When was the last time you walked out of an exam room thinking “Yes! Now that’s what being a family physician is all about”? If you’re like most family physicians, the enjoyable moments are few and far between these days, crowded out by the everyday frustrations of working within the current health care system. Still, some physicians continue to thrive, enjoying medicine today as much as or more than they did when they first put on a lab coat. What are their secrets? Above all, according to several, enjoying practice means finding new ways to challenge oneself and approaching every situation with self-confidence; an upbeat, warm attitude; and a keen eye for humor and joy. Here’s how they do it:
Be all you can be
“Focus on what you do each day and how you can do it better,” advises Karl Singer, MD, a 29-year veteran of family medicine. Singer practices with five other physicians and two nurse practitioners in Exeter, N.H. “I try to do multiple things within medicine to stay fulfilled,” he says. “It means I always have something different to think about or look forward to during the course of the day. I think that constantly trying to improve yourself and keeping up-to-date are the things that really make practice fun.
“For example, my practice has a journal club that meets once every month or two. All the medical personnel get together to talk about articles or conferences or interesting or challenging patients,” Singer explains. “Other people have different approaches to problems, they’ve learned new things when they’ve gone away to conferences, they read journals that I don’t read. They can bring approaches to management that will improve what I do.”
Staff members at Singer’s practice don’t just read about and discuss clinical quality improvement; over the past few years, they’ve embarked on four quality improvement projects of their own. “We’ve looked at our immunization rates and the quality of our Pap smears,” Singer says. “And we’ve studied and restudied our management of congestive heart failure. Now we’re looking at how we manage our patients with diabetes.”
Quality improvement projects make practice more enjoyable, Singer says, because “they help us make sure that we’re doing as well as we think we are and they give us ways we can improve the quality of our care.” And in the end, he says, “we not only say we’re doing a good job; we can prove it.”
Follow your passion
For some physicians, medicine is their passion. Others recognize that keeping their enthusiasm for medicine strong necessitates combining it with other interests.
“I enjoy doing a mix of things,” says Carolyn Thiedke, MD, a family physician in the Department of Family Medicine at the Medical University of South Carolina in Charleston. “I enjoy doing patient care but also teaching and writing. I’ve even done a little bit of research.” Thiedke, a member of the FPM board of editors, moved to the academic world about three years ago, after 10 years in private practice. “I also try to keep a ‘growing edge’ by developing expertise in new areas,” she says. “It’s important to keep curiosity alive and explore new ideas.”
Singer also thinks finding new challenges and new ways to feel accomplished are paramount to fulfillment. “Try to do new things and keep your vision broad,” Singer advises. “If you’re a little bored with what you’re doing, look for another way you can use your medical knowledge.”
That’s exactly what Matt Lewis, MD, did. Lewis, a family physician, realized early on in his career that he didn’t want to see patients 60 to 70 hours a week. He currently splits his time between a staff fellowship in the AAFP division of medical education and an urgent care practice in Lawrence, Kan., so he can pursue another interest – technology. “I do some Palm development and some medical software development, and I’ve given talks introducing physicians to technology,” he says. “That’s been a lot of fun for me. I’ve noticed that whenever I’m working on something that I enjoy, the time just flies by and all of a sudden it’s time to go.”
Family physicians who continue to enjoy practicing medicine are always on the lookout for new challenges and new things to learn.
Family physicians may not always find fulfillment in clinical practice; those who don’t have expanded their expertise to other areas of medicine.
Keys to enjoying practice include hiring and keeping a great staff, cultivating good work habits and maintaining a sense of humor.
Lewis advises against buying into the notion that there’s only one way to practice family medicine. “Look for unusual job opportunities, such as job sharing,” he says. “Then you’ll have an opportunity to pursue other passions. If your passion is partly in clinical care, but you also have an interest in research or informatics or anything else, even if it’s outside of medicine, go for it. I believe in following your passion. Life happens now.”
Run a tight ship
There’s no doubt about it: Physicians who have found ways to streamline their practices for maximum efficiency have more time for their patients and for themselves. “I’m sure you can do the same amount of work in terms of gross production, working 35 to 40 hours a week or working 70 hours a week. But the people who do it in 40 are going to have a life, and they’re going to end up enjoying themselves more,” says Doug Iliff, MD, a family physician in solo practice in Topeka, Kan.
“To do this, you’ve got to have good communication skills,” he says, “because if you don’t you’re creating chaos, and no one enjoys working amid chaos. If you cannot clearly tell a patient what your expectations are and if you can’t clearly hear what the problems are, you’re going to have a lot of extra phone calls later on.”
According to Iliff, the most efficient family physicians make quick, consistent decisions. Standing by those decisions requires physicians to be assured of their own skills and abilities. “Insecure people are defensive, and that’s no fun,” says Iliff. “When you can’t stick with decisions, you confuse your staff, who depend on your consistency.
“For example, if you treat urinary infections the same way every time, then your nurses get to understand the way you do things. If you never take charts home with you, the nurses don’t have to waste time wondering if you’ve got charts at home. Consistency simplifies life.”
Iliff also encourages physicians to cultivate good work habits to get more work done in less time. “Don’t procrastinate,” he advises. “Leave with a clean desk at the end of the day. Make your decisions and leave them; don’t worry tomorrow about the work you’ve done today.”
