Clinician Educators and Midlife Crisis

By: Daniel Cabrera (@cabreraERDR)

The life cycle of a Clinician Educator (CE) is not much different from typical professionals in industrialized countries; however, there is a significant upfront investment in our careers (undergrad, med school, residency, fellowship and graduate programs) that may make the timing of the mid portion of our careers different when compared to non-health care workers.

Regardless of the timing, most of us will experience a midlife crisis (MLC) at some point between our late 30s and early 50s. Although not universally accepted, the concept of a MLC includes physical components (decline in stamina and health), social changes (responsibility for one’s children and potentially parents, financial issues), professional and personal boredom as well as emotional discomfort and frustration (mismatch of early expectations with current reality and potential limited future).

Recent research appears to support the existence of an existential period of unhappiness located in the middle of the functional life of most people. (There is also some evidence supporting a similar phenomenon in high primates). The interesting observation is that a MLC is independent of success, affecting people across all walks of life and degrees of achievement.  For successful individuals the problem appears to be dissatisfaction with the goals obtained (“Is this all?”) and for less accomplished people the frustration is with the mismatch of idealistic early plans and actual outcomes (“I failed”).

For CEs, this phenomenon is not different and I would argue is potentially more common. We invested our early lives in clinical, academic and educational training. After a long road we achieved a reasonable mastery of these domains and we rapidly assume roles of increasing prominence in our institutions. The complicating factor for CEs is the very short period between the end of early life and midlife. We reach the chronological stage of a MLC with very little time to accomplish plans established during our optimistic youth, while simultaneously realizing the road in front is quite difficult. In fact, things are even more complicated. The medical education environment is undergoing transformative change; the difficult road in front is hard to see and even harder to navigate.

There is hope. Experiencing dissatisfaction and frustration with your life appears to be normal. This period of life follows a U-shape, bottoming out within 5 years of onset.  After that, everything gets better. The key is to navigate this period without doing something stupid.  Use this time as an opportunity to craft a better plan for an improved vision of the future.

Interestingly, no matter what you do, things are going to be better. Middle-aged people tend to underestimate future satisfaction. This expectation gap now works in your favour.

A MLC is an opportunity to accept limitations, stop focusing on failures, re-evaluate goals and propose new ones.  It is a time to move from social-competition to social-connectedness. It is a time to re-adjudicate your accomplishments. “I may not be the dean of the med school, but what I have is pretty darn good”

What can you do when you realize you are in the MLC?

First, and above all, avoid drastic, impetuous, life-changing decisions, such as divorce, a complete change of career, becoming an outlaw biker or freestyle skydiving. theAlso, these changes will not change your mid and long-term happiness.

Second, remember a MLC is not synonymous with decline in abilities.

Third, you are in great position to re-invent your goals. People in this stage of their careers have a deep understanding of their knowledge domain as well as the culture of the institution, specialty and academia in general. The quality of a new plan is signficantly better than the plans crafted at the very start of a career.

Fourth, in general, is not a bad idea to discuss your MLC with your mentor, with your learners and even with your boss. This will make easier for everybody to understand where you are going and reasons for course corrections. It may help your boss to place you in a better position for development and help your learners understand a process they will also experience. But exercise caution in disclosure.

Fifth, and last, reinvent yourself. There is research to support that the creation of a second-life is beneficial to overcoming a MLC. This second life involves the creation of a distinct new career or side-career and may leverage existing abilities in new ways or in new environments. I may or may not be in a MLC myself, but I have talked to a lot of smart people about this.  Most of them gave me the same advice: reinvent yourself and do it often. Perhaps you are frustrated with being the medical school clerkship director, why not use your transferable skills and lead a CE diploma program? You may see no light at the end of the tunnel in residency education, why not move into Social Media?

This is not a crisis, it is just a great opportunity.


References and further reading

Image by halfrain (flickr) under Creative Commons License CC2.0