Control your medical career before it controls you

6 minute read

The Creative Careers in Medicine conference showed how varied and colourful a medical career can be, when it’s not a soulless abyss.

Creative Careers in Medicine is not about learning the cello or writing screenplays in your spare time – though all such outlets are encouraged.

The organisation, founded by Dr Amandeep Hansra five years ago and now boasting 23,000 members, is more about helping doctors break free from the treadmill that begins in medical school and can cause some of our brightest people to burn out and quit – or worse – if they don’t claim some control over their lives.

At the CCIM 2024 conference held in Sydney over the weekend – titled “Welcome to the Mediverse” – attendees saw many examples of medical careers unshackled from the ordinary hospital or practice rat race, interspersed with warnings on how toxic the medical workplace can be.

Some, like Dr Carlo Bellini, took the traditional high-achiever path into medicine then branched out. He gave a motivational presentation on how to “Unfuck your career”, saying doctors often “excel at the science of achievement, [but] struggle with the art of fulfillment”.

“Doctors train and work in systems designed to reduce agency,” he said. “The medical treadmill infantilises talented and competent adults” with the exam process, by controlling where doctors can practise, what hours they work and when they can take leave, with hierarchies based on time served and with payments based on activity, not outcome.

“Agency is about trusting yourself as the driver of your own life and always ensuring that you’re in the driver’s seat. I know so many people that are in the passenger seat of their own life.”

Dr Ben Bravery, psychiatry trainee and author of The Patient Doctor: How one man’s cancer diagnosis led to a quest to put the heart back into healthcare, took the reverse path: he was working as conservation biologist and science communicator when he was diagnosed with bowel cancer at just 28.

His dehumanising experience during treatment inspired him to go into medicine, where he was dehumanised all over again, and which in turn inspired him to change medical culture.

“It’s almost like the system, which is inherently stressful for you, dials up the distress unnecessarily,” he said.

“I wanted to go to med school learn the language of doctors because they seem to be at the top of the tree … I thought, I’m gonna get some of that status and work out what they’re doing and why and then change it. I’m still working on it.”

He said medical school was not only “outrageously competitive” and full of people selected for a “weird” set of skills, but also fostered a counterproductive culture in which patients were identical with their diagnoses and their experiences didn’t count.

“All we need to know is that at the end of the stethoscope, we just have to listen,” he said. “And medical schools should reward that listening and incentivise it. We should be memorising patient accounts just like we’re memorising the Krebs cycle.”

A panel discussion on the “Future of the Healthcare Workforce” focused largely on burnout, which is estimated to affect up to 80% of health workers.

Dr Bethan Richards, a rheumatologist and chief wellness officer for the Sydney LHD – one of only a handful of people in Australia with that title, who was appointed in 2010 after the district lost four basic physician trainees to suicide in four months.

“We put a business case together [on improving staff morale] and fortunately we had some data to show that actually it’s going to save a lot of money,” she said. “There’s no better return on investment than when you invest in staff wellbeing.”

She said during covid 17% of the workforce screened positive for depression, 33% for anxiety.

However, wellbeing programs in the workplace, if not thoughtful enough, could elicit a backlash along the lines of: “Do not fix us with yoga, fix the damn system.”

Dr Cheryl Martin, an emergency physician who podcasts on health worker wellbeing and professional fulfillment, said the culture of medicine could be a prison.

“You’re on this treadmill and it feels like you can’t step off – you can. People say ‘You can’t do that’, but you can do that.”

Dr Bravery said younger trainees were more prepared to talk about their mental health, and that medicine was now seen as a job rather than a vocation, which limited what people were prepared to put up with.

Dr Jillann Farmer, CEO of A Better Culture, used Slido to elicit words from the audience that described their workplaces. The term that consistently dominated the word cloud was TOXIC, surrounded by rigid, inflexible, oppressive, conservative, suffocation, archaic, unsustainable and so on.

She said doctors worked in conditions that “wouldn’t be tolerated anywhere else. We’ve normalised practices that are inherently harmful.”

Dr Farmer shared statistics on bullying witnessed or experienced in the workplace. These disproportionately affect Aboriginal and Torres Strait Islander doctors, who report wishing to leave medicine at a higher rate – 28% – than non-Indigenous doctors.

Dr Prash Puspanathan described a kaleidoscope of roles and interests: the psychiatrist and psychedelics researcher (the interest in psychedelics came first) is also the founder of a cryptocurrency brokerage, an entrepreneur, an art collector and an amateur roboticist.

Dr Sandro Demaio, CEO of state preventative health agency VicHealth, gave us a tour of his precocious and very international public health CV before sharing his four tips for a healthy career:

  • take care of yourself first
  • find and understand your sense of purpose
  • reflect it in your practice
  • use your voice and privilege for good

In a later session three doctors raised adrenalin levels by describing their work outside the average comfort zone.

Dr Lachlan McIver, a rural generalist and writer who has worked for the WHO and MSF in “some of the most wacky and wonderful parts of the globe”, used a (very creative) “Choose your own adventure” format for his presentation, symbolising the fact that medical graduates do have choice.

His tips for thriving in medicine:

  • If you are nice to people, they will generally be nice back to you
  • Remember the nurses’ names
  • Be prepared to volunteer
  • Always have a headtorch
  • Spend time working in rural communities

“I’m an unashamed unapologetic ambassador for rural medicine and if you haven’t done it yet, stop messing about,” he said.

Dr Derrick Tin, a disaster medicine specialist and researcher, despite saying “there is nothing creative in what I do”, gave an inspiring albeit sobering rundown of his work, which focuses on responses to conflict and terrorism events; and Dr Brenton Systermans, skiing enthusiast, talked about finding a path that combined his love of winter sports and medicine, working with the Winter Olympics team and in frosty regions from the top to the bottom of the globe.

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