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  • Are you “Treed”?

    Interesting article written for the radiologist audience but probably applicable to many physicians and folks in the corporate world, too.

    http://www.diagnosticimaging.com/practice-management/treed

    It is very easy to get comfortable enough in your physician role that you:

    1) No longer advance or progress professionally.

    2) Prefer to tolerate a deteriorating practice environment (“the devil you know...”) rather than trying something new.

    3) No longer fit the needs of your practice and are difficult to move.

     

    While I was previously unfamiliar with the “treed” metaphor, I have made a conscious effort throughout my career to sidestep these three pitfalls, but number 2 is my nemesis (and probably is for most). I have flirted with leaving my current group—actually I did leave early in my career and returned— that was 18 years ago!. It is very difficult to leave the comfort of what you know, but it’s something that you (and I) just have to do sometimes.

    I have two senior partners that fit #3 perfectly. They are very good at what they do, but what they contribute is increasingly narrow such that it would be better to replace them both with two new people that might be less proficient in these niches but have broader skills (and better group and interpersonal skills).

  • #2
    The difficulty is trying to decipher whether it's just your job that's deteriorating or the whole field!
    Helping those who wear the white coat get a fair shake on Wall Street since 2011

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    • #3
      #1 and#3 - are more granular and can come more often in personal drive than group environment (unless #1 is hostile towards physician administrative advancement)

      #2 Is definitely a common and difficult situation when one knows that the current situation isn't ideal and the distance between the next 'greener pastures' can be hazardous and at the very least uncertain.

      It took some time for us to fully commit (2 years brewing) to a new setting and hitting the reset button.  During our interview sessions, one nice advice I picked up ---   You're at a evening house party for awhile and it's comfortable, but gotten a bit long in the tooth; getting the jacket on and going outside takes a bit of gumption.  Once outside, the darkness and coolness may feel a bit overwhelming, but you'll soon notice there's many other house parties going on and of your choice to join.  Embrace it.  You'll be warm and comfortable again soon.

      Comment


      • #4
        Well, where I come from, "treed" by definition involves a bunch of snarling dogs.  Depending on the situation, staying in the tree or coming down could both lead to disaster!

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        • #5
          Yes I am in 2.  I call it inertia.  I would hate to "have" to learn a new hospital, new nurses, and new computer system at my age.  But hey I don't have to.

          Comment


          • #6
            partly it depends on if a new job would force you to uproot your whole family and how much your spouse loves their job.  and, as wci says, whether it's your local hospital or the field in general going through mandated changes.  also golden handcuffs, aka pension.

            Comment


            • #7
              Absolutely hard.  We kicked around several opportunities over the two years -  looked locally, nearby, and eventually social issues broke the camel's back and we went full on looking to relocate --- didn't even end up in the job that we initially had interest in the location.  One just doesn't know until you get out there and start kicking the tires around and then ultimately cutting bait with the current situation.  --regardless of those golden handcuffs.   We had both Kaiser and VA pensions (still have since 5+ years vested).  Golden handcuffs only really hurt once you've passed a line, usually 45-55 years old, that makes it harder to reestablish new sets of handcuffs at your new setting.

               

               

               

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              • #8
                I have experienced all three but in 2 different setting

                Had 2) apply to me me when I was in a multi specialty group for 7 years, being comfortable but highly underpaid, overworked and was never going to become a partner. Finally had the seething irritation build up sufficiently to say FU to the owner and start a solo practice over a period of 15 days. Luckily I had saved enough, was single at that time and did not own a house.

                Now 1) and 3) apply to me. As a soloist I don't advance professionally. I am in the same spot, year in and year out. I don't do the procedures and therapies I used to do earlier on and limit myself to a small part of my specialization. Five years ago I was offered a job at the hospital which would have doubled my income and got me doing the cutting edge therapies in my field but turned it down since I had gotten so comfortable to being solo. Now that ship has sailed and I am struck in my job till I call it quits.

                The only consolation is that Alzheimer's has not set in yet since I could clear my IM and 2 subspeciality boards in Oct 2015. But I don't know how long I have professionally to stave off my obsolesce.

                Comment


                • #9




                  I have experienced all three but in 2 different setting

                  Had 2) apply to me me when I was in a multi specialty group for 7 years, being comfortable but highly underpaid, overworked and was never going to become a partner. Finally had the seething irritation build up sufficiently to say FU to the owner and start a solo practice over a period of 15 days. Luckily I had saved enough, was single at that time and did not own a house.

