamster wheel and into something much better.

So how does all this apply to physicians?

Well, when you have a career discussion with most physicians, it often boils down to whether or not that individual wants to continue practicing clinical medicine or go into a nonclinical job.  There's nothing wrong with either, mind you, and I have friends who have great careers in each; however, for me and for many other physicians, I suspect, this approach is just too simplistic.

The fact is, I like clinical medicine.  I've spent a of of time getting good at what I do and I'd like to continue to be able to help people by providing good clinical care to patients who need it.  I also like many aspects of the nonclinical opportunities available to physicians-- things like consulting, writing, medical device development, and many other niches really appeal to me.

My main question is not whether I want to practice clinical medicine or jump into a nonclinical career, it's how do I design my life to be able to practice medicine, participate in the nonclinical activities I enjoy, and still have the flexibility to pursue life outside of medicine?  Discussions about clinical versus nonclinical are at their core too reductionistic for most modern physicians.  What most modern physicians really need to be having are overarching discussions about how to design a lifestyle that incorporates the multiple facets of their career interests and also does not overlook the ultimate (and most likely unspoken) goals they have for their lives. This is a much deeper conversation, but one that is desperately needed today in this time of significant upheaval in our healthcare system.

So where do you begin if you're a physician and you are interested in exploring this idea of "lifestyle design?"

Well, don't go to the career advice section of your specialty journal and certainly don't go to the HR person at your hospital or academic institution.  

In my opinion, you should begin by checking out the conversations going on in other fields.  There are some incredible websites built around some really creative and interesting people who are living fascinating lives and teaching others how to do the same.  Check out the following as a starting point:

• The Blog of Tim Ferriss: Experiments in Lifestyle Design
• The Art of Non-Conformity Blog
• Thrilling Heroics with Cody McKibben
• The Blog of Corbett Barr

Once you immerse yourself in this culture you begin to see possibilities that you never would have realized before.  What's more, as a physician there are even more possibilities available to you than for the typical person, if only you'll step out and take a little risk.

Over the last few years this idea of lifestyle design has been a focal point of my thinking when it comes to career moves and ultimate goals.  I've invested a lot of time, cash, and sweat into learning how to build a unique career, and my hope with ExpedMed is that we can use this website as a vehicle to help other physicians, just like you, succeed in designing a lifestyle and career they truly enjoy. 

As a medical school student, you can begin by using Uncommon Student MD to become familiar with all of the ways that you can leverage your medical degree and choose a lifestyle as a physician that you find most rewarding.

About: Dr. Greg Bledsoe is has founded a number of startups including ExpedMed, the Medical Fusion Conference and Freelance MD.

Interview With Dr. Steven Knope: Concierge Medicine, Medical School & Doctors Taking Control Of Their Careers

Steven Knope MD weighs in on concierge medicine, medical school, the future of healthcare, and doctors taking control of their careers.

The television show Royal Pains explores the thrills, challenges, and adventures of Dr. Hank Lawson an Emergency Room Physician who, through a simple twist of fate, became a concierge medicine doctor. Though I’m not an avid fan, I have seen a few episodes and remember thinking, “Sure it makes for great television, but nobody really does that...right?” Well I was wrong. Enter Dr. Steven Knope MD; he has become a leader and innovator in the field of concierge medicine. A quick look at Dr. Knope’s biography and you realize he is part physican, musician, athlete, and ninja. His bio includes a stint as a professional french horn player, triathlete who has completed four ironman triathlons, and a martial artist with a 3rd degree black belt in Kenpo Karate. He is a physician who has always been willing to chart his own course and follow his passion to deliver the best health care possible to his patients. I was able to catch Dr. Knope in between seeing patients and practicing Chuck Norris round-house-kicks to pick his brain a bit; here is what I learned.

How did you get started doing Concierge Medicine?

I was actually asked to start a concierge practice by 4 of my patients 11 years ago.  They wanted more of my time and more access to their physician. They liked my care, but they didn’t like having office visits limited to 10 minutes. They wanted a more personal relationship with their doctor. After they approached me with this request, my initial thought was that this type of practice model was “elitist” and “unethical." How could I limit patients access to my services to only the few who have the means to pay up front? These thoughts forced me to do a lot of reading and soul searching. I ultimately came to the conclusion that our current third-party system was in many ways unethical in it’s own right, and I decided I wanted to begin treating patients on my own terms. So, I started a pilot concierge program with just 4 patients, and it slowly grew into my present full-time practice.

