Results from a highly preliminary ophthalmologist study reveal signposts for career, life happiness

Part 3 of a three-part series: respondent comments, practical pearls from a study of life satisfaction among eye surgeons.

John B. Pinto

Craig N. Piso

Introduction

What makes a merely good ophthalmic practice great? This is the last column in a three-part series exploring the determinants of eye surgeon happiness and satisfaction.

In this first, highly informal effort to measure ophthalmologist happiness, we employed a standard psychological profiling tool, the Quality of Life Indicator (QOLI), and used a methodology described in part 1 (www.osnsupersite.com/view.aspx?rid=51000) of this series.

In part 2 (www.osnsupersite.com/view.aspx?rid=59737), published last month, we discussed the core findings:

lThe most satisfied doctors appear to be those who manage to live on smaller percentages of their personal incomes, those who have very busy clinic volumes, those driven by feelings of self-esteem, and those who intend to have a much longer career span than the rest of their colleagues who filled out this instrument.

lThe available data suggest, but certainly do not confirm, that the somewhat less-satisfied doctors are those whose happiness is more financially derived, those in higher income brackets, and those who describe themselves more as leaders than followers or peers within their group practice setting.

We believe it is entirely appropriate for managing partners, practice administrators, consultants and others to study the satisfaction of the surgeons we serve, work to increase their sources of potential happiness, and limit sources of frustration and unhappiness.

In this last segment, we note comments made by respondents and explore practical pearls and actions you can take in your own practice.

Time

Very few eye surgeons — and certainly very few of the caliber seen in the large practices participating in this study — do a great job of balancing work with other aspects of life. The selected comments below get at the conflict inherent in devoting time to attaining and maintaining status as an expert, as well as the allure of workaholism in any fee-for-service environment.

• “I never get enough time off.”
• “I don’t get enough time to relax.”
• “I always feel behind and never have time to be creative.”
• “There’s not enough time to pursue personal interests, hobbies.”
• “I would like to trade income for more play time, but am afraid of what would happen if I did this.”
• “Although an MD, I don’t have time to tend to my own health or exercise.”
• “I have more interests than time.”
• “There is not enough time for friends, exercise, spouse, children, hobbies. Just working.”
• “Time is the major constraint on my creativity, play and learning.”
• “Time, time, time, time, time.”
• “Not enough time. Not enough time. Not enough time.”
• “Not enough time to exercise or will-power to eat right.”

Relations with others

Through the years, most of our male eye surgeon clients have reported to us that they believe they have fewer and shallower friendships than non-doctors. The comments below corroborate this impression:

• Limits on raw time to find and nurture relationships
• The large intellectual and income disparity between most physicians and most non-physicians
• Little time for hobbies, which would allow one to rub shoulders with those having similar interests
• A professional life with thousands of patient-acquaintances, dozens of lay support staff, but in most cases few economic or educational peers at work (unlike the typical corporate environment, where executives commonly have scores of peers with whom friendships can be cultivated)

Consider the comments below in the context of research indicating that by far the greatest predictor of happiness is intimate relationships.

• “Not many friends.”
• “I have a problem getting along with others.”
• “I don’t get along well with others in my practice.”
• “Constant bickering with partners makes long-term planning a challenge.”
• “Partner discord prevents us from coming up with a plan to help our community.”
• “Relationship issues with parents, siblings are upsetting.”
• “Most of my friends live around the country, not in my town.”
• “I feel professionally isolated only working with docs in our group and not with the wider community.”
• “Non-physician friends don’t understand me.”
• “The friends I have are self-serving and not genuine.”
• “I have few friends of high quality and longevity.”
• “I find it hard to make friends in our community.”
• “Little or no contact with my siblings for many years.”
• “Like most men, I don’t feel I need a lot of close friends.”

Security and validation

It is ironic that eye surgeons, being among the most fiscally secure and societally admired professionals, should harbor some of the feelings expressed below. Whether reasonable or not, these feelings are valid to those who have them and can create a challenge for the executives, staff, peers and advisors who work with such individuals. The underlying insecurity that commonly drives ophthalmologists to attain professional greatness does not go away when the pinnacle is reached.

• “I’ve worked so hard to have what I have; but it’s not 100% safe.”
• “We are the only business where we are paid by our enemies.”
• “My spouse/family don’t appreciate why I work so hard to secure the future.”
• “I’m not financially ready for retirement, but I’m sick of working.”
• “It’s frustrating not having my high-producer status better rewarded by partners.”
• “Deep down, I’m afraid to try new things, like new surgeries.”
• “Payers and patients devalue the quality of the work I do.”
• “Getting harder and harder to save money.”

General comments

• “When it comes to learning, I’ve become lazy.”
• “The days are getting repetitive. … Not enough that’s new.”
• “Coming from a humble background helps me appreciate what I have now.”
• “I was once very creative … now stuck in a rut.”
• “I don’t think much about the future. … I’m more here-and-now-oriented.”

Closing thoughts

As happiness expert Bill O’Hanlon frames things, happiness can be boiled down to a simple SOAP acronym: social connection, optimism, appreciation and purpose greater than oneself.

