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Do you have an intentional or accidental practice?
Thinking more deeply about your personal life may affect what you want to do with your practice as a business.
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“The greatest discovery of my generation is that a human being can alter his life by altering his attitudes of mind.” – William James
“The price of anything is the amount of life you exchange for it.” – Henry David Thoreau
“Nobody can go back and start a new beginning, but anyone can start today and make a new ending.” – Maria Robinson
It is Sunday afternoon, and I just got off the phone with a client. He is 50-ish. Veddy East Coast. Quite conforming with the status quo, probably going all the way back to the expectations and rules of his parents and first teachers.
He has absolutely no idea how he got where he is today, except by putting one foot in front of the other at the insistence of others, without self-planning, without internalized expectations, without self-intention. So it is not surprising that now he is asking for yet another outside opinion on what he should do with his life and practice.
It does not matter if your intent is to maintain the status quo of a modest practice or shoot for great commercial heights. Being more internally intentional — and not simply directed by those around you — ups the odds of achieving what you want and not winding up like this gentleman, Dr. Puppet, who after all these years is still unclear about what he truly wants for his professional life.
Before even thinking about what you want in strict practice terms, it is helpful to know what you want for your life. Listen to your own heart (or brain or guts or solar plexus).
Making professional choices
If you are a practicing ophthalmologist, you have already chosen a profession that has obliged you to trade about 4 prime years of your youth for perhaps a $200,000 or greater annual earnings premium over what you would have earned as a general practitioner. You can either spend that roughly $6 million lifetime earnings premium on more take-home pay and material possessions by working the usual 45 hours a week as an eye surgeon, or you can trade in that earnings premium for more free time.
If you work half-time as an ophthalmologist, you will earn about the same as you would have as a family doctor. And you will gain about 32,000 hours of free time to fill with passions that may exceed your passion for eye care. As a young person before starting a family, or as an older surgeon with the kids grown and the retirement fund nicely topped up, it is absolutely your choice. Are your actions today aligned with your intentions?
This same choice over how many hours of your life you spend at your profession can be applied to how these professional hours are spent. And that choice, in turn, reveals many other forks in the road:
- The choice of financial abundance or mere sufficiency, with the former generally obliging greater time, greater risk or both
- The choice of being a durable employee or being an owner
- The choice of private vs. institutional practice (working for a hospital, clinic or government branch, or a life in academics)
- The choice of being on the technical cutting edge or being more conservative
- The choice of comprehensive or subspecialty practice
- The choice of rural or urban practice.
Changing your choices
If you are now 40-something or 50-something and in the middle years of your career, ask yourself: “Did I take the right path? Is this where I’m supposed to be? If not, what would it cost for a do-over a couple of forks ago in the road? Am I willing to pay that price?”
Pursuing an intentional professional practice is not just for new graduates. In a career as financially abundant as ophthalmology, you can pivot to a different context. Even if you are now relatively locked down in mid-career — and mid-mortgage and mid-parenting — there are daily decisions to be more mindful and intentional about. With a little bravery, and a bit more self-liberation and self-actualizing, you can break out of old habits:
- Firing tiresome patients and staff
- Starting clinic at 10 a.m. if you are really not a morning person
- Referring out complicated cases you currently grit your teeth through out of a sense of ego or pride
- Driving the exotic sports car you can readily afford, instead of the beater sedan that you think sends the “proper message”
- Leaving the bespoke suits, Italian shoes and choking ties in the closet, and seeing patients in scrubs and Crocs
I know surgeons who, after considering their lives and getting more intentional, are ramping up their businesses to mitigate expected fee reductions. And I know several ophthalmologists — at every career stage — who are leaving for a life of mission work, early retirement or at least extended sabbaticals. Such self-actuated surgeons are among the happiest in America today.
It is important to surround yourself with people who will help you self-actuate. Is your spouse just a substitute for a controlling parent or someone who encourages your authentic growth? Do your partners encourage exploration or conformity?
Practice administrators can be cleaved into roughly two cohorts: those who want to build the practice of their dreams and those who want to build the practice of your dreams. Pick the latter kind. Do not be harassed by a business manager with more ambition than you into creating a professional life not suited to your temperament.
Finally, realize that the business cognate of creating a more intentional personal and professional life involves writing a longer-term business plan. Indeed, the absence of formal business planning in many practice settings is indicative of a lack of personal life-planning insights on the part of the owners. The two domains are hinged to each other.
If you are stuck on what you want to do with your practice as a business, it can indicate a need to think more deeply about your life, and vice versa.