Get your crew on board
A well-oiled machine doesn’t run itself, even if it appears to. Iliff promotes an “all for one, one for all” mentality in his practice. “It shouldn’t be a ‘job description’ mentality,” he says. “It’s not ‘you’re supposed to take care of that patient.’ It’s ‘we all pitch in and get the job done and then we go home.’ That makes for a happy office.”
“Your morale governs the morale of the whole office,” says David L. Albenberg, MD, a family physician working in a three-physician practice in Charleston, S.C. “It’s very important that physicians give the appearance of enjoying what they’re doing. If your staff sees you enjoying your job, they’re more likely to have fun doing theirs. That means smiling, laughing and relating to your staff and your patients.”
Hiring – and keeping – a great staff is key to an efficient and enjoyable practice. “Look for an office manager who will run your practice efficiently so that you don’t have to be concerned about the micromanagement of the practice, because that’s a deterrent to enjoying your work,” says Albenberg.
Julea Garner, MD, a member of the FPM board of editors and a solo physician working in rural practice in Hardy, Ark., emphasizes the importance of treating staff well. “Take care of your staff, support them, make sure they have what they need and teach them what you want them to do,” she says. “It just makes all the difference in the world.”
Iliff agrees. “The most important thing is to enjoy the people you work with,” he says. “The best way to do that is to treat your employees well and not have office turnover. If you’ve got people you like and they’ve been with you for a long time, I think you’re going to have a good time.”
Humor can be good medicine
Thiedke has cared for some of her patients since residency 15 years ago. “It’s very rewarding to follow them through all the major events in their lives and to gain their trust,” she says. “Over time, I’ve gotten a real sense of my patients and I know how to joke with them.” Adding humor (when appropriate) to patient interactions adds to Thiedke’s enjoyment of office visits. “With some people I can be silly; other times I can be dry. Some I don’t joke with at all,” she says. “The key to using humor is to match your demeanor to your patient’s demeanor.”
Albenberg sees the importance of using humor, too. “Patients often come to us when they’re in pain, when they’re sick and when they’re scared. They’re not in the best of spirits. We have a lot of work to do to change that very, very serious air into one of reassurance, levity and fun. That’s our challenge – to turn that around appropriately.
“Family doctors provide a tremendous amount of reassurance,” he continues. “Once we’ve done that, we can laugh along with our patients, and we can laugh at ourselves in the process.” (For more information about how to use humor when communicating with patients, see “Physician, Laugh at Thyself,” FPM, September 1998, page 72.)
Albenberg warns that physicians are in danger of taking themselves too seriously and suggests they take steps to add humor to practice. “It’s important for patients to feel there’s a sense of levity in the office,” he says. For example, his practice posts community bulletin boards filled with comics and articles that deal with medicine in a humorous way. Staff and patients are encouraged to add to the boards. Occasional syntax errors or typos in medical charts are other potential sources for humor. Albenberg suggests offering a prize to the staff member who finds the most ridiculous misspelling or funniest double meaning.
Eyes on the prize
When it’s all said and done, most of the joy of being a family physician is just that – being a family physician. “I expect that all contented family physicians enjoy their patients,” says Iliff.
Continuity of care is one of family practice’s unique blessings and the reason why many physicians make the trip to the office each day, so protect your face-to-face time with patients. “Enjoying practice is about being in an exam room with your patients, interacting with them on a human level, being with them during the process of healing, and taking your time doing it,” Albenberg says. “That’s why we all went into medicine.”
Singer agrees. “I really enjoy the fact that I’ve gotten to know these patients over a very long period of time,” he says. He has cared for several generations of the same families during his years in practice. “It means I can talk to them about what happened with their dad or their mom and show them how, if they change what they do, genetics doesn’t have to be inevitable.
“Work on focusing on the wonderful opportunity to get to know people and be a part of their lives and help them make their lives better,” he says. “You’ll inevitably run up against other doctors, people in your practice and patients who do things differently, but you have to try to accept that and be open-minded.”
Garner urges family physicians to check their day-to-day frustrations with insurance and billing problems at the exam-room door. “When I’m in the exam room I stay pleasantly ignorant about a patient’s insurance carrier,” she says. “I am able to treat everyone the same way. Patients seem to appreciate that and the day seems to go better.”
FPM ARTICLES ON LIFE BALANCE
“How Close Are You to Burnout?” Musick JL. April 1997:30–46.
“Rediscovering the Joy of Family Practice.” Thiedke CC. November/December 1996:32–40.
Take a taste of your own medicine
As a family physician, you urge your patients to take care of their health and find joy in their lives. The same advice should apply to you. “Stay a step healthier than your patients,” Albenberg says. “That means eating right and exercising, taking vacations and managing your stress. You have to do these things, or you’ll sound like a hypocrite when you ask your patients to do the same.”
Keeping your life in balance benefits you, your patients and everyone around you. (For more on balancing your professional and personal lives, see the reading list.) Make an effort to pursue interests that have nothing to do with family medicine. A good place to start is to spend more time with friends who do not have careers in health care. And once in a while, push aside that pile of medical journals and pick up that novel you’ve been meaning to crack. Or start planning your next vacation.
Above all, “get some perspective on what you want to do and what’s important to you,” says Garner. “Learn how to enjoy patients as they come and go, regardless of their complaints. Ground yourself outside the clinic with family, friends, hobbies, whatever is important … and look at your job as a job and as a part of your life at the same time.”