Physicians and the midlife dip

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It seems that the midlife “slump,” “crisis,” or “malaise” phenomenon is actually something that has been studied and written about a lot in the last 40+ years. The phrase “midlife crisis” was originally coined in the 1960s, as explains Jonathan Rauch in his 2018 book, The Happiness Curve: Why Life Gets Better After 50.  He describes some fascinating research that shows a definite age-related dip (a U-shaped curve) in happiness in midlife.  What is even more fascinating is the research on chimps and orangutans he describes that shows a similar phenomenon in ape midlife. Could it be that we are predetermined to experience a slump in happiness after 40?

In another book I read recently, The Second Mountain, David Brooks of PBS News fame, writes about the search for meaning and purpose that happens after we’ve reached a level of success and happiness in the early part of our lives.  At that point, there is often a reckoning of sorts, resulting in the search for a bigger, deeper purpose, and a more fulfilled, meaningful life, the “second mountain.”

In the field of medicine, we see burned-out doctors of all ages, but the phenomenon of midlife burnout may be part of a bigger process in psychological growth that happens after 40.  Your career is generally settled by this point, and you have attained the “things” of life: marriage, house, kids.  Often there is something that happens that shakes up the monotony: a death in the family, an illness, a pandemic- and there is a reevaluation of life and of the direction it is going.

I coach women physicians at this stage of life, and it is so interesting to me how universal these feelings are—the feeling of discontent, the longing for something else, many times with no inkling of what it is, the desire to make a difference and to leave a meaningful legacy. There also seems to be an awakening of “self.”  Women physicians often neglect self-care their whole lives, and then feel empty as they realize in midlife that they have been taking care of their patients, their partner, their kids, their pets, but not themselves.  Unfortunately, this often comes with feelings of failure and shame, in addition to discontent.

Though it may coincide with perimenopause and menopause in women, this transition is by no means unique to women. Men also have an awakening in their 40s. Many find that there is a shift in their values; life becomes more about connection and community than ambition. And, with this shift, we care less about what people think of us, and more about what we think of ourselves and our place in existence.

Before knowing any of this intellectually, my own experience was (and is) totally representative of these concepts. The “midlife dip” is the term I have coined after experiencing it at age 50.  I was at the peak of my career and was burned out, but it was more than that; there was a feeling that I needed more in my life.  After dealing with the burnout (which involved the concrete steps to change up the details of my career), I still felt a calling– to physician wellness, to personal wellbeing, and then eventually to physician coaching.  I am now on the upswing of the Happiness Curve, on the Second Mountain, and continuing upward from the Midlife Dip.

Whitney Johnson talks a lot about the S-curve of learning, in her book and podcast Disrupt Yourself.  I think of this as a corollary to all these other curves. She describes the process of making a courageous choice to do something new, of taking a risk. It is at the bottom of the S-curve, in the stage of incompetence, that the learning happens. You evaluate your strengths, you discover the possibilities, and you come up with creative ideas.  Then, you reach a tipping point, and start to ascend the vertical part of the curve in a phase of “hypergrowth,” where you develop confidence and finally competence and mastery.  This is the exciting part, the part that gives you that sense of purpose, the phase that serial entrepreneurs crave, and the reason they jump from one S-curve to another once reaching mastery.

How does this apply to medicine?  We all go through our early lives in the S-curve of our medical education–college, medical school, residency, early practice.  As you reach the mastery phase, I would posit that there is a downward dip as we realize that we are no longer in that exciting hypergrowth phase.  The search for a new curve happens, the desire to ascend the second mountain, to find a more meaningful purpose.

How do you begin to find that purpose? Some people take a sabbatical or quit their job entirely. Some physicians look for leadership positions or transition to a non-clinical role. But while this may fix some of the career discontentment, you will stay in the dip, the valley, the bottom of the U-curve without a true search within yourself. It is through a reassessment of your true values that you will find your why.

What’s particularly interesting is that things just continue to improve once you get to this point in midlife and beyond. Whereas you may have burned out once or twice before, once you have reached this point on the happiness curve, or are on the second mountain, or have come out of the midlife dip and have found the purpose and meaning you were looking for, you will find yourself more content, and generally happier. With age comes wisdom, compassion, and gratitude. Connections matter more, and the little annoyances of life matter less.  What people think of you is much less important, and what you believe and about yourself, and how you treat yourself, is everything.

Beverly Joyce is an obstetrician-gynecologist and physician coach. She can be reached at DrJoyCoaching.

Image credit: Shutterstock.com

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