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A downsized doctor's survival guide


A doctor who lost his job reflects on the lessons he learned between positions.


A downsized doctor’s survival guide

A doctor who lost his job reflects on the lessons he learned between positions.

By Arthur Lazarus, MD
Psychiatrist/Prospect, KY

"I’ve decided to close your position," said my boss over lunch. "We’re going to decentralize operations."

How could this be happening, I wondered, my appetite suddenly gone. Perhaps I was naive, but I’d never thought I could lose my job, that of medical director with a large managed care organization. But the company needed to downsize to offset a loss in premium revenue.

I was lucky: I started a new position just a month after being laid off. But during that month, several thoughts came into focus. If you’re ever out of work, perhaps they’ll help you.

Don’t think of yourself as unemployed. Think of yourself as a recovering taxpayer. Every physician today is "recovering" in one sense or another, especially those who’ve made the transition from practice to management. The ability to make this transition gave me the strength to handle the anxiety of being temporarily jobless. As a group, physicians don’t fare well in ambiguous situations.

Recall past words of encouragement. My father died in 1989, but I found solace in his humor. "What do you call a medical student who graduates last in his class?" he’d ask. "Answer: a doctor." Having grown up during the Depression, he was delighted I chose medicine. "There’s no such thing as an unemployed doctor," he said. If he were still alive, I’d reply, "Not in the long run, at least."

Heed warning signals. A month before being terminated, I suspected something was wrong. Decisions were being made without me, e-mails went unanswered, and I felt increasingly isolated. Alarm bells went off as the budget was being prepared and a workforce reduction was announced.

Don’t try to pretend you’re indispensable. Don’t put off updating your résumé because things may work out. Learn to trust your instincts.

The bottom line is the bottom line. Most organizations, no matter how large, are run by a very small group of decision-makers. Physicians in that capacity are outnumbered by businesspeople, many with advanced degrees, whose reaction to financial crisis is to eliminate jobs. This is especially true with public companies, which are under pressure to show profits every quarter. CEOs who improve the bottom line are lauded, even when the real contributions come from laid-off workers and their families.

If you haven’t lost at least one job, you haven’t taken enough risk. During my psychiatry residency, my supervisor commented, "Art, if none of your patients commits suicide during your career, you’re not seeing difficult patients." Another supervisor offered this corollary: "The only thing worse than a suicidal patient in your office is one who doesn’t show for an appointment."

I took a calculated risk when I accepted the job I eventually lost. It had great potential and prestige, although it involved relocating my family to a city I’d never have considered moving to. I had hoped to last five years there, but fell short.

Become a "company of one." To cope with today’s turbulent job market, you must learn to behave like the CEO of a "company of one"–yourself–and acquire strategic skills for success.

Gain knowledge of the health care industry, learn to manage change and innovation, sharpen your analytical abilities, select and cultivate mentors, develop people skills, and market yourself. As it turns out, physicians already possess many of these strategic planning techniques that top corporations have used for years.

Look forward, not backward. The days of undivided loyalty in exchange for lifetime employment and a gold watch are gone. The new deal is to work for as long as the company needs you and you need the company. Be proud of your accomplishments and what you’ve learned, and think about how you’ll apply newly acquired skills in your next job.

Whether you leave voluntarily or not, never trash your employer. One of the first things I did after getting the bad news was to write letters to the two highest-ranking executives in the organization, thanking them for the opportunity to have worked there.

Network, network, network. When you receive a pink slip, don’t waste time feeling sorry for yourself or wondering "Why me?" The sooner you begin your search for a new job, the more productive you’ll feel and the more severance pay you’ll retain.

Learn how to dodge the next bullet. Economics wasn’t the only reason my job was eliminated. The two people who had hired me were themselves let go within a year of my arrival. My new boss was bent on cleaning house. Politics is perhaps the No. 1 reason why physician executives lose their jobs. So go out of your way to establish good relations with your new boss.

In any life and at any age, jobs will come and go. Virtually all physicians who lose a job will find another soon. I’m told there’s a shortage of physician executives–good news if you’re seeking employment.


Arthur Lazarus. A downsized doctor's survival guide.

Medical Economics


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© National Institute for Occupational Safety and Health
© National Institute for Occupational Safety and Health
© National Institute for Occupational Safety and Health
© National Institute for Occupational Safety and Health
© National Institute for Occupational Safety and Health
© National Institute for Occupational Safety and Health