John's Decision

A common theme I hear from physicians is this:

“I’ve lost confidence in my ability to pick a good job because I’m looking to leave…again.”

And honestly, healthcare is different than it was decades ago when physicians often stayed in one practice for 30–40 years. Expectations, systems, autonomy, complexity, and patient care demands have all shifted.

Job change is more common than many physicians realize.

So this week I want to introduce you to “John,” a fictional physician whose story reflects common struggles and questions I hear repeatedly in coaching conversations.

John is a mid-career family physician who left his first post-residency job serving the underserved, his long-term goal, within 3 years because the place felt chaotic and overwhelming.

He found a great job that paid him well and he had a more balanced patient mix. He enjoyed that job for a while. Eventually, he recognized that "enjoy" was no longer an accurate description. His experience had shifted to one of tolerance or endurance. The dysfunction of processes and policies without plans or progress were driving him a bit mad.

He transitioned again to a job with broad patient care, wraparound services, and strong team support. The problem? The patient volume and complexity became unsustainable.

And now he wants to leave, again.

Which led him to coaching with this conclusion: “Either I can’t vet jobs well, something is inherently wrong with me, or both.”

Over the next few weeks, I’m going to give you different versions of how John’s story played out to demonstrate different approaches, which in reality, can often be combined.

A. Recognizing and Changing the Story. The broken soundtrack playing in the background of John’s mind was “I’m bad at choosing jobs and because I haven’t stayed in one job something is wrong with me.”

Once he recognized it, he looked at variations of his automatic thought models. He discovered how that and other unchecked thoughts were affecting him.

Circumstance: Lots of facts about the job including patient volume and RVU targets, and time spent at work and as pajama time.

Thought. “I’m bad at choosing jobs and because I haven’t stayed in one job something is wrong with me.”

Feeling: Despair and Shame

Actions: Replayed his other jobs and found proof he messed up, overcorrects and is now looking for the “perfect job,” compares self to others that seem to have it all together to reinforce the story that something is wrong with him, fantasizes about leaving abruptly. Doesn’t explore options at current job and others in an objective way.

Result: Self-fulfilling prophecy. He chooses, stays, or leaves in ways that reinforce the belief something is wrong with him.

From what he’d learned about the thought model, he then decided to expand the circumstance line.

He was missing a lot of facts. He has a patient panel size smaller than the FQHC. He and his MA smile multiple times a day. He’s being paid $X. He’s off most nights and weekends.

After sitting with the full story, he was able to focus his mind on the believable but better for him thought “Medicine is both challenging and rewarding, and that’s okay” Feeling: settled. Actions: stopped looking for proof he’s messed up, stopped comparing himself, started asking what the most important parts of the job that he wants to enjoy and how he could get more of that. Gained Clarity. And made the next best decision.

(In this scenario, maybe he left for another position or maybe he chose to find contentment and joy in this one, or maybe he decided to influence the system from within, or to take on a part time leadership position but keep his patient panel, no matter what it was, was his decision, made from clarity and intention, and he then enjoyed it more).

Over the next couple of weeks, we will look at the remaining versions of John’s story that will include:

• Self-Assessment to Look for Blind Spots
• Having His Own Back
• Moving Towards, Not Running From
• Savoring the Lessons

Stay tuned.

Changing the circumstance without doing the work may not get you where you want to be.

Reflection: As demonstrated in John’s story this week, it’s easy for the negativity bias to take over and you leave the full complement of facts out of the circumstance line.

What circumstances may you be forgetting to consider or list?

How does that change how you think, feel, and act?