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Why [Some] Doctors Won’t Ever Work for Uncle Sam

Understanding the Medical Career Path

[circa 2019]


By Dr. David E. Marcinko MBA

By Eugene Schmuckler PhD, MBA



Who seaks for, or writes about, physician careers under a M-4-Uber scenario?

When you think about careers, how many adults are truly aware of their own interests, values, strengths and weaknesses during their teen years? As with much of human behavior, career choices actually go through a series of stages.

Psychologists have for years identified stages of human development.  Kohlberg discussed stages of moral development. In the 1970’s, Daniel Levinson published The Season’s of a Man’s Life, a project he undertook when he began to look inward and tried to understand his behaviors, values and attitudes to work. Discussions with his university colleagues indicated that what he was experiencing was not unique to him.

Traditional Career Routes

For many years the prevailing thought was that the correct way to function in the labor market was to gain employment with a company progressing through the years until such time as you were eligible to receive the “gold watch”, the symbol of retirement. If you entered a professional discipline such as medicine or law, you did that for the rest of your life.

Alternate Career Paths

Today there are still individuals who follow these traditional patterns but there are other career paths that may be taken.

The most traditional career route follows a linear path, one that most of you have rejected. This entails gaining employment in a large, bureaucratic organization with a tall pyramidal structure [command-control]. It involves a series of upward (hopefully) moves in the organization until the career limit is reached. As the individual progresses upward in the organization he or she may work in different functional departments such as marketing, finance, and production. Organizations having these paths seek employees who tend to be highly oriented toward success defined in organizational terms and exhibit “leadership” skills. In general, these people demonstrate a strong commitment to the workplace. A person with this type of orientation (Organizationalist) exhibits the following tendencies:

  1. A strong identification with the organization; seeking organization rewards and advancement that are important measures of success and organizational status.
  2. High morale and job satisfaction.
  3. A low tolerance for ambiguity about work goals and assignments.
  4. Identification with superiors, showing deference toward them, conforming and complying out of a desire to advance; maintains the chain of command and compliance, and views respect for authority as the way to succeed.
  5. Emphasis on organizational goals of efficiency and effectiveness, avoiding controversy and showing concern for threats to organizational success.

As many readers of the Medical Executive-Post are aware, you have followed the expert medical career path, building a career on the basis of personal competence, or the development of a profession (legal or accounting professionals). As you are so painfully aware, you invest heavily, personally and financially in acquiring a particular skill and then you spend the major portion of your life following that skill. Unlike the pyramidal structure of the linear path, career paths are found in organizations that tend to be relatively flat, have departments in which there is a functional emphasis, emphasize quality and reliability, and have reward systems containing a strong recognition component.


Medical Professionals are Different

Medical professionals are folks who are job-centered – not organization centered – viewing the demands of the organization as a nuisance that they seek to avoid [THINK: Gregory House MD].

However, that avoidance is impossible since the healthcare professional must have an organization in which to work. This is even more prevalent in today’s era of managed health care and e-Health 2.0, than ever before. At work, professionals experience more role conflict and are more alienated. Medical professionals exhibit these four tendencies:

  1. An experience of occupational socialization that instills high standards of performance in the chosen field; highly ideological about work values.
  2. Sees organizational authority as non-rational when there is pressure to act in ways that are not professionally acceptable.
  3. Tends to feel that their skills are not fully utilized in organizations; self-esteem may be threatened when they do not have the opportunity to do those things for which they have been trained;
  4. Seeks recognition from other professionals outside the organization, and refuses to play the organizational status game except as it reflects their worth relative to others in the organization. Professionals are very concerned with personal achievement and doing well in their chosen field. Organizational rewards serve to reflect the professional’s importance relative to others in the system. This recognition may be extremely fulfilling, especially when he or she is accorded higher status and pay than others. In the absence of organizational rewards the professional may use material objects (large homes, expensive cars) as a way of reflecting status and accomplishment.

Performance not Authority

Medical professionals are of the opinion that successful performance, not compliance with authority, is more reinforcing. With this mindset it is not surprising why many medical practitioners balk at working in the managed health care, state-run or governmental lead healthcare environment. Many professionally oriented people come from the middle class and have become successful through a higher level of education or by other efforts to acquire competence.

