Why is an Anesthesia Career Change So Damn Hard?

At first glance, anesthesia providers are in a perfect position to execute dramatic career changes, such as developing non-clinical opportunities.
Anesthesia Career Change

At first glance, anesthesia providers are in a perfect position to execute dramatic career changes, such as developing non-clinical opportunities. After all, anesthesia providers as a group are some of the most intelligent people in our economy. On top of this, anesthesia providers do not shy away from hard work. They are willing to delay gratification for big goals. The very fact that they survived anesthesia training proves their ability to push themselves and outperform others. Objectively, anesthesia providers are more likely to succeed in any new career endeavor regardless of the challenges.

So if anesthesia providers have all of the ingredients needed for a successful career transition, why is it so hard?

Simply put, its is because our primitive brains get in the way! Evolutionary neuroscience tells us that our brains evolved to minimize danger. Although the world is no longer physically dangerous, our brains persist in behaviors learned over millions of years and still act as if danger is everywhere. This has some unintended consequences for modern life, such as navigating a career transition. The following three examples are some that I see everyday in my physician coaching practice:

The Don’t Get Eaten Agenda:

As we began to elucidate above, we are all hardwired to avoid risk. Evolutionarily, our brains are a “don’t get eaten machine,” constantly worrying about the tiger around the corner.

Life of course is very different now. There are very few threats in the physical world to our well-being. However, our lives are full of existential threats. Career change in particular threatens our sense of identity, stability, meaning, and purpose – and our brains don’t really know how to differentiate this from physical danger. Ambiguity and unknowns are inherently stressful to our primitive brains. So our brains fight back and try to help us avoid risk, and say things like “how can you leave such a stable job?” or “what if you are no good at this?” “Are you sure you really want to do that?”

For anesthesia providers this is even worse than for the average person, because this risk aversion is particularly reinforced in our medical training. We are taught not make a decision or act until we have analyzed every possibility and every data point – lest we kill someone and get sued. This hypervigilence and contentiousness results in safe and effective patient care.

When extrapolated to career change, however, it results in paralysis. When contemplating changing careers there is always more data that could be considered, more things that we could read, and more people that we could talk to. No amount of doing these things will ever completely reduce ambiguity or uncertainty, and therefore our brains say “maybe we should wait, maybe we are not quite ready yet – maybe we need to look into this a little further,” and so we decide not to act.

This brings an immediate sense of relief, while still preserving the promise that we will act in the future once we get just a little bit more clarity – but in reality this is just rumination and procrastination. Two years later we find ourselves in the same position, nothing changed.

The Tribe Agenda:

Fifty million years ago, our ancestors started living in groups. These groups, or tribes, were critical for protecting us from predators, protecting us from other tribes, raising our young, and helping us when we were sick or injured. Being able to live with and work with others, sharing a common purpose, became just as important to our survival as the ability to physically fight or flee predators.

As such, we became as hypervigilant about our social world as our physical world. We are hardwired to constantly ask, “Do I fit in here, is there any chance I will get kicked out? Am I good enough? Do they like me?” Constantly craving this social validation insured that we in fact did not get kicked out of our tribe, which would be synonymous with death.

But these hardwired social validation behaviors play havoc with our minds when we think about leaving medicine. We constantly wrestle with what others will think, and we internalize that voice as our inner critic: “Does is this mean I am not good enough? Everyone else seems to be happy and fitting in.”

We also tend to see our patients as part of our tribe, which results in an incredible shame and guilt. “Am I abandoning patients? What does that say about me as a physician?” “If not me, who will take care of these people?”

The critical voices are also external. In leaving medicine we are are rejecting our colleagues’ choices. Some of those around us will feel spurned. Others who feel as we do but don’t dare to act will be jealous. People will say “how could you want to walk away from this is amazing/ honorable/ privileged profession?” or “You’re just not dedicated.”

Of course, the best way to avoid this social pain is to not rock the boat, keeping our heads down, putting one foot in front of the other, until things “get better”. Again, two years later nothing has changed because we have changed nothing.

The More Agenda:

We are also evolutionarily hardwired to want more – more food, more resources, more power. This makes perfect sense in a world where our physical well-being was constantly threatened and we constantly faced scarcity.

Unfortunately, this makes it very hard to pursue opportunities that might result in less. At least temporarily, many career transitions for anesthesia providers do result in a reduction in income. Often there is also a reduction in position or authority.

On a practical level, our struggle with this is really about ego. It is very threatening to our egos to tell our family that we are taking a 50% pay cut to pursue a new opportunity. It is very threatening to our egos to transition to pharmaceutical marketing and find ourselves junior on a team led by someone 15 years younger than us with no medical education.

So ego binds us, and stops us from pursuing actions that would be more in accord with who and what is important to us.

These agendas – the neurocognitive hardwiring we all have as humans – are very powerful barriers to career change. But they are not insurmountable.

First, simply recognizing why are brain is doing this is incredibly empowering. It allows us to catch ourselves in the moment, and say to our brain “thank you for that thought, I know you’re trying to protect me, but I can take it from here!”

Second, we can use individual strategies for each of these agendas:

Act When You Are 80% Ready – The “Dont Get Eaten Agenda” wants us to wait for certainty and safety before acting. But of course we will never have this. We could always buff up our resume more, talk to more people, prepare more, or think about it more.

But if we act when we are 80% certain, or 80% ready, we avoid the never ending cycle of rumination and preparation. Is it better to wait until we are 100% ready to make that first phone call, or have that first interview – which results in never doing it? Or is it better to act at 80%, see where we get through trial and error, and use that feedback to make the next tangible step more clear and more likely to succeed?

Care Less About The Critics – Easier said than done, I know. But we have to realize that for all of the critical voices out there, the only person who has to live with the consequences of your decisions is you. Parents, colleagues, or society at large may guilt you into not making a change, but at the same time it is no skin off their backs. You are the one who suffers when you fail to commit to moving your life in a more vital and valued direction.

Realize When More Isn’t More – Its easy to look at our income, or our status, and compare it to other opportunities that on paper appear “less than.” But what is staying where you are at really costing you? How many hours a week are you really working, and what is your actual hourly wage? What is your current job costing you in terms of relationships, personal health, and joy?

The status quo often costs us dearly. Once we realize that more isn’t really more, the More Agenda losses its hold.

Author: Ryan Bayley, MD is a physician executive coach who specializes in helping healthcare providers create inspiring careers and lives, and helping leaders create the type of environments where people can bring their best selves to their work. Through his coaching and consulting practice, RyanBayleyMD.com, he has worked with hundreds of physicians to improve their experience of their work. 

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