We welcome your feedback on this modest first attempt to give you new tools to help your managers and providers flourish.

Practical pearls for consideration

1. Just because a provider has a great practice in terms of volume, don’t assume that he or she is happy. As a practice executive or managing partner, speak to your providers often enough to identify their unique perspectives, the influence of their outside life on practice happiness, and to gain insight on how more data or operational adjustments might improve their daily experience.

2. Consider using an instrument such as the QOLI or a practice-focused cognate of this tool you might develop on your own to track provider and senior staff happiness over time.

3. Because of the strong correlation between personal financial prudence and happiness, urge your providers to get competent assistance with family budgeting, retirement planning and asset management. In the highest-functioning settings, partners will all use one financial planner and share the results openly to assure that contemplated practice development initiatives are not unduly burdening any partner. This is especially important guidance at a time when medical incomes may be softening.

4. Encourage balance and boundaries. When a doctor is paid per visit or surgical case, and as practice profits inexorably erode, it’s easy to creep into workaholism, robbing time from other dimensions of life. If finding balance is a chronic challenge that is adversely impacting the clinic, urge the affected individual(s) to seek professional counseling. Like alcoholism, workaholism is progressive and can ultimately be fatal — if not in a literal sense, then certainly to a provider’s relationships and happiness.

5. Addiction can occur with positive stimulation of the pleasure center of the brain and with the accompanying negative rebound effect of withdrawal. Ophthalmologists must recognize the inherent risks of becoming addicted to their work. Factors that can predispose a person to workaholism in ophthalmology are: 1) tremendous earning potential matched with feelings that it is never enough; 2) low self-esteem, which is temporarily (but never satisfactorily) uplifted via recognition, a position of power and material affluence; and 3) an external locus of control wherein a person feels driven, rather than being the driver of his or her life, thereby becoming vulnerable to external pressures or rewards without a sufficiently strong inner compass to resist temptations to act compulsively. The most driven people tend to abdicate responsibility for their unhealthy behavior, often with a sense of being victimized without having control or recourse. Here’s a useful metaphor: People with a healthy, realistic sense of personal power and responsibility are more like the wind than the weather vane; they drive themselves with a sense of freedom, influencing their world and others around them, while less powerful people subscribe to a sense of passivity, helplessness and spinning in reaction to forces and people, simply turning as the winds blow. Therefore, become the wind, living powerfully with free choice and emotional independence fueled by strong core values and self-determination.

6. Because a lack of personal friendships is a long-seen phenomenon among many male ophthalmologists, don’t rely on accidental encounters to make new friends. Start a hobby and join a local interest group. Join a sports team. Launch a rotating dinner with a few compatible couples. Become involved with your hospital’s management team. Orbit a local community cause. Lean on your spouse to be the social director in your family. In group practices, use a regular journal club or board meeting, held over a relaxed social dinner, to create deeper interpersonal ties. At the very least, get a dog.

7. Regarding time, recognize and accept that you will never have more than 24 hours in any given day, about 8 hours of which must be devoted to regular sleep hygiene in order to sustain basic physical vitality, mental sharpness and emotional well-being. The happiest and most productive physicians in the long term take personal responsibility for the choices they make, including how they spend their time. Remember, you don’t “have to” do anything. Everything you do is by choice and under your power, for which you and only you are responsible. You will free up more time to do more of the things you desire by saying no to other things, recognizing without resentment or regret that we can’t have or do it all. With balanced planning and execution, you can have your cake and eat it too, simply by taking smaller bites.

8. Write down your long-range vision and plans for success in your life — including but not limited to your career, which is a dramatically important but not exclusive source of reward and fulfillment. Crafting and living by such a plan requires maturity and effective self-management. Try to plan your life outcomes as deliberately as you plan for clinical and surgical outcomes. Remember that the happiest people will often say, confidently and without regret, “I could be making more money, but paying the time toll to do so doesn’t fit my goals and priorities. I’m doing what I want to do, and I have all that I need. In the choices and trade-offs I’ve made, I’m right where I choose to be.”

• John B. Pinto is president of J. Pinto & Associates Inc., an ophthalmic practice management consulting firm established in 1979. He is the author of John Pinto’s Little Green Book of Ophthalmology; Turnaround: 21 Weeks to Ophthalmic Practice Survival and Permanent Improvement; Cash Flow: The Practical Art of Earning More From Your Ophthalmology Practice; The Efficient Ophthalmologist: How to See More Patients, Provide Better Care and Prosper in an Era of Falling Fees; The Women of Ophthalmology; and his new book, Legal Issues in Ophthalmology: A Review for Surgeons and Administrators. He can be reached at 619-223-2233; e-mail: pintoinc@aol.com; Web site: www.pintoinc.com.
• Craig N. Piso, PhD, is president of Piso and Associates, LLC, an organizational development and psychological services consulting firm based in Northeastern Pennsylvania. A consultant/psychologist with 30 years of corporate executive and clinical practice experience, Craig is the author of a new book, Dream of Life … Live Your Dream – A Manual of Skills for Living for Today’s Young Adults. He can be reached at 570-239-3114; e-mail: cpiso@pisoandassociates.com; Web site: www.pisoandassociates.com.