Winthrop F. Whitcomb, MD, 58, was never one to follow the crowd. After earning his MD in the early 1990s, he fulfilled a dream by spending a year on the ski slopes in Montana, supporting himself with locum tenens jobs followed by a short stint in primary care. Then, in 1994, he heard about hospital medicine, a just-emerging career track.
Intrigued, he joined the staff at Mercy Hospital in Springfield, Mass., the first 24/7 hospitalist program in the country, where he stayed for the next 17 years, taking on several clinical and administrative leadership roles. Eventually he was ready for still more change, leaving the hospital about a decade ago.
Since then, Dr. Whitcomb has helped launch several health care technology companies—one of which recently went public. Now self-employed, he serves as an advisor to early-stage health care companies and is medical director for two skilled nursing facilities owned by Pittsfield, Mass.-based Berkshire Healthcare Systems.
“Once you're at the mid-career stage, it's important to take a look at your bucket list and remember the things you really want to accomplish in your life,” he said. “For me, helping to start a company and take it public was near the top of that list.”
As a new specialty in the 1990s, hospital medicine was an exciting, unexplored career choice offering young internists a chance to carve out unique roles and move quickly into leadership positions. Many of the hospitalists who made that initial leap, now in their 50s, have continued to take on new roles in mid-career and beyond.
“As you're sundowning in your career, you have an opportunity to explore all the things you learned along the way and decide where you want to end up,” said Diane Pine, MD, FACP, 59, an independent consultant and a hospitalist at Vassar Brothers Medical Center in Poughkeepsie, N.Y. “It's a time to do the things that you really love.”
Knowing when to shift gears
Burnout is a familiar term in medicine, but feeling unmotivated or lacking in energy doesn't necessarily mean you need to slow down or find a new career, said several longtime hospitalists. Rather, such feelings should prompt self-reflection about your interests, goals, and priorities.
Dr. Pine faced one such crossroads after more than a decade serving as medical director of the hospitalist service at Orange Regional Medical Center in Middletown, N.Y. When she started the position, she was immersed in launching a new hospitalist program and building inpatient services—ambitious plans that kept her motivated and energized in her day-to-day work. By 2015, however, she wanted a fresh challenge.
“Once I decided to leave, I felt like a college student choosing a new career,” said Dr. Pine. “I eventually ended up doing two things that I love most—patient admissions and medical/legal defense work.”
Later that year, she accepted a staff position in Fort Kent, Maine, a rural town an 11-hour drive from her home in Montgomery, N.Y., or a short flight from Boston or Newark. Dr. Pine made the trip four to six times a year for about four years, working 24-hour shifts for four days and nights straight while living in an apartment across from the hospital. She remains on the hospital's staff and does occasional shifts as needed.
“The trip could be difficult at times, but I got to do something extraordinary, to practice on my terms and experience rural medicine, and it turned out to be a highlight of my career,” she said. At the same time she took the part-time job in Maine, she also joined the staff of Vassar Brothers Medical Center in Poughkeepsie and launched an independent consulting business working with law firms representing physicians and hospitals in malpractice cases.
Scott Flanders, MD, FACP, 55, now chief clinical strategy officer for Michigan Medicine at the University of Michigan in Ann Arbor, felt a similar flagging of energy and initiative about six years ago, after more than a decade leading Michigan's hospital medicine program.
During his tenure as division head, he oversaw several quality improvement initiatives and became increasingly interested in corporate strategy—pursuits that eventually led to his current position, in which he spends much of his time forging clinical partnerships with hospitals and clinics around the state. Although the job existed previously, it was renamed when Dr. Flanders took over, to reflect an expanded set of roles and responsibilities.
“I've always been attracted to new opportunities as opposed to stepping into a role that's already been established,” said Dr. Flanders. “My career has been a series of one role leading to another, of developing sub-skillsets that lead to new opportunities that then allow me to move onto other things.”
The solution to burnout can also be as simple as applying existing skills to the areas that interest you most. After completing his residency in 1998, Philip Vaidyan, MD, FACP, stayed on as a faculty member at Brown University School of Medicine in Providence, R.I., for seven years.
While that first job allowed him to teach and care for patients, 80% of his clinical time was spent in the outpatient setting, said Dr. Vaidyan, 55, now director of general internal medicine at St. Louis University School of Medicine in St. Louis, Mo. Eventually, he decided to embark on a series of career moves that would allow him to spend most of his time on his core passions: teaching and inpatient care.