What do you like best about being a concierge doctor?  

I enjoy having the time to practice good medicine and the freedom from corrupt insurance companies, HMOs and the U.S. Government in the form of Medicare.  In short, I am intensely individualistic, and I like practicing medicine on my own terms. For example, in addition to helping my patient when they are sick, all of my patients have a customized nutrition and exercise program. This type of freedom comes with a price, but I feel it is worth the price.

What does a day in the life of a Concierge Medicine Doc look like?  

Every day is different, which is why I like it. In my old practice, I used to see 30 to 40 patients every day!  It was mind-numbing. Every day was the same, and I was always running, always buried in trivial paperwork, always trying to meet my overhead – as Medicare, insurance companies and HMOs determined how much money I was allowed to make.  If you like servitude, you’ll love third-party medicine.  If you are an independent soul, you’ll need to get outside of this system.

What where some of the key lessons you learned while making the switch from a more traditional medical practice to becoming a concierge doctor?  

You have to develop entrepreneurial skills that you never were taught in medical school.  You have to learn to follow your own path and not pay attention to the crowd.  You have to question some of the group-think mentality that was taught in medical school.  As an example, I’ve publicly debated medical professors from academic centers on ObamaCare.  These people pretend to be geniuses in the field, yet they can’t, or simply refuse, to do the simple arithmetic and see that Medicare and Medicaid are going bankrupt. It really does not take a genius to realize that ObamaCare is insane.  They are ideologues, not thinkers.  Learn medicine from your professors, because this is what they know best; but don’t internalize their liberal, socialized medicine dogma without thinking long and hard about it. It is just a simple fact that many academics could not run a private medical practice if they wanted to because they simply do not understand the first thing about making a payroll, paying an overhead, or the basics of “eating what you kill."

What is the best piece of advice you would like to give to today's aspiring doctors?

Think for yourself!  Internal medicine and family practice has sadly become a bad job under the third-party system; there is just no other way to put it. It is almost no longer a profession. The word about primary care has gotten out to students, and very few young doctors are going into these areas of medicine. However, this means that there will be a shortage of primary care doctors, as the demand is continually increasing. There will be great opportunities for young doctors in these areas, provided that they are willing to go into direct practices, without the interference of third-party payers.

You have had some critics. What advice would you give to students on dealing with criticism?

Listen to the criticisms objectively, think about them, and then make your own decisions.  If you think the criticisms are baseless, ignore them.  It doesn’t matter what other people think of you.  Period! Personally, I could give a rat’s ass about what other people think of me.  I’ve written an entire chapter in my book, Concierge Medicine, on the ethical arguments on this topic.  I happily challenge any doctor to debate me on the ethics of our current third-party payer system.  The current system just doesn’t work.  It is corrupt and unethical to its core.  And if you think socialized, government-run medicine is the answer, reflect back on your experiences at any VA hospital.  Does the government provide great care to our veterans?  Not in my experience.  Big government, big business, and crony capitalism are not the answers for our broken system. These things are what broke the system in the first place.  We need to return to the days when doctors ran their own, small private practices if our goal is to provide compassionate, quality, personalized medical care to patients.

You seem to have a lot going in and out of medicine.  How do you stay at the top of your game as a doctor while still maintaining an active balanced lifestyle?

I love medicine, but there is more to life than medicine.  I’m a martial artist and an athlete.  I believe that being physically and mentally strong makes me a better doctor.  You only live once.  You want to be more than a doctor in your short time on this planet.  Be the person you want to be first; this will determine the kind of doctor that you become.

If you could recommend that every medical student read one book what would it be? (In addition to your book, of course)  

Atlas Shrugged by Ayn Rand!  Trust me on this one.  It is a long book, but it will change your life.  If you don’t have time to read it now, put it on your list and read it later.

More: Listen to an hour long interview with Dr. Knope from Medical Spa MD

Medical Specialty Aptitude Test

As every medical student knows, first year of medical school everyone is talking about all the funny new words you get to learn; Tenesmus is my favorite.

Second year is all about studying and USMILE step I. And third year is about deciding what type of doctor you will become. The classic surgery vs medicine approach is a good place to start, but beyond that most things begin to fall apart for a lot of people.

