Physicians Need to Challenge Their Brains, Not Just Think

Gregory A. Hood, MD


October 21, 2019

It probably takes physicians the longest of all working professionals to begin earning a living. Architects, lawyers, and other professionals must shake their heads in disbelief at how long physicians in certain subspecialties take to complete their training and begin their productive earning years.

For many physicians, the combination of being driven and academically successful from a young age coupled with a pervasive lack of financial education can create significant misconceptions and blind spots. There is often a large impact from delayed gratification on investing timelines and lifestyle decisions.

However, there's an even greater concern. Physicians often have an inherent assumption of the permanence of their career and their performance abilities.

What happens if physicians or surgeons overestimate the longevity of their productivity and fail to realize when their careers reach peak performance? What if the decline in their professional abilities and/or earnings comes much sooner than they anticipated?

These days, physicians are often employees. Rather than running their own practice and making the decisions about when to stop, I've known excellent physicians who have simply been pushed out or cast aside by their employers for a variety of reasons.

Sadly, there can be a large personal cost to a physician's individual changes in performance abilities. It can be self-destructively easy to conclude that a point is reached where she or he is no longer wanted.

To receive this message midcareer when the effects of age are becoming real can be very destructive. The nobility of the calling to help the health of other mortals can tarnish rapidly in a beleaguered mind when vulnerabilities and mortality are felt. For those who have also neglected their physical health and outside interests due to the pursuit of their calling, it's easy to conclude they aren't needed any longer and perhaps not in almost any aspect of life.

How can physicians avoid misery and achieve happiness when their active time within the profession nears its end, whether through voluntary retirement or other circumstance?

This unhappiness is preventable, or at least manageable, with planning and effort.

The Pressing Need to Feel Wanted and Relevant

Certainly, physicians who embrace the mantra of lifelong learning seem to have an advantage. This is a vital lifeline for precluding, or at least managing, the dreaded, eventual professional decline. The decline in happiness physicians feel into their 40s and early 50s has been well documented. It's essential to find ways to mitigate this trend and ride the wave of resurgence in happiness that typically recovers and increases through the 50s until age 70 (in wealthier countries).

…perhaps the career of a physician is, to those who become disillusioned, no more enduring than the works of a sidewalk chalk street artist.

A key is having the sense that you remain relevant and useful. You might think that gifted and accomplished people, such as physicians, would be less susceptible to having a sense of irrelevance. However, although many people assume that accomplishment is a continuing source of happiness, perhaps the career of a physician is, for those who become disillusioned, no more enduring than the works of a sidewalk chalk street artist.

How does a physician define relevance and maintain her or his skills in a rewarding fashion? First, feel useful, which involves setting and managing self-expectations.

Being gifted and achieving successes early in life doesn't appear to insulate you against suffering later on. In fact, it's quite the opposite. In 1999, Holahan and Holahan published the results of a study of older adults who had been identified early in life as highly gifted. They found that intellectual giftedness was inversely related to psychological well-being at age 80. In other words, if you create your self-identity around being a physician and being highly intelligent and capable, you may be worshipping an idol of yourself built on feet of clay.

The Holahans concluded that creating "unrealistic expectations for success" causes people to fail to take into account the many other life influences on success and recognition. Infirmity and time compound this effect. Alex Dias Ribeiro, a former Formula One race car driver, wrote in a blog, " Unhappy is he who depends on success to be happy. For such a person, the end of a successful career is the end of the line. His destiny is to die of bitterness or to search for more success in other careers and to go on living from success to success until he falls dead. In this case, there will not be life after success."

Sadly, the career decline starts earlier than most people want to concede. According to Dean Keith Simonton, PhD, professor emeritus of psychology at UC Davis, success and productivity increase for about the first 20 years after a person's career begins.

For physicians, their careers will begin around age 30. They can expect to do their best work around age 50 and begin their career decline soon thereafter. However, there is hope for sustainability in their careers and satisfaction in their lives.

The Importance of Challenging the Brain

Endurance comes through the ability to reinvent yourself—to channel your energies and activities in expanding directions. This doesn't mean you must abandon the practice of medicine. Rather, you should undertake new interests and pursuits that interest you, both within and beyond your scope of practice.

According to the theory of fluid and crystallized intelligence, if fluid intelligence is the ability to reason, analyze, and solve novel problems, and crystallized intelligence is the ability to use knowledge gained in the past, you can see the increasing value of experience across your career. It is also easy to see that if you do not continuously use your fluid intelligence, you should be expected to, well, "crystallize"­—although perhaps fossilize might be a more apt term.

In order to fulfill your potential and your life, it's important to pursue objectives that are the most important to you.

Maintaining this fluidity requires unlocking your brain's abilities. Decisions can take the form of new initiatives in your practice processes and services, new spiritual directions, new avocations, or wholly new experiences. In order to fulfill your potential and your life, it's important to pursue objectives that are the most important to you.

Just as our society often prematurely concludes that someone's ability to be "useful" has passed, society also too often concludes that a brain is too old to learn. The key, it seems, is to actually challenge your brain. This is different than merely thinking, which is why simply doing crossword puzzles, although still beneficial, isn't enough to grow or transform the brain.

Challenging a brain gives it the opportunity to work faster with greater accuracy. As Camilla Cavendish, British journalist and director of policy for former Prime Minister David Cameron, said:

Until recently, we thought that the brain cells we were born with were a lifetime quota and that brains became fixed in adulthood. But in the past decade, with the help of MRI scans and experiments on mice and monkeys, neuroscientists have demonstrated comprehensively that the human brain remains plastic throughout life. Like Victorian cartographers, they have mapped the landscape of the brain to show that old dogs can learn new tricks—and in fact they must, to keep in shape.

Cavendish is correct when she says the data suggest "we are far too fatalistic about many aspects of longer lives… If we are to enjoy this extra time, we need to extend our mental lifespans to match our physical ones. And that means making the most of breakthroughs in neuroscience which show that our brains keep learning and adapting throughout our lives."

We've known for some time that physical exercise benefits the brain. More recently, research has shown that cognitive exercise provokes physical changes in the brain as well. Taking on aerobic exercise, for example, for the midcareer physician, can be transformative for all aspects of body, mind, and life. Reevaluating your priorities, enhancing your social contacts, and adopting new changes, all done with a positive spirit, can help avert a midlife crisis.

Leaving a profession that you love (or once loved) can feel like a part of you is dying. Yet perhaps your self-identity as a physician isn't essential. You might attain greater long-term contentment from detaching yourself from the influence, status, and income associated with your career.

The biggest mistake successful professionals often make is attempting to sustain peak accomplishment at the same level indefinitely. As Lou Holtz, former head football coach at Notre Dame, said, "In this world you're either growing or you're dying, so get in motion and grow."

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