In 2005, he moved to SSM St. Mary's Hospital in St. Louis, attracted by the chance to lead a new academic hospitalist program. Then, in 2017, he became a regional medical director for Tacoma, Wash.-based Sound Physicians, which provides hospitalist staffing in the St. Louis area. That role involved less and less time in bedside care and teaching, prompting him to make another career move to become the director of general internal medicine at St. Louis University School of Medicine in late 2019.
“Now I'm spending most of my time doing what I love, being a clinician educator,” said Dr. Vaidyan.
For Caroline Burton, MD, FACP, 59, the biggest career change occurred in her 40s, when she first became a hospitalist. After spending 16 years in outpatient private practice in Louisiana, she signed on as a hospitalist at Mayo Clinic in Rochester, Minn., which in 2008 was in the process of establishing its first division of hospital medicine.
“Just because you chose something back in medical school doesn't mean it's still the best path for you now. Stay open and flexible because you never know what door may open,” said Dr. Burton, who is now chair of hospital medicine at Mayo. “As an office-based physician, I took care of my patients when they were hospitalized and I found that I enjoyed the higher acuity of the hospital setting more than doing office visits.”
Like Dr. Burton, many hospitalists were initially attracted to the intensity and acuity of full-time inpatient care. However, the typical seven on/seven off schedule can become increasingly difficult as a physician ages.
“The value of the seven on/seven off shift is you can plan your life with long stretches of time off, but that isn't always conducive to achieving balance in your day-to-day life,” said Dr. Whitcomb. “There's a reason the typical work week is five days on with two days off.”
For some hospitalists, a solution is to reduce their overall clinical hours while maintaining the intensity of shift work. For example, Dr. Pine likes immersing herself in 24-hour patient care during occasional shifts in rural Maine.
“I'm still only practicing medicine part-time, so along with my consulting I'm working two-thirds time overall, which is perfect for me,” she said. “Cutting back a little allows me to continue doing what I really love in my career while having more time to do what I enjoy outside of medicine.”
Dr. Burton found shift work appealing when she first started as a hospitalist because it allowed her to pursue other interests during her time off. However, as department chair, she's looking into ways to modify or customize shifts to accommodate different career stages and workstyles across her department.
“How do physicians grow old in hospital medicine and how do we keep our division members engaged as they age?” she said. “Hospitalists don't necessarily want to cut back or be given administrative time, because what's attractive to them is patient care. We need to figure this out because our mid- and late-career hospitalists are often our best clinicians who have a lot to offer junior faculty.”
Dr. Burton is leading an effort at Mayo to examine alternatives to the seven on/seven off model, such five days on/five days off with individual shifts reduced from 12 to 10 hours. Preliminary results from a faculty survey suggest many are in favor of switching to a five-day model or offering it as an option, she said.
However, burnout is often rooted in what you do every day versus how many hours you spend doing it, some of the hospitalists said.
“For a couple of years I got lost in an administrative world that I wasn't enjoying,” said Dr. Vaidyan. “My work now as a clinician educator is just as demanding but more rewarding.”
To identify the causes of one's mid-career discontent, hospitalists recommended consciously taking time to reflect, both on your own and with colleagues or mentors. Methods include enrolling in a formal leadership development program, taking courses, or reading books that expand your worldview or indulge an interest outside of your immediate job focus.
Ideally, long before mid-career, you will have mapped out what you most want to accomplish and experience in your life, both personally and professionally, said Dr. Flanders. “One of the best pieces of advice I received early in my career was to figure out what those things are and put them in my bucket first before I started adding other things on.”
He also encourages younger physicians to continuously explore new career possibilities as they gain confidence and experience in various areas of hospital medicine.
“Hospitalists learn many skills that can translate into other opportunities,” he said. “We are generalists who work with people, teams, and complex systems. If you're feeling burned out, remember that you almost always have options.”
This approach worked for Dr. Whitcomb. “A close friend in Silicon Valley coached me on how to be a physician working in business and technology and helped me realize the value I could bring to that world,” he said. “Getting the opinion of a trusted colleague or mentor in a different discipline can unlock a whole stream of creativity and innovation.”