June 26, 2017

ER Doctor Transitions Into Teaching – As Told By a Curious Surgeon

Dear Readers, you are in for a treat today with this guest post by my client Dr. Sue Zimmermann, an orthopedic surgeon. As part of her career transition process, she met with and interviewed one of my former clients, Dr. Rob Baginski, who made the leap from Emergency Medicine into teaching in 2013.

Before the interview, Dr. Zimmermann shares some of her journey. Take it away Sue!

I started working with Heather over a year ago. At that time I had been in clinical practice as an orthopedic surgeon for over 23 years and was very unhappy in my job. I loved doing surgery and taking care of patients, but I was tired of being on call, having increased pressure to do more, being micromanaged by administrators, and feeling anxious over not being able to help everyone. I was planning to retire in a few years, and I wanted to plan for my future career doing something I was passionate about. The coaching process was my lifeline; it gave me something to look forward to, and every step I took brought me a little closer to my new career. I started teaching at a local medical school as a volunteer, working with a small group of students doing case-based learning. I discovered that after each class, I felt energetic and excited. It was not only rewarding to connect with students and guide them through the learning process, it was also fun! I decided that I wanted to incorporate teaching into my future plans.

The future arrived sooner than I had expected. I was recently laid off from my job with no warning, and I suddenly had a lot of time to explore a new career. It was a shock, but my preparation over the past year gave me a head start. Heather introduced me to a former client of hers, Dr. Rob Baginski, who had been a full-time Emergency Medicine physician and is now the Medical Director of the Physician Assistant program at a university near me. We initially met for lunch at an art museum, and during our conversation he told me about a program which brings PA students to the museum for lectures on the relationship between medicine and art. I was also able to observe one of his courses. What follows is our conversation about the path he took to become a professor at this university in Boston.

SZ: What were you doing before you started teaching? 

RB: I was working as a full-time EM physician. I had worked in various settings – a trauma center, community hospitals, and freestanding ERs. I started working with Heather as my coach because I just didn’t feel fulfilled in my work.

SZ: How did you start teaching at the University?

RB: Believe it or not, I was driving down the highway and I saw a sign advertising a teaching position at the PA school. I decided to apply for it. As part of the application, I had to give a lecture to the committee. My lecture was on Evidence Based Medicine, which is a big topic nowadays, and I was hired.

SZ: What previous experience did you have that helped you get the teaching job?

RB: I was a clinical preceptor for both medical students and residents. I had also given a lecture series for paramedics when I was the Director of EMS at a hospital where I used to work. I had also been an instructor in Health Sciences at a local community college for a few semesters prior to applying for the job at the University. Finally, I provided lectures and didactic instruction for the Emergency Medicine residents at a local hospital program.

SZ: What is your schedule like? Are you still doing clinical practice?

RB: Yes, I am still working one day a week in the ER. I teach four days a week, and as part of my position I serve on several academic committees. Most full-time academic positions require some committee involvement. I also do a lot of work outside of class preparing lectures, writing syllabi, grading assignments, creating exams, and evaluating students. As part of my job, I need to be current on educational theory – which is very different from clinical practice. For example, schools are emphasizing “differentiated instruction” to address students’ different learning styles.

SZ: What are some of the differences between teaching PA students and medical students?

RB: The PA program is two years; the first year is didactic and the second year is all clinical. So we have to teach a large amount of information in one year. Our curriculum includes traditional lectures and exams, and obviously the students have to prepare for their Board exams. We also have three medical simulations per semester. The simulations involve clinical scenarios in which the students have to make a diagnosis and come up with a treatment plan. We have different scenarios for each discipline in the health science school (i.e., nursing, physical therapy, physician assistant), and we conduct interprofessional simulations as well. Some of the simulations are geared toward diagnosing and treating illness, while others deal with, for example, how to give bad news to a patient and family.

SZ: What is “interprofessional” education? I’ve heard it mentioned a lot recently.

RB: Interprofessional education includes different disciplines in health care, such as MD’s, PA’s, nurses, pharmacists, physical therapists, etc. Students are taught to work as part of the health care team, using case-based learning. A lot of schools are moving toward this type of instruction.

SZ: Do you have any advice for physicians who want to go into teaching?

RB: My advice would be to get as much teaching experience as you can. The pay for part-time or adjunct instructors is minimal, so expect to be basically volunteering your time in exchange for experience and to extend your CV. You can approach schools in other allied health professions, although nursing schools tend to prefer nurses as instructors.

