by Dr. Kenneth H. Cohn

Last weekend, I was a speaker and mentor at the SEAK Non-Clinical Careers for Physicians Conference, which was attended by approximately 250 physicians. My topic was "Practical Strategies for Transitioning to Non-Clinical Careers," in which I described part-time hospital administrative work, locum tenens coverage, and creating and sustaining a personal brand using Internet technology.

The experience that I will never forget was serving as a mentor to more than 50 physicians who signed up to see me in 15-minute blocks throughout the weekend. I met people from a variety of specialties (ED, cardiology, primary care, radiology, surgery) and many states, from Florida to California.

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The major question they had for me was how to find their niche. My experience since 1996, when I lost my academic job, suggests that it is a journey more than a destination. I told the physicians that I was there to give them hope and to help them learn from my mistakes. We have a strong help ethic in our profession, as I have witnessed in the operating room, or when the heart of someone else's patient stops beating--it seems natural to join in the resuscitation.

The exercise that they seemed to benefit from the most involved asking them, from Jim Collins' Good to Great, three questions:

* What are you really good at (expertise)?

* What do people pay you for (market)?

* When was the last time you felt really alive (passion)?

Some struggled with these questions, admitting, "No one has ever asked me that before." Once we fleshed out preliminary answers however, the intersection of the three areas led them closer to discovering their niche. For example:

* A rural surgeon whose wife said, "His passion left him years ago," realized that he was good at teaching and developed a plan to teach anatomy in the city where his grandchildren lived.

* An emergency room physician who had dismissed his love of cartooning with, "How is that relevant to healthcare?" conceived an educational campaign to teach inner-city residents how to decrease their chances of being infected with methicillin-resistant Staphylococcus aureus (MRSA).

* A pediatric radiologist decided to indulge her passions for antiquities and education by working part-time at the hospital and studying to become a docent at her local museum.

I could tell that their brief sessions had value because I took notes on two-part carbonless forms that I offered to share with them at the end. All of them took their piece of paper, smiled, and thanked me warmly as they left. The ED physician saw me later in the bathroom and confessed, "My mind is spinning. You have given me so much to think about."

Over the past seven years, I have traveled over 600,000 miles and worked with physicians in 40 states. My experience convinces me that physicians are not leaving the profession solely due to the costs of running a practice, as a recent CNN article states, but also because they have lost touch with the feelings that attracted them to healthcare careers in the first place; to make a difference in the lives of patients and their families.

In Collaborative Listening, I wrote:

We all have our own data points, but Brian Wong's survey of more than 1,500 practicing physicians (A Prescription for Physician Reengagement, Futurescan 2009:23-26) revealed that the majority of physicians seek:

* meaningful work that makes a difference in patients' lives;

* a sense of community;

* and regular, reliable, positive feedback that affirms their value.

I wrote in "The Tectonic Plates Are Shifting: Cultural Change vs. Mural Dyslexia" that:

* hospitals and physicians are facing rising expenses, burdensome regulations, heightened consumer pressures and stagnant or declining reimbursement;

* and that the response to global economic pressures and the need to improve clinical and financial outcomes at the same time can bring hospitals and physicians together.

What do you think?

* Do you see reason for optimism in the face of uncertainty and despair?

* Is the struggle we face bringing physicians and hospital leaders together?

* Could Jim Collins' three questions resonate with physicians where you work?

I welcome your input.

Ken is a practicing general surgeon/MBA who divides his time between providing general surgical coverage and speaking, writing, teaching and consulting on physician-hospital relations. Learn more about what he does by visiting http://healthcarecollaboration.com.