Where to Draw the Line

As physicians, we pride ourselves on persevering through unfavorable conditions to deliver optimal results and satisfaction to our patients. Medical training is not luxurious—indeed, we all have ‘war stories' of 36-hour shifts, surviving on graham crackers and Ensure, letting down loved ones (and potential loved ones), and being reprimanded by attendings and senior fellows. All the while, we had to make life and death decisions for those in our care. But as aesthetic medicine is bombarded with increasing regulatory scrutiny, certification requirements from specialty organizations, exploding competition from those without proper training, as well as increased demand from patients, it is not surprising that physicians feel alternatively defensive and despondent.

While our general medicine and pediatric colleagues may think we are immune to this doom-and-gloom, the latest Medscape Plastic Surgeon Lifestyle Report actually shows that frustration is spreading fast throughout our community. The report found that 37 percent of dermatologists and 45 percent of plastic surgeons are feeling “burned out,” with the latter ranking among the highest severity of burnout among all specialties.

Arguably the most unsettling aspect of this data is the underlying implication of the term “burnout.” Physicians are not burning out because they are not doing enough, but rather because they are trying to do too much. To practice medicine in this environment requires practicing medicine, managing a business, and an exponential increase in ‘paperwork,' often keeping us at the office for several extra hours a day. It sometimes seems that the non-medical aspects of our practice are squeezing out the medical aspects.

And yet, reducing our workload or saying “no” to another surgery, patient, late night appointment, ER call, hospital administrator, or academic society request seems so difficult for us to do. By nature most physicians are altruistic, perhaps to a fault at times. We tend to be givers and while this in the past seemed synonymous with professional fulfillment and success, today it can lead to depression, substance abuse, and burnout. More senior physicians are retiring years before they'd planned because the ‘joy' of practice was overshadowed by the ‘scut' and ultimately the economics didn't make sense any longer. For those physicians at the beginning or middle of their careers, how do we continue to not only survive but enjoy being aesthetic physicians?

This edition of Modern Aesthetics^® takes a hard look at the concept of letting go, as it applies to the changing field of aesthetic medicine. Replete with personal insights from authors' own experiences, the accounts herein detail the struggles and opportunities that come with restructuring what medical practice means, whether deciding to pull out of Medicare, turning away difficult patients, or taking a pass on the rising tide of electronic medical records.

Sometimes you have to make a difficult or unpopular decision when it doesn't align with your mission and ethics, or when the anxiety or stress is greater than the potential reward. Although the decision to let go of something may cause an initial setback, the prospects of long-term happiness are more important than short-term financial gain. The Pareto principle states that 80 percent of your outcomes come from 20 percent of your inputs: 80 percent of a company's sales come from 20 percent of its clients, 80 percent of company's complaints come from 20 percent of its customers, 80 percent of company's income comes from 20 percent of its products and services, etc. Thus, dramatic improvements in profitability, productivity, and happiness can result from focusing on maximizing that 80 percent.

If we must summarize in one word, the core of aesthetic practice, we need to go back to care . We care about doing the best for our patients, we care about maintaining an ethical and profitable business so that we can care for our families, and we care about maintaining the level of quality in our specialities. But we must also work harder at caring for and protecting ourselves. At times that means stopping or making a full U-turn.