SZ: Do you miss treating patients? Doing procedures? I think I would miss doing surgery.

 RB: Well, I still do some surgery. I am a volunteer at a local aquarium, and I was asked to assist with a gastrostomy on a seal! I couldn’t find any seal anatomy references, so I read up on dog anatomy the night before – I figured it couldn’t be that different. When I arrived at the aquarium, I found out that I would be the surgeon, not the assistant! Fortunately the surgery was successful and the patient is doing well. I have also assisted with mandible resections and digit amputations.

SZ: Wow! So maybe I can still find a way to do some surgery in my future career. Thank you so much!

RB: You’re welcome – I’ll let you know about coming in to observe one of our simulations.

Postscript: I was able to attend a simulation a few weeks later. The students were given a scenario of a patient in an emergency room. They had to speak to the “patient,” examine her, and come up with a differential diagnosis and treatment plan. There were distractions coming from a “nurse” going in and out of the room and from the patient complaining of pain and asking for relief. After the simulation, the instructors met with the students for a debriefing.

I was impressed with the simulation, which was quite realistic. From my research, it appears that medical education is moving toward more simulation and case-based learning. Some schools are drastically cutting lectures, and are instead having the students learn the essential facts on their own and coming to class to apply the material. I think it will be a great improvement over the endless lectures that I attended in medical school, and I’m looking forward to becoming more involved in medical education.  

By Sue Zimmermann, a recovering orthopedic surgeon who lives in Massachusetts. 

A big “Thank You!” to Dr. Sue Zimmermann and Dr. Rob Baginski for their great contributions to this blog!

 

 

Leaving Medicine and Reentry – Know Before You Go!

doctor thinking

Hold onto that medical license and keep your stethoscope handy!

If you’re thinking about leaving clinical practice, don’t retire that license too fast or stay out of practice too long – unless you‘re lock, stock and barrel sure you’re not going back. Even then, it’s wise to keep everything current.

You may be burned out, wanting more time with your children, or needing to care for elderly parents. Perhaps you’re shifting into administrative work or have been enticed away to a start-up company. You might only intend to be away from practice for a year, but then before you know it, 5 years or 10 years have passed, or more. Maybe your financial situation has changed. Is it too late to return?

What is required to return to practice?

Depending on how long you’ve been out, your specialty, and other factors, it could be as simple as making a few phone calls, or it could be harder than climbing a double Mount Everest to return. And as with summiting Everest, no one guarantees your success.

Dr. Christine Stone, an internal medicine physician was gone for 14 years before she decided to return to practice. In her blog, Reentry Physician, she chronicles her return to primary care, which took 27 months and cost $40,000. To begin practicing again, Dr. Stone had to get her license back, pass her board certification, find a preceptor willing to supervise her, and then find a job. Every step took longer and was more difficult than she anticipated, but she made it and offers her blog as a way to help other reentering doctors.

What are the challenges to reentry?

Where do I start? First of all, each state sets their own policy on reentry, and close to 50% of the medical boards do not have a formal reentry policy (AMA fact sheet on reentry). Per the AMA’s 2011 medical board survey, 2.8 years is the average length of time out of practice after which some type of reentry program is required.

Second, the programs for reentry are few and far between, and they are not inexpensive. Each program has different features, but at a minimum, they involve some type of assessment to determine the physician’s knowledge base and clinical competence. The assessment phase on average runs around $10,000.  If there is a patient care component offered, it may be more of an observership or involve direct hands-on patient care.  The fees for this phase can be $10 – $20,000+, not including living expenses.

Dr. Stone did the CPEP Program (Center for Personalized Education for Physicians). CPEP is for physicians from any specialty who left medicine in good standing and involves two phases. Phase 1 is an assessment of clinical skills and knowledge base. Phase 2 involves practice-based learning which is usually done in the physician’s home community. It’s the physician’s responsibility to find a preceptor (supervisor), and this can be daunting.

After getting a lot of “No’s” when trying to find a preceptor, and even wondering if after coming so far, she was going to fail to meet her goal, Dr. Stone finally found a preceptor through a personal connection and was able to fulfill her reentry requirements. She is now working again in primary care.