                  Now 1) and 3) apply to me. As a soloist I don’t advance professionally. I am in the same spot, year in and year out. I don’t do the procedures and therapies I used to do earlier on and limit myself to a small part of my specialization. Five years ago I was offered a job at the hospital which would have doubled my income and got me doing the cutting edge therapies in my field but turned it down since I had gotten so comfortable to being solo. Now that ship has sailed and I am struck in my job till I call it quits.

                  The only consolation is that Alzheimer’s has not set in yet since I could clear my IM and 2 subspeciality boards in Oct 2015. But I don’t know how long I have professionally to stave off my obsolesce.
                  Click to expand...


                  I am currently in your number 2 and trying to figure it out. Make a comfy income, very comfy schedule, but its horrendous compared to what Im bringing in and being the most productive/best reviewed/most available guy in the practice. Am not single or houseless though (but id drop the house in a heartbeat, wife may not like that). This probably applies to everyone at some time.

                  Have looked at a couple opportunities, geo arb, but so far nothing seems to be very attractive when opening my own place is likely the best solution. Even if its loaded with a million more issues and pains.

                  I dont care about advancing professionally, not even sure what that means or if it applies to my specialty. Almost everything 'cutting edge' etc...in my specialty is pretty much marketing bs. I do what I do and do it well, specialties are too broad now to do it all if you want to do it well.

                  Comment


                  • #10







                    I have experienced all three but in 2 different setting

                    Had 2) apply to me me when I was in a multi specialty group for 7 years, being comfortable but highly underpaid, overworked and was never going to become a partner. Finally had the seething irritation build up sufficiently to say FU to the owner and start a solo practice over a period of 15 days. Luckily I had saved enough, was single at that time and did not own a house.

                    Now 1) and 3) apply to me. As a soloist I don’t advance professionally. I am in the same spot, year in and year out. I don’t do the procedures and therapies I used to do earlier on and limit myself to a small part of my specialization. Five years ago I was offered a job at the hospital which would have doubled my income and got me doing the cutting edge therapies in my field but turned it down since I had gotten so comfortable to being solo. Now that ship has sailed and I am struck in my job till I call it quits.

                    The only consolation is that Alzheimer’s has not set in yet since I could clear my IM and 2 subspeciality boards in Oct 2015. But I don’t know how long I have professionally to stave off my obsolesce.
                    Click to expand…


                    I am currently in your number 2 and trying to figure it out. Make a comfy income, very comfy schedule, but its horrendous compared to what Im bringing in and being the most productive/best reviewed/most available guy in the practice. Am not single or houseless though (but id drop the house in a heartbeat, wife may not like that). This probably applies to everyone at some time.

                    Have looked at a couple opportunities, geo arb, but so far nothing seems to be very attractive when opening my own place is likely the best solution. Even if its loaded with a million more issues and pains.

                    I dont care about advancing professionally, not even sure what that means or if it applies to my specialty. Almost everything ‘cutting edge’ etc…in my specialty is pretty much marketing bs. I do what I do and do it well, specialties are too broad now to do it all if you want to do it well.
                    Click to expand...


                    Well in your case, if we assume that you can't get even better at what you currently do, I'd say it would be adding to what you do.  Add one more procedure, develop your skill, and do it as well as you do everything else that you currently do.

                    You may have no desire to do it, and there's nothing wrong with that, but I think that's what it would mean in your case.

                    Comment


                    • #11
                      So if you are working on FIRE - would that be like tinkering on making a jet pack to blast off to another forest?

                      I don’t even know if the grass is greener anywhere else.  I have it pretty good. My biggest issue is I’d like to work part-time since I have other things that interest me, but there isn’t a part time option for me in our organization and it would be foolish to switch out now.  In about 5-7 yrs I’ll have some big decisions to make...

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                      • #12
                        Is it so wrong to be content? Is good enough not good enough?

                        Comment


                        • #13










                          I have experienced all three but in 2 different setting

                          Had 2) apply to me me when I was in a multi specialty group for 7 years, being comfortable but highly underpaid, overworked and was never going to become a partner. Finally had the seething irritation build up sufficiently to say FU to the owner and start a solo practice over a period of 15 days. Luckily I had saved enough, was single at that time and did not own a house.

