Lockstep Physicians

February 8, 2012

I had lunch with a colleague who is finishing his MBA in May.  We talked about what he planned to do going forward.  The conversation then turned to doctors and the way they see themselves and their options.  In medicine we’re used to having the way paved for us.  We do what’s been done before.

When you’re training to be a doctor you’re always looking to the next thing.  When you’re a student, your endpoint is getting into medical school.  In medical school you see residency as the goal.  During residency you count the days to completion or look to do a fellowship.  In academic medicine you march to accumulate scholarly accomplishments and publications in peer-reviewed journals.  It’s all about following the path.  You desperately keep in step with the doctor in front of you.  Flowchart-like endpoints drive our existence.  We live and die by checklists and administrative throughput.

And our most visible mentors are those who have walked the same path.

But recently I’ve met a few doctors doing amazing things after creating their own way.  In nearly every case they took risk with no one to show them how.  I suspect physician-driven health care innovation will come not from those who stick to the century old milestones, but from those looking to mark professional advancement in a new way.

This doesn’t require an MBA or the culture of a startup.  Disruption can begin with one doctor, a good idea and an environment willing to shoulder some of the risk of looking at things just a little differently.

We should help students and residents understand that its okay to think outside of our current system of lockstep professional advancement.


Jim Salwitz February 9, 2012 at 11:51 am

This generation of students and residents are naturally qualified to step out of line. This socially and culturally diverse generation has a deep understanding of the potential of electronic integration and social media. They therefore have the world view and tools to fracture the mold. We need to not only encourage them not to follow in our footsteps, but demand their disobedience. Perhaps if they guide us down unseen forks, our profession will not plummet over the cliffs of Salutre.

Irwin Lim February 9, 2012 at 4:04 pm

Nice post Bryan & it expresses my own view. Trying to implement new ways of tackling old problems is innovation but unfortunately, often draws criticism or at least, a sense of disdain/distrust from medical establishment. Our approach to treating arthritis drew flak for its comprehensive, and internal team-based approach. Hopefully, this will change & influence a new, and I think, better way of practising rheumatology.

Andrew Albert February 15, 2012 at 8:40 am

Dr. Vartabedian
I’ve very much enjoyed your posts since subscribing to 33 Charts. For me, this last post truly hit home. As you well know with regard to Gastroenterology….first a pre-med, then a med student, a resident, a GI fellow, and subsequently an attending.
I remember getting off the train to my final destination of “attending” to find no paved path or crowd to greet me. Was this it? Was the challange over? 5 years later, I found myself asking the same question. I found myself searching for MORE. I entered the world of social media and cloud based software to build “Fibroblast” with a colleague. I love performing Colonoscopy but could I contribute something different? Could I “disobey” my teachings and think outside the box; attempting to change healthcare just a little? Suddenly, I found myself travelling down a very unfamiliar road. I don’t remember covering these topics during my 3rd year rotations at G.W.!
Medicine was previously a world where Doctors practiced in a bubble. That world has changed with social media and modern technology. As you said so well….”We should help students and residents understand that it’s okay to think outside of our current system of lockstep professional advancement”. This is the new world of medicine. What an important and exciting time to be a part of it!

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