The Spiral Career Path

Those on the spiral career path make periodic moves from one occupation to another. Individuals who follow this career path tend to have high personal growth motives and are relatively creative. Usually these changes come after you have developed competence in the occupation you are working in and you think it is time to change what you do. The ideal spiral career path is to move from one occupation to an area related to it. This enables you to use some of the basic knowledge that you developed in your past work and to transfer it to your new occupation. The difference between this path and the linear path discussed above is that in this case the mobility pattern is lateral, not upward.

The Transitory Career Path

People who take the transitory career path cannot seem to, and perhaps do not want to settle down. The pattern is one of consistent inconsistency in their work. These are individuals who may find a great deal of satisfaction working as healthcare consultants. The work style is marked by an ability to do many things reasonably well. They value independence and variety, and they work best in relatively loose and unstructured organizations that tolerate the type of freedom they demand in their work.

Sam (1)

The Indifferents          

We have so far discussed the four types of career paths and two career orientations. A final form of career orientation is that of the indifferents, those who simply work for a paycheck. Will this be the result of Obama care? These are individuals who do their work well, but they are not highly committed to their job or the organization. Some characteristics of indifferents are:

  1. More oriented toward leisure, not the work ethic (is it Friday yet?); separates work from more meaningful aspects of life, and seeks higher-order need satisfaction outside the work organization.
  2. Tends to be alienated from work and not committed to the organization.
  3. Rejects status symbols in organizations.
  4. Withdraws psychologically from work and organizations when possible.

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Indifferents are not necessarily born that way; some are actually a product of their work experiences. People who once had an organizational orientation and were highly loyal may no longer follow orders without question.

For example, you may have had a medical officer manager who very early in his or her career was extremely committed to you and your medical practice, hospital or healthcare organization. He or she may seek rewards and want to advance. However, in later career life, after having been passed over several times for promotion, the person seeks rewards elsewhere. Thus, it is possible that through office practices, your healthcare organization may turn highly committed organizationalists (or medical professionals) into relative indifferents; HMO patsies or grunts for Uncle Sam.


And so, your thoughts and comments on this ME-P are appreciated. Feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, be sure to subscribe. It is fast, free and secure.

Link: http://feeds.feedburner.com/HealthcareFinancialsthePostForcxos

Note: Dr. Gene Schmuckler is director of behavior economics for www.MedicalBusinessAdvisors.com. He is an expert on physician career re-engineering, and a retired Professor of Organizational Behavior who taught Dr. Marcinko [our Publisher-in-Chief] in business school, almost two decades ago.

Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko and Dr. Schmuckler are available for seminar or speaking engagements .Contact: MarcinkoAdvisors@msn.com

Subscribe Now: Did you like this Medical Executive-Post, or find it helpful, interesting and informative? Want to get the latest ME-Ps delivered to your email box each morning? Just subscribe using the link below. You can unsubscribe at any time. http://feeds.feedburner.com/HealthcareFinancialsthePostForcxos

Sponsors Welcomed: And, credible sponsors and like-minded advertisers are always welcomed.Link: https://healthcarefinancials.wordpress.com/2007/11/11/advertise

Brousseau, K.R., Driver, M.J., Eneroth, K. and Larson, R.: Career Pandemonium: Realigning organizations and individuals. Academy of Management Executive 10 (4), 52-66. 1996

Presthus, R. The Organizational Society. New York, NY: St. Martin’s Press.

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3 Responses

  1. With the constant lowering of reimbursement … I’ll bet MOST doctors would LOVE to work for the government … 6 weeks of vacation per year and a nice fat pension after 30 years on the job.

    If Washington DC secretaries make $100k+ … doctors should make a little more than that. Sign me up!

    Dr. WPS


  2. Why some Docs don’t want to remain in the AMA

    Did you know that the Florida Medical Association [FMA] is scheduled to consider a resolution severing ties with the American Medical Association because of its support for the healthcare reform law?

    The scathing resolution takes the AMA to task for having “failed to achieve one single concession” in the healthcare reform bill. It calls the organization’s efforts to repeal the Medicare payment formula for physicians a “fiasco” and accuses the AMA of “failing to lead and represent America’s physicians and the American People on the signature medical legislative issue of this century.”




  3. Don’t Sell Your Soul to the Hospital Yet

    Being an employee at a hospital can be a great fit for many doctors.

    But, for (supposedly) high-income specialists, this decision could come at an unnecessarily high financial cost. You can receive more net income in private practice when you invest in better management and systems. Once you understand how good things could be, you will be able to more fairly assess the costs and benefits of giving up private practice for hospital employment.


    Ann Miller RN MHA


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