                          Now 1) and 3) apply to me. As a soloist I don’t advance professionally. I am in the same spot, year in and year out. I don’t do the procedures and therapies I used to do earlier on and limit myself to a small part of my specialization. Five years ago I was offered a job at the hospital which would have doubled my income and got me doing the cutting edge therapies in my field but turned it down since I had gotten so comfortable to being solo. Now that ship has sailed and I am struck in my job till I call it quits.

                          The only consolation is that Alzheimer’s has not set in yet since I could clear my IM and 2 subspeciality boards in Oct 2015. But I don’t know how long I have professionally to stave off my obsolesce.
                          Click to expand…


                          I am currently in your number 2 and trying to figure it out. Make a comfy income, very comfy schedule, but its horrendous compared to what Im bringing in and being the most productive/best reviewed/most available guy in the practice. Am not single or houseless though (but id drop the house in a heartbeat, wife may not like that). This probably applies to everyone at some time.

                          Have looked at a couple opportunities, geo arb, but so far nothing seems to be very attractive when opening my own place is likely the best solution. Even if its loaded with a million more issues and pains.

                          I dont care about advancing professionally, not even sure what that means or if it applies to my specialty. Almost everything ‘cutting edge’ etc…in my specialty is pretty much marketing bs. I do what I do and do it well, specialties are too broad now to do it all if you want to do it well.
                          Click to expand…


                          Well in your case, if we assume that you can’t get even better at what you currently do, I’d say it would be adding to what you do.  Add one more procedure, develop your skill, and do it as well as you do everything else that you currently do.

                          You may have no desire to do it, and there’s nothing wrong with that, but I think that’s what it would mean in your case.
                          Click to expand...


                          That makes sense, I guess I interpreted as something grander and more important.

                          Comment


                          • #14







                            I have experienced all three but in 2 different setting

                            Had 2) apply to me me when I was in a multi specialty group for 7 years, being comfortable but highly underpaid, overworked and was never going to become a partner. Finally had the seething irritation build up sufficiently to say FU to the owner and start a solo practice over a period of 15 days. Luckily I had saved enough, was single at that time and did not own a house.

                            Now 1) and 3) apply to me. As a soloist I don’t advance professionally. I am in the same spot, year in and year out. I don’t do the procedures and therapies I used to do earlier on and limit myself to a small part of my specialization. Five years ago I was offered a job at the hospital which would have doubled my income and got me doing the cutting edge therapies in my field but turned it down since I had gotten so comfortable to being solo. Now that ship has sailed and I am struck in my job till I call it quits.

                            The only consolation is that Alzheimer’s has not set in yet since I could clear my IM and 2 subspeciality boards in Oct 2015. But I don’t know how long I have professionally to stave off my obsolesce.
                            Click to expand…


                            I am currently in your number 2 and trying to figure it out. Make a comfy income, very comfy schedule, but its horrendous compared to what Im bringing in and being the most productive/best reviewed/most available guy in the practice. Am not single or houseless though (but id drop the house in a heartbeat, wife may not like that). This probably applies to everyone at some time.

                            Have looked at a couple opportunities, geo arb, but so far nothing seems to be very attractive when opening my own place is likely the best solution. Even if its loaded with a million more issues and pains.

                            I dont care about advancing professionally, not even sure what that means or if it applies to my specialty. Almost everything ‘cutting edge’ etc…in my specialty is pretty much marketing bs. I do what I do and do it well, specialties are too broad now to do it all if you want to do it well.
                            Click to expand...


                            I've been feeling similarly about my job recently. I love what I do, I make a ridiculous amount, and am generally happy with work. Over the last few years, I've noticed an increased corporate feel at the hospital and I can feel the very beginning of rustling changes.

                            There are times I also feel I've lost that sense of adventure and excitement that I had in residency and in academic medicine. I almost feel like an overpaid technician at times.

                            But the pay is so good, I just can't imagine walking away from it until either the money disappears or the work environment truly descends into chaos.

                            I also feel that given my current job's high pay, low hours, and almost perfect structure, the only way I could move on is to open my own practice. The only thing missing is autonomy. (My 2 predecessors who made even more ended up departing to open their own practices. I'm sure there comes a point when autonomy might trump pure earning potential for those further in their career with an already solid net worth)

                            Comment


                            • #15
                              Opening your own practice does give you total control over your schedule.  It also give you control over personnel.  You get to decide what benefits you want.  You get to decide what insurance you take and what you do not.  On the flip side you are responsible for everything.  You don’t get to work a shift and go home.  I more than doubled my income when I opened my own practice. It sounds like you are in a good evergreen tree.  You might be happy in your tree.

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