Advice on the subject is almost endless and I have found that the more people you ask the more answers you will get. Never-the-less, it’s good to ask lots of questions and find out as much as possible about your areas of interest. The Univeristy of Virgina has this snazzy Medical Specialty Aptitude Test that may steer you in a good direction. If you are still not sure however, here are son alternative ways you can choose a specialty.

The British Medical Journal published an article in 2005 by Boris Veysman called Physician, Know Thyself, it includes the algorithm, posted above, to use as a guide when choosing a residency. I’m not sure of the sensitivity and specificity but I think most physicans say it's pretty accurate. If that algorithm didn’t solve all your problems this video may help. ZDoggMD and Dr.Harry gives a nuanced break down of a few different types of doctors and what to expect if you decide to join their ranks. Don't let the beatboxing and Justin Bieber impressions distract you from the pearls.

There Must Be A Better Way

10 Steps To Avoid Becoming "That Doctor"

“What man actually needs is not a tensionless state but rather the striving and struggling for some goal worthy of him. What he needs is not the discharge of tension at any cost, but the call of a potential meaning waiting to be fulfilled by him.” - Dr. Viktor Frankl

Recently, I was examining a 4 year old boy who came to the clinic with a cough. As I bent my six foot five inch frame down to his level and pressed my stethoscope to his small chest, he watched me intensely. I flashed him a quick smile; he returned the favor and continue to observe every move I made. When I finished listening to his lungs, his curiosity could no longer be contained. He looked at me and said, “Can I listen to your heart now?” So for a moment we traded places; he became the doctor and me the patient. He was actually quite good at imitating me by quietly tuning in to hear my heart beat and prompting me for a deep breath by inhaling and nodding for me to follow suit. As he was finishing with my exam, his mother, beaming with pride, said, “He wants to be a doctor, and that’s what I want him to do too.” I chuckled thinking at once of my many sleepless nights, stress over exams, and the events with family and friends I had already missed in pursuit of this noble goal, and I’m just getting started.

As the little boy and his mom left the clinic, I began to think about the many overworked physicians I see or speak to, who started out like my young patient then slowly had the wonder and excitement sucked out of their physician experience. Some doctors have even responded to my questions for advice with, “I have no idea why anyone would want to go into medicine any more!” If I’m honest, sometimes I feel they may have a point. Then again, I have met physicians who still love the work they do. Over the weekend, I spent some time with a family friend who is an ER doctor. I asked if he got frustrated by all the “waste of time” consults he sees in the emergency department. Looking at me genuinely he said, “Every patient visit is an honor for me, I see them as a life I can touch.” I guess I shouldn’t have been taken back, but I didn’t expect that response from an ER doc with 30 years under his belt.

The question that begs to be asked is simple, "What’s the difference?" We have all met different versions of both doctors and one has to wonder what makes a doctor bitter, miserable, and look 10 years older than they should and the other still happy to examine or even reexamine a child with a cold because his pushy paranoid mom insists her son needs a prescription right now! Does it all come down to specialty, work hours, who gets paid more, or just personality?

This question is one that I am not qualified to answer, and is one that I will likely continue to answer throughout my career. However, I did find a great start in a comment Dr. Arlen Meyers posted in response to my post on Practicing Medicine In The Year 2050. You can read it there, but it’s worth a reprint.

For those who don’t know, Dr. Meyers is and ENT Surgeon, entrepreneur, author, educator, and CEO and President of the Society of Physician Entrepreneurs.

Here's what I would say to students interested in medicine:

1. Like anything else, follow your heart, not your parents.
2. There are lots of ways to make a difference with an MD degree other than seeing patients.
3. You will need to get your ticket punched (MD degree, residency) to do most of them.
4. Don't tell the admissions officer at the medical school that you have no interest in practicing medicine.
5. Hear all the people who are bitching. Just don't listen to them.
6. Don't be a slave to debt if possible. Sacrifice and pay it off as soon as possible.
7. Taking care of business is a part of taking care of patients. Start learning it as soon as possible on your own because you won't learn it in medical school.
8. Innovate
9. Innovate
10. Innovate

These ten steps are not a prescription for an easy, turn-key career, but they will allow you to have a career on your own terms. I believe that these 10 things will make the difference between physicians who continue to stay engaged and passionate and those who become jaded and defeated.