The Brave New World of Work

Career phenomena are all the buzz nowadays including "work from home," "quiet quitting," and now 4 day work week experiments. Moreover, there are larger questions about the role of independent contractors (eg, see the fights over the classification of Uber drivers) and the so-called "gig economy" as well as increasing competition from a global workforce as well as the rise of automation, chat GPT and more.

What's going on ?!

The pandemic has become the nexus and crescendo for a series of related questions about not only how we work but why we work. People are questioning the role of work in their lives and if the always on call lifestyle of our hyper-aggressive hustle oriented is really making us happy (see previous post on success and fulfillment).

Doctors, naively, seem to think that they are immune to these changes. "There are always sick people , after all." While this may be true, this doesn't protect medical providers from the larger shifts in the economy. Here is a rundown of the forces of which you need to be aware.

1) There is no such thing as job loyalty. A job only should be kept as long as it meets the mutual needs of you and your employer. The second it doesn't for either party, the position or the working relationship is terminated. 40 year careers are a thing of the past.

It doesn't matter if you trained at an institution and you stay there as an attending. As a house-staff member or junior faculty, you typically have some financial support from your home organization in order for you to learn and establish yourself financially whether from patient care or grants. But it a very short runaway. Money rules medicine. Same principles apply for community or private practice.

This is shocking for young doctors, in particular, because they are asked to do so much free work for their patients either in training or a young attending. It is your duty after all. This may be true but your employer doesn't feel that towards you. Plus, employers are making business moves (opening a new clinic, merging with a private equity, etc). that you are not privy to but absolutely can affect you.

This is not to be all doom and gloom but you need to be savvy to this reality. Burnout is happening to doctors for a reason.

2) The Education-Work-Retirement Model is Dead. Since the late Industrial Era, life has been roughly broken down into the following ratios in sequence:

1/4 of your life in formal schooling then 1/2 in income generating work then 1/4 of your remaining life in retirement.

This model is both antiquated and a bit ludicrous. Although this is the one that most doctors follow by dint of their training and the fossilized career arcs in healthcare.

The modern situation is more about flux. Work, Education, and Retirement are all inter-related strands that wax and wane over time. Education, both formal and informal, is necessary throughout your life to stay on top of an ever increasingly complex and complicated society. Work skills, particularly entrepreneurship needs to be learned while still in "school." And people need sabbaticals, mini-retirements, and vacations throughout their life. Tim Ferris described this phenomenon of so-called "lifestyle design," in his popular book the 4 Hour Work Week.

3) Healthcare labor is commoditized - We spoke about this earlier, but the reality is that with the corporate and consolidated take over of healthcare delivery in the US, most physicians are going to be W2 employees very soon.

Moreover, as a doctor you are considered a liability on the balance sheet of health systems and a source of "medical losses" for the insurance industry. After altruism, professional autonomy and guaranteed high income are both major drivers of why people enter into medicine. So these changes are potentially troublesome.

4) You are a start-up. Everyone is a startup, even doctors. With no job loyalty, and high inflation as of the writing of this post (2023) and coming AI/automation, even medical providers need to think of themselves as business and personal brand (at least professionally), In the Start-up of You, LinkedIn Founder Reid Hoffman describes two components to this philosophy: permanent beta mode (constantly iterating, working on yourself, improving skill set etc) and an entrepreneurial adaptive skillset.

Even if you are happy in a stable W2 job (more power to you!), EVERY doctor needs to the basics of entrepreneurialism.

5) Portfolio Careers v Career Path - Historically, doctors have been in the latter group. In fact all of medical training is, in fact, a (very) long career path. Doctors may hop around between a few practice options but they then just work in the community until they retire. Private practice is harder to do as a solo or small group for a variety of reasons and non-compete clauses often prevent doctors from leaving and establishing themselves elsewhere.

But physicians are doing many different things now - working for pharma or medical device, expert witness, consulting for companies, creating books and podcasts, and more. Many young doctors and medical students even enter into medicine without a desire to take care of patients full time. See my podcast here with Bootstrap MD Dr Mike Woo Ming for more on this phenomena:

Rather, there is a concept of related but distinct jobs that can make up a portfolio career, not unlike the body of work unlike an artists' portfolio. People move from project to project as long as it interests them, enhances their network, and provides meta-skills that will be useful for them in the future.

6) Embrace risk - Doctors are notoriously risk averse. Let's be honest, many of us entered into medicine in part for the perceived stability of the field. Employers know this as well as the fact that many doctors have significant educational debt, making physicians more pliable than other professionals. But as the late Steve Jobs once said, you better disrupt yourself before you're disrupted. Embrace risk intelligently. Too many things are shifting in healthcare for doctors to stay the same. There are new entrants (eg Amazon), new reimbursement models (changes to Medicare + value based care), new technologies (eg virtual care , AI, and biological innovations like blood based cancer screening replacing things like colonoscopies).

But understand this truism: Risk and Luck are nearly identical. Avoiding one invariably means you miss out on the other. And in medicine as in life, it is as important to be lucky as it is to be good.

Find small ways to bring in new sources of referrals, income, opportunities and contacts into your life. Create an ecosystem where change is valued and leverage appropriately. Your individual change may be bigger - leaving your group for a new practice, transitioning out of medicine entirely perhaps, or finding a different way to serve patients. Whatever it is, being an MD hero means being the author of your own life and create change not receive it. You don't want to wake up on the wrong side of disruption

We are in a time of change - a liminal period where one way of working is ending and a new one is being created. What this brave new world of work looks like is anyone's guess. It is also one of the many reasons there is so much uncertainty in our society.

7) The Uberization of Everything - on demand platforms with freelancers - either by choice or by coercion - will be the model of how employment and work operates in all businesses. This will be true even of traditional employers and traditional employees. Flex schedule, accrual of PTO, payment models and benefits (and lack thereof) will be the norm in the future. Many nurses are already are doing double duty - holding down a part-time traditional employed job while also doing per diem/float/temp nursing work. While these changes may talk longer to affect physicians, I still expect them come sooner than most anticipate. Read more here :

As a result there are multiple different work models depending on which organizations pay the salary, bear the risk for benefits and manage personnel:

But there is opportunity as well. The first step is to be aware of what possibilities and pitfalls await you as a working doctor. Then act. Because to stay where you are and not change is a decision also.

Sometimes the riskiest thing you can do is play it safe