Dr. Gould, a psychiatrist who had been out of practice for years filling several executive roles in healthcare, did the CPEP program as well. He also had an incredibly hard time trying to find a preceptor for the necessary supervision. About his reentry process, Dr. Gould recounted,

“Prior to starting the process I requested a meeting with the Minnesota Board of Medical Practice, having submitted my basic credentials to them, and asked them outright if, with the proper re-training, would they be willing to license me. If not, I wouldn’t waste my or their time. They were generous in being willing to preview my application and told me if I worked with a company they knew and had confidence in, like CPEP, they would. So, I immediately contacted CPEP and did whatever they wanted me to do, so when I returned to the Board, I had their approval.  Finding a clinical supervisor turned out to be the biggest problem in the whole process. I had my own malpractice insurance and was willing to pay a supervisor their hourly rate for supervisory time, but I needed some program that would let me see their patients as a mature trainee.”

After months of trying to find a supervisor, Dr. Gould’s persistence paid off and a connection from 20 years ago came through for him.

“All in all, Dr. Gould said, “the whole process took about 18 months and cost about $20,000.”

How About a Mini-Residency?

A reentry program in Texas has a solution to the challenges of finding a willing preceptor. The KSTAR/UTMB Reentry Program (A partnership of Texas A&M and The University of Texas Medical Branch) offers a mini onsite residency at UTMB in Galveston.

Physicians need to do a two-day assessment first to see if they qualify for the 3-month mini-residency. Most specialty and subspecialty programs will be possible for those who are eligible. Reentry physicians function as part of the medical team and have access to performing procedures. Liability insurance is available.

Another option is The Drexel Reentry Program in Philadelphia

Eligible specialties for the Drexel Program are internal medicine and subspecialties, pediatrics, OB/GYN, radiology, and anesthesia (other specialties may be possible). While there is no direct hands-on patient care, there is an extensive assessment followed by clinical rotations on the wards, simulated patient encounters, instruction, and feedback.

Lifeguard is a program in Harrisburg, PA open to physicians seeking reentry, including those who have been involved in disciplinary action or may not have finished a residency (depends on the state).

In an interesting twist on reentry, the Physician Retraining and Reentry Program (PRR) in California offers an online program for physicians wanting to reenter or transition into adult primary care. Physicians do not need to be from primary care to be eligible, and doctors from a variety of specialties, including surgery, have enrolled in this program. As a case in point, former urologist Dr. Michael LaRocque became restless in retirement and decided to do the PRR program. He now works as a primary care physician seeing patients at a federally qualified health center in California.

Is a formal reentry program necessary?

Every physician’s situation is different, depending on specialty, time away, state licensure, CME hours, etc. My recommendation is to find out what your state board requires.

One of my clients who left internal medicine for over a decade to raise her children just landed a great job at a progressive primary care clinic. She had kept her license active, and took an intensive Harvard Review Course to prepare for her boards, which she happily passed. She shared this information about her reentry for the blog,

“When I was starting my process, before I took my boards, I contacted Drexel, because I wanted to enroll. They told me to apply for jobs first, and if the employer required me to do a refresher program, to call them back. My current employer did not require me to do a refresher program. Before I started I did some shadowing of one of the primary care physicians. They are starting me slowly, seeing about 10 patients a day. So far, it’s been like riding a bike. My main questions are related to the EMR, and not clinical.”

If I’m transitioning to a non-clinical job, do I need an active license?

Many doctors are surprised to learn that a good number of non-clinical positions require an active license and even board-certification.

Do I need to keep clinically active to some degree?

If you are in a nonclinical job and are able to do some intermittent patient care (locums, volunteering, urgent care shifts, teaching, etc.) you could have a much easier time returning to medicine if you so choose. While this can be impractical for some jobs and specialties, it is worth considering and seeing what’s possible.

Does this mean I can’t take a break?

Absolutely not. I’ve seen doctors take significant time away and return without missing a beat.  Obviously, this depends on your particular situation, but for a reasonable time period, there is more latitude than you might think. Giving yourself time to recover from burnout, flex some different muscles, or devote time to family, can give you an entirely new perspective. Do your due diligence before you go, and if you plan to be out for a while, you might want to set aside some money in a “reentry jar,” just in case.

 

Considering Pharma? Check out the DIA 2017!

pharma reseracherLast year was a big year for pharma at the Doctor’s Crossing. Four of my clients landed great jobs in pharma and I attended the inspiring world-renowned pharmaceutical conference – The DIA Global (DIA – Drug Information Association).

One of my four clients had no prior pharma experience and she is now working happily as a Drug Safety Officer for a large pharmaceutical company. She is proof that you can get into pharma without having experience in clinical trials or research. 

