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Excellence is an act, and we are what we do. --Aristotle
Every two to three years, Lancaster General Health contracts for an independent evaluation of our Medical Staff development plan. LG Health leadership uses the community-wide assessment to strategically match anticipated healthcare needs and provider access. Blending art and science, the evaluation includes complex data analysis, population demographics, national benchmarks and team-based panel management.
The evaluation -- no surprise -- identified physician needs in psychiatry/behavioral health, neurology, internal medicine and hematology/oncology.  An unsettling prediction of the study was the potential retirement of 20 to 25 percent of the physician staff in key areas, like pediatrics, family medicine, general surgery, obstetrics and radiology, by 2021. The sterility of the organizational statistics grossly undervalues the clinical skills and judgment tempered by years of experience. A challenge to acquire, these are even more difficult to replace.
In a regular feature of the Journal of the American Medical Association, “A Piece of my Mind,” physicians offer their perspectives on a variety of healthcare issues, including healthcare delivery, quality, access, change -- and frequently, professional quality of life. In January, Dr. Lawrence Hergott, a cardiologist, reflected upon his career as he closed his practice and packed away artifacts that “signify formative and sustaining occurrences in my life that took me from the uncarved block of wood at the beginning of my career to the physician and person I am.” Somehow those patient gifts of gratitude and family pictures marked the trail of lives touched and the emotional support of his home. Only packing the stethoscope, symbolic of “letting go of patients and their loved ones” brought tears. He thought of the collegiality and camaraderie often manifested and shared through humor, ironically at some of the most difficult times. As physician offices are downsized to work stations, space for gifts, pictures and oft outdated textbooks shrinks. While the packing may be easier, we risk losing touch with the trail. 
Stephen Covey, through his book, “The 7 Habits of Highly Effective People,” has offered perspectives on personal and professional satisfaction for over 25 years. One of his habits, “Begin with the End in Mind,” can easily apply to medical education and clinical training, leading to patient care and service. He describes professional careers created twice -- once in the design phase and once in delivery -- based on principles and values. Through the bittersweet lens of packing an office, are the two congruent, and do the milestones provide comfort that we followed the trail once imagined? 
Clayton Christensen, a Harvard business professor and prolific writer on innovation, challenges his students to find happiness in their career and strength in relationships, and to live with integrity. He cautions against “frittering away time and energy on obtaining marginal cost items, those most tangible and short-term signs of achievement.” Instead, he advocates for opportunities that provide learning, expand opportunities, contribute to others and provide recognition -- experiences that can provide resilience during difficult times.
Those on final approach to retirement should easily recognize William Shatner as the brash Commander Kirk of the starship Enterprise. In an industry where box office success can be as short-lived as a Super Bowl commercial, Shatner’s 50+ year career testifies to his ability to reinvent himself through his roles, ranging from “Star Trek” to a retired police officer to a Boston lawyer and most recently as the Priceline negotiator. His disciplined training prepared him to thrive on riskier roles other performers rejected. His irreverent approach belied his amusement, both with the roles he played, as well as the audience he entertained -- perhaps a secret of his success.
While medical training does not foster reinvention, many of our colleagues have succeeded beyond their clinical roles. Dr. Larry Bonchek chaired the LG Health/Lancaster medical manpower commission, advanced LG Health’s medical education capabilities, shaped both medical and undergraduate education through BOT membership and chairmanship, and edits/publishes a highly respected clinical journal. Dr. Fred Rogers, after stepping down from his Trauma directorship duties, educates and mentors surgical clerks from Temple and continues to advance trauma research. Dr. Robert Gillio, a Mayo-trained pulmonary and critical care physician, left clinical duties to advance pharmacy delivery systems and develop community-based healthcare before population health was a concept. 
Dr. Hergott – the JAMA author -- retooled shortly after closing his cardiology practice and office. He supplements a large cardiology group with outpatient consultations, minus his office. He reports that he is “having a blast,” and his “days are full but not hectic … sated with meaning and joy.”
We should all be so lucky.


Lee M. Duke II, M.D.
Chief Physician Executive
Progress Notes' Editor-in-Chief

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