The Physician Optionality Problem

— by Scott F. Cameron, MD | Physician Vantage Studio | Essays on physician optionality, leverage, and professional design

After I published that first essay, I heard back from physicians across multiple specialties, telling me that the feeling is real. Their responses were versions of the same message: “I thought it was just me.” Just because we acknowledge this feeling, however, doesn’t mean that we fully understand it - we have to dig deeper and discover the reasons why we feel this way. Why do we have this sense that despite all of our training, achievements, and abilities, we can feel constrained in a professional identity that is narrower than their skills should allow?

Physicians have many possible career paths and many forms of leverage that they can use, but medicine rarely equips them to truly understand what these options are or how to use them. This results in a wide gap between what physicians actually do, and what they are capable of doing. After recognizing this pattern, I’ve started calling it the Physician Optionality Problem. In the context of physician careers, we can think of different optionality domains that can impact the experience of one’s professional arc. For example, you have financial options, but you also have intellectual, creative, and professional options as well. Without recognizing these, you artificially constrain yourself. This isn’t a personal failing - this is a consequence of a system that is designed to have you perform in a narrow lane.

There are 4 main drivers of the Physician Optionality Problem.

Driver 1: Identity Compression

Becoming a physician requires tremendous time, energy, and sacrifice, focused on the goal of becoming a doctor. You form this identity over a timeframe of a decade or more, with each year invested providing additional reinforcement that the end-result is near. Once your goal has been achieved, there is a rightful sense of pride and ‘arrival’ at the destination. However, once you place this identity as so central to your sense of self, it can become solidified to the point that it is hard to see yourself as anything else. It’s in the way that you accept certain responsibilities as just ‘part of being a doctor’ - like the after hours or weekend shifts, or the clean-up charting in the evening - in a way that other people wouldn’t understand. These things are ‘part of the package’ of being able to be a doctor. But the very same thing that gave you fuel and direction in the early days of your journey can in some ways become a constraint. It becomes challenging to see yourself as anything other than an outstanding doctor practicing medicine in the way you were taught to do.

Driver 2: Path Rigidity

Another reason the Physician Optionality Problem exists is that the pathway to become a physician is relatively rigid and well-defined. From the early pre-med days of MCATs, to the core clerkships in medical school, to the checklists and SOAP notes on the rounds, medicine has historically followed a very prescriptive educational and developmental structure. Much of your roadmap is very well defined for you. Deviate from it and you may find yourself off of the road, in a dimly lit area without a flashlight. As such, you become guided along a path that has few branch points or opportunities for exploration along the way. Running career experiments or simultaneously entertaining very different outcomes at the same time becomes very challenging to do, especially when you consider how demanding medical education, training, and practice actually is.

Driver 3: Opportunity Blindness

Another major driver is being unaware of the options that are available to you. Much of this has to do with your environment. If you are in a place where physicians generally follow the same career path, you may not be exposed to new ideas and understand the different ways you could use your skills in medicine, outside of medicine, or in medical-adjacent fields. How can you learn about the different ways in which to innovate within your institution if you don’t have anyone role-modeling this for you? How can you know that it’s possible to create a conference, a new service line opportunity, or a writing platform if you haven’t seen or heard of others doing it? Artificial Intelligence is creating numerous opportunities for physicians to become involved in healthcare startups as well as within one’s own institutions - but where are the people who are talking about these things? If you don’t know what and where the opportunities are, then you won’t know how to act.

Driver 4: Leverage Underdevelopment

Finally, underdevelopment of different forms of leverage is a large part of the Physician Optionality Problem. Leverage exists in various forms - knowledge, capital, networks, platforms, and credibility. But nowhere in training are you ever taught how to fully understand these forms of leverage and how to activate them. You may have low financial leverage despite a high clinical income. You may have great writing skills and clinical expertise but no platform leverage. You may have deep domain knowledge in different aspects of medicine, but it doesn’t necessarily mean you can articulate to other members of the healthcare ecosystem what the value is that you truly bring, or how you can capture that value and utilize your leverage to optimize your position. If you don’t know, it limits your optionality.

Here’s why this matters now. The pressures have been building over the years - reimbursement challenges and productivity pressures, burnout and isolation, consolidation and the healthcare workforce crises. Liability concerns, defensive medicine, and administrative bloat are all leading to work hours creeping into the fringes of the day.

And now, artificial intelligence is completely re-shaping the way in which we deliver our work product - not only in terms of how we can make diagnoses, but also in terms of our workflows and tools, and even the ways in which we interact with our patients. The timing for positioning ourselves to fully use our true optionality matters. When we realize that external pressures are all shaping our careers and our experience more than ever, we understand that our autonomy is at risk and that our opportunity to be proactive in designing our future state may be narrower than we think. Physicians who think strategically about their careers will find themselves in a career that was designed by them instead of for them. For all the energy we have spent on wellness solutions to combat burnout, meditation and yoga cannot fix a career that is too small for you.

Ultimately, we have to move beyond a diagnosis and into treatment - so in the coming essays, I’m going to explore some specifics of what we as physicians can do about these problems. I’ve been thinking about specific frameworks - around the different forms of leverage that physicians have, around conducting career experiments instead of making career changes, and around what career architecture can look like when a physician designs a portfolio career. Evolution instead of revolution. More on that to come soon.

If the Physician Optionality Problem resonates, reach out and let me know. If you read those four drivers and recognized yourself, I’d love to hear from you and learn which one hit hardest.

— Scott F. Cameron, MD

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