In my on-going efforts to learn more about pharma, scout for opportunities for clients, and get a better feel for the community, I attended the DIA’s annual conference in Philadelphia last year. I was one of 6,454 participants and I loved every minute. There was an electricity in the air which I attributed to being amongst so many bright individuals who are passionate about improving the health of patients in profound ways. Before I share specifics about the conference, I want to give you an idea of positions open to physicians in pharma.

  1. Drug Safety Officer  (Pharmacovigilance)– involved with reported side effects from drugs, labeling, SAE’s (serious adverse events). Can include involvement in preclinical studies. clinical trials and post-market stages. Public education.
  1. Medical Monitor – advises on clinical trials, planning, and implementation. Monitors patients enrolled in trials for safety, side effects and suitability for study enrollment and completion.
  1. Clinical Trial Researcher – participates in and oversees clinical trial design and implementation. Actively involved in running trials and design.
  1. Medical Affairs Director– bridge between drug development, marketing, and public education. Involved with medical information, communication, launch and post-market strategies.
  1. Medical Science Liaison –a knowledge expert in a therapeutic area, develops relationships with KOL’s (Key Opinion Leaders) externally, resource for physicians in practice; educational and communications role. Frequent travel.
  1. Medical Writer– prepares regulatory documents, slide decks, scientific articles, white papers, covers scientific and medical conferences, etc.
  1. Regulatory Affairs Director – knowledgeable about FDA regulations, prepares and submits regulatory documents, negotiates for market authorization for drugs and devices, keeps informed regarding legislative changes.
  1. Health Economics and Outcomes Researcher (HEOR) – concerned with the cost-effectiveness of drugs and devices, value, as well as the impact of treatments on patients.

 For a more complete description of these positions for physicians, please click HERE. (Note – the job opening links are no longer active).

Click HERE specifically for the Medial Science Liaison.

Sameer Thapar (PharmD), Director of Global Pharmacovigilance for Oracle, and one of the speakers at the DIA, shared a simple way to think about the complex array of jobs in pharma. He said, “There are the Makers, the Sellers, and the Defenders.”  The Medical Affairs and Medical Science Liaison positions help to bridge these three areas (my addition).

When considering a transition to pharma, you may wonder whether or not you would miss patient care and if you’d feel like you were making a difference in a meaningful way.

Dr. Kelly Curtis, my former client who now works remotely as a Medical Director and Medical Monitor for INC Research said this about his transition, “I find non-clinical work very rewarding and feel like I make more of an impact on the future of oncology in this role than when I was in academia.” 

I personally know a pediatrician who works remotely for pharma and he does a few pedi-urgent care shifts a month to keep his clinical connection to patients.  Although maintaining some degree of patient care while working in pharma is not the norm, some doctors find ways to do this through volunteering, medical trips abroad, or attending in a teaching setting.

The satisfaction from helping an individual patient can shift to helping entire populations of patients. Dr. Larry Brilliant, who gave the DIA 2016 Keynote address, recounted his fascinating involvement in eradicating smallpox and his on-going efforts to prevent and treat blindness in millions of individuals in developing countries. You can read about his amazing life’s work intertwined with his spiritual journey in his hard-to-put-down new book, Sometimes Brilliant

Here are some of the Hot Topics on tap for DIA 2017:

  • Data/Big Data/eHealth – informatics, data integration, bioethics
  • Disruptive Innovation – innovative science, technology and therapies: stem cells, regenerative therapies, gene therapies
  • Medical Affairs – MSL (medical science liaison), medical writing, medical affairs roles throughout product lifecycle
  • Patient Engagement – patient-centric practices, advocacy, culture, tools
  • Safety – best practices, post-market safety considerations, monitoring
  • Regulatory – advertising and promotional laws, regulatory writing, document management, compliance
  • Special Populations – Rare diseases, pediatrics, women’s health, aging
  • Preclinical and Clinical Development – discovery, clinical research, recruitment, clinical trial data disclosure, outcomes, statistics
  • Value and Access – drug pricing, reimbursement, access, real world outcomes

For additional information on the Hot Topics for DIA 2017 please click HERE.

For the Agenda for the DIA 2017 please click HERE.

I particularly enjoyed a panel presentation on “Big Data” with oncologist Dr. Brad Hirsch, CEO at SignalPath Research. Dr. Hirsch continues to see patients as well as work in pharma in the areas of informatics, innovation and gene-based therapies. You can tell he loves caring for his patients, and also being at the cutting edge of finding cures for the cancers that threaten their lives.

If you’re considering pharma, attending the DIA will give you a deep dive into this area, as well as the chance to make helpful networking connections. And your attendance would be an undeniable indication to any hiring authority of your genuine interest in this career direction. This is just one of a number of ways to increase your chances to land a pharma job.

