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When was the last time you felt genuinely excited about the long-term direction of your career?

Not about a recent accolade at work, or a patient satisfaction letter, or a case that went well, but excited about where you would be in 5, 10, 15 years or more from now? When did you have the sense that your career end-goal was something that you were truly energized by?

You may not have the answer to this. You strive to be great at what you do, without knowing if the final chapter of your career holds anything that is surprising or compelling.

The quiet but recurring question in the background keeps repeating - is there something more? It’s not necessarily burnout or fatigue - it may have a pinch of boredom or monotony - but it’s really about the question: Do I know what the potential versions of myself professionally even are?

The paradox of achievement

By every external measure, you are incredibly successful. A practicing physician, perhaps a specialist or subspecialist, respected for your expertise by your peers, respected in your community and in your social circles, and with all the conventional trappings of success - great income, vacation, home, and for many, a great family life as well.

But despite all of this, something is missing. In some ways, as time has gone on, you feel like your career has become more restrictive instead of more expansive. You may have more titles or responsibilities, but your feelings about future possibilities appear somewhat narrower instead of feeling like they are wide open.

Comparing yourself to your peers, many of them seem content or complacent - or just have a reluctant acceptance of the current state of things - and they aren’t necessarily being vocal about whether they’re feeling the same restlessness. You wonder to yourself - is this just a personal issue I’m having? Or is there something structural here? And since I have it so well in many respects, does it sound ungrateful of me to even be asking these questions? And so the conversation is suppressed before it ever gets vocalized.

This questioning tends to hit most acutely between the ages of 38 and 52. When the initial trajectory of one’s career plateaus a bit, and the next one or two decades on the horizon seem like they hold the potential for sameness or monotony. At this point, you’ve gotten into a rhythm which is working well in many respects, and you just don’t know if or how you’re going to break out of it…. and whether it’s even worth it to try.

Why this happens

A big part of why this happens is a structural one. It’s not a personal or character issue - it’s a design issue.

The first reason why this happens is the script. Medicine is a very well-defined pathway, with a very particular set of steps that leads to the desired outcome of being a physician. The journey is so well defined and rigorous that by the time you reach the end of the path, you may have forgotten that you have any control at all over your destination. Physicians become great at executing the script, but not necessarily great at the intentional design of one.

The second reason why this happens is narrow-mindedness. Medicine has its own ecosystem that tends to echo the same ideas within it. You are in close contact with peers in the same role in the same institution following the same path … and who measure their success by the same metrics. Possibilities available outside of the typical path may not be discussed, or you may not even be aware of them.

The third reason why this happens is a deep sense of professional identity. When you have invested so much of your time and energy into becoming a physician, and made so many sacrifices along the way, and can finally contribute to society in such as meaningful way, this becomes a core part of your identity as a human being - above and beyond a mere vocation. There is a sense of deep pride in knowing yourself as a ‘doctor’. There is the deep admiration when your parent introduces you as “the doctor”. And so ironically, by mid-career, the very thing that anchored you and gave you the strongest resonance early on can start to become a limiter to your other possibilities.

And the fourth reason this may happen relates to something more subtle: mild suspicion or awkwardness surrounding the conversation of ambition and branching out. Wanting to experiment - or even the sense of wanting more - can feel selfish or unappreciative to some, especially when they see what you have already achieved. Also, physicians tend to be risk averse, and so they may suppress these feelings and put their head down and continue to work as they’ve always done.

It doesn’t have to be this way

But here’s the thing - it doesn’t have to be this way.

We live in a world in which physicians are allowed to explore, have ideas and expand. You don’t have to do this by leaving medicine and pulling the ripcord, but you can do it by building upon the foundation that you already have.

Some of this could involve innovation and projects at your own institution. It may involve work with startups, advisory, or consulting. It may involve writing on a variety of topics, which could in turn create new ideas and opportunities. Some of this could involve investing in different parts of the health care ecosystem. And some of this could relate to strategic personal and professional positioning when rapidly developing artificial Intelligence is starting to reshape what physician careers look like.

These paths don’t necessarily involve ways to escape medicine, but rather, they are ways to build upon the advantage that you already have, using it as an anchor to create a richer and more interesting professional identity.

One of the commonalities around physicians that have more interesting lives and careers is that they’ve been much more intentional about the ways that they’ve built it. Instead of inheriting a pre defined formula and pathway, they’ve created their own custom solution. They are the designers and not just the executors of a plan that someone else gave them.

Why I’m writing this

I’ve been thinking about these questions for a while - because I’ve been grappling with them myself. I’m a successful mid-career physician who has been experimenting and learning for years, while trying to design a more interesting and purposeful career without leaving medicine. I’ve learned a lot along the way about what I’m starting to think of as optionality, leverage, and the intentional design of physician careers, and I want to share what I think it means for us.

If this resonates, I’d love to hear from you. I’ll be writing more about these topics - which I’ll be referring to as the architecture of modern physician careers. I think it matters to us as physicians, and I think the conversation is long overdue.

— Scott F. Cameron, MD

Radiologist. AI implementation leader. Angel investor. MRS Past President. Career architect.