by Juliet Farmer
Richard A. Sheff, author of Doctor Confidential: Secrets Behind the Veil, is a Rhode Island family physician with over 30 years of experience in medicine. Dr. Sheff received his MD from the University of Pennsylvania School of Medicine before serving his residency with Brown University Division of Family Medicine at The Memorial Hospital in Pawtucket, Rhode Island.
After practicing family medicine in Massachusetts for 12 years and teaching at Tufts University School of Medicine in Boston for a decade, Dr. Sheff launched a company, CommonWell, with the goal of helping the healthcare system integrate the best of complementary and alternative medicine with the best of conventional medicine. He also began consulting with hospitals and physician organizations in the U.S. and internationally.
Currently, Dr. Sheff is chairman and executive director of The Greeley Company, a healthcare consulting and education company. Dr. Sheff is a member of both the American College of Physician Executives and Physicians for Social Responsibility.
Why did you choose to become a physician?
I first became interested in medicine in high school while reading I Never Promised You a Rose Garden, a story about a woman’s journey through schizophrenia as told from her perspective and her psychiatrist’s perspective. I was so taken with the psychiatrist in the book that I felt I had found a potential career I could see myself doing for my whole life. In college I explored both psychology and psychiatry (along with a number of other areas of interest), and finally settled on psychiatry. That’s why I entered medical school fairly sure I would go into the specialty of psychiatry. One of the stories that weaves throughout the first half of Doctor Confidential is my journey in choosing a specialty, which ultimately became family medicine.
If you had it to do all over again, would you still become a physician? (Why or why not? What would you have done instead?)
I have no hesitation in answering that I would choose to become a physician again. I can think of no other endeavor that allows me to be and do all that I want to in this life. The experience of being a physician is that people come to you, entrust you, with their deepest vulnerabilities. You commit to bring all