Even though my time at the DIA was beyond busy, especially since I made a point to network at all of the exhibitor booths (pens anyone?), I left energized and uplifted. Call me pollyanna, but I felt that I was among a large group of people who really care about giving patients the chance for healthier and longer lives.  As physicians, and as individuals with loved ones, we know personally how devastating having an untreatable condition is, or having a poor quality of life due to illness. Pharmaceuticals are, of course, only part of the answer to good health, but when nothing else works, the right drug is truly a miracle.

The DIA 2017 will be in Chicago, June 18 – 22. 

 

 

 

 

 

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2017 Conferences – Could One Lead You to a Happier Career?

armadillo-pixabay

One of the many things I love about my work is getting to attend conferences to explore new career options for my physician clients. I search out both non-clinical directions as well as ways to be happier as a clinician. I always learn a tremendous amount, meet interesting people, and gain a better sense of the opportunities available for doctors.        

And I usually have some fun too! The life insurance conference in Austin was no exception. On the final night, we were treated to a Texas-style party complete with dancing, a live band, BBQ, and something I’ve never seen before – armadillo races! Actually, it was one race. Armadillos, it seems, prefer bug hunting and running in erratic circles to going for the gold!

Attending a conference can help you:

  • Gauge your interest level in a specific area
  • Network with those who have already transitioned
  • Find out about job opportunities and hiring trends
  • See if the attendees feel like your “tribe”
  • Learn more about the pros and cons of a new area
  • Have some fun and get out of dodge for a few days

As doctors, we often don’t really know what’s out there. We may think working for a life insurance company means selling life insurance when the job actually entails using your medical knowledge to evaluate mortality risk. We may dismiss pharma as “going to the dark side” when there are many dedicated physicians working with integrity and high satisfaction in this diverse field. We may still want to practice, but need a new approach to patient care. Below I have listed select conferences for this year. Since it is early in the year, some are just beginning to post their agendas.  Click on the links for conference details.

Medical Writing / Writing

Click here for the 2016 agenda – 2017 not available yet)
American Medical Writers Association Conference
November 1 – 4, 2017  Orlando, Florida

The Life Examined – Exploring the intersection of the arts and medicine
October 12 -14, 2017 Iowa City, Iowa

Non-Clinical Careers
SEAK Nonclinical Careers Conference
October 21 -22, 2017  Chicago, IL

SEAK’s ongoing seminars on expert witness, consulting, IME’s etc

Chart Review/Disability
How to Start, Build and Run a Successful Disability and File Review Practice
February 11 – 12, 2017  Clearwater Beach, FL

Pharma
DIA Global* (largest pharma conference in the US)
June 18 – 22, 2017 Chicago, IL

Life Insurance
Click here for 2016 conference agenda – 2017 not available yet)
American Association of Insurance Medicine
October 15 – 18  2017 Atlanta, Georgia

Physician Advisor
Click here to read a blog about being a physician advisor

Physician Advisor and UR Team Boot Camp
July 19 -21 2017 Bonita Springs, FL

Physician Advisor Summit
March 20 -21, 2017 Orlando, FL

Functional Medicine
Institute for Functional Medicine
March 13 – 17, 2017 Huntington Beach, CA
(others in Washington, DC, Dallas, TX various dates)

Integrative Medicine
AIHM Academy of Integrative Health and Medicine
October 22 – 25, 2017 San Diego, CA

Lifestyle Medicine
American College of Lifestyle Medicine
October 22 -24, 2017 La Paloma, Tucson

Nutrition/Diet
Plant-Based Nutrition Healthcare Conference
September 24 – 27, 2017 Garden Grove, CA

Informatics/Electronic Medical Record
HIMMS* (largest informatics/EMR conference)
February 19 -23, 2017 Orlando, Florida

AMIA (smaller informatics/EMR conference)
November 4 – 8, 2017 Washington, DC

Physician Leadership
Amerian Association for Physician Leadership
Ongoing Institutes throughout the year
January, April, July, and November 2017

Coaching – Leadership, Wellness, Health, Lifestyle, Career, etc.
ICF International Coaches Federation Annual Conference
August 24 – 26, 2017 Washington, DC

Harvard Institute  of Coaching in Leadership and Healthcare
October 13 – 14, 2017 Boston, MA

Tips for getting the most out of a conference

  • Read the agenda in advance to assess your interest level
  • Bring business cards with your personal contact info
  • Pump yourself up to network and make connections
  • Join others for lunch and dinner – don’t dine alone or hole up in your hotel room
  • Talk with vendors in the  Exhibitor Hall to find out about opportunities for doctors
  • Take notes on the people you network with & follow-up
  • Have fun!

Suggestions for additions to this list are welcome!

Here’s to a great start to the New Year and a more fulfilling career!

 

 

Parental Pressure to Be a Doctor – Did This Happen To You?

mount-everest

I was lucky. I had parents who never tried to push me into a specific career direction. They held pretty loose reins and let my brothers and I chart our own futures. We became a physicist, an engineer, and a physician. When I announced I was going to be an Art History Major, I’m sure my mom and dad bit their tongues and scratched their heads. But they let me make my own decisions and my own mistakes. After a year of studying Italian Baroque painters, I was scratching my head too.

I know a lot of you have not been so fortunate. I hear your stories. One physician told me his mother recounts how she would push him around in his stroller, proclaiming to strangers, “This is my son and he is going to be a doctor.” He tried his best to live up to her expectations, but when he was in medical school, he called his mother up to tell her this decision was a mistake. She wouldn’t accept it and made it clear how devastated she would be if he quit. To help himself make it through, he used to imagine his medical school was made of glass. Pretending that he could see through the walls made him feel less trapped. Decades later, this physician is dealing with a deep sense of regret for having followed a path that was not his own.

He was able to make it through (for better or worse) but for some, the body and mind can revolt. One young physician, who had been “directed” into medicine by family pressures, began experiencing depression in medical school, which continued into residency and was compounded by chronic fatigue-like symptoms. Being unable to perform to expectations, despite having been a top-notch student, she left residency.

Over a period of time, her depression and symptoms resolved, yet if she took steps to return to residency, the symptoms abruptly recurred. She is trying to figure out the right career path for herself, but the challenge is compounded by external pressure. She shared with me, “Now my entire family (including extended family) is in a united front to convince me to continue in medicine, as long as it is a specialty acceptable to them. Overall, there was and is a lot of controlling in my family as it relates to my career… Parents really should give kids the opportunity to explore careers and decide for themselves!! At the end of the day, I have to learn to trust myself, right?”

Right! I wholeheartedly agree.

I do believe most parents genuinely want their children to be happy and successful. Many work very hard and make significant sacrifices so their children can have the best chance for a fulfilling life. However, when these good intentions are muddied with parental attachment to a fixed idea of what their son or daughter should do or be, there is no longer a clear space for direction to come from within. I’d be rich if I had a nickel for every time someone told me that growing up they heard, “You are going to be a doctor, a lawyer or an engineer.”

Medicine can be a great career but it’s challenging and places a lot of responsibility on the individual. There are considerable sacrifices – the years of studying and training, countless sleepless nights on call, the challenge of balancing work and family, the long hours, giving up outside interests, etc. The decision should really be one’s own. When we become doctors, we are the ones who are responsible for our patients. When there is a bad outcome, it’s our responsibility. When a patient dies, it’s on our heart. If we are sued, we are the ones in court. The joys are ours too, but they come with a price, and we need to have consented freely to that cost.

When my Uncle Tom was dying from lung cancer, he asked me to take him to a talk on the difference between love and attachment. The speaker held out a clenched fist to illustrate the concept of attachment. He explained that when we are coming from attachment, we hold tight and cling to what we want – whether it is a person, an idea or an outcome. Attachment stems from fear of loss and makes us resistant to other perspectives. He then opened his hand and stretched out his fingers so his palm was facing up. “This is love,” he said. He explained that love comes from trust and gives space to others. Love is not invested in having things be a certain way, but desires for truth to be revealed, even if it is painful.

In order for each of us to find the truth of who we are, we need the chance to figure out our own calling and purpose. It is one of the big mysteries and joys of life.

When I think of people such as Martin Luther King, Elizabeth Taylor, Georgia O’Keefe, Ben Franklin, and Ghandi, it’s hard for me to imagine them being anything other than who they were. What if they had all been told to be doctors? It’s hard to even conceive of this. What they did was so much a part of who they were. Whether we become famous or not, whether we have a “do-or-die” calling or not, we should still have the chance to find out who we were created to be.

No one else should be selecting our destiny for us. I doubt there are very few individuals who climbed Mount Everest because their parents wanted them to. Becoming a physician is akin to climbing a kind of medical Mount Everest. The choice should be yours. Everest needs to be calling you.

The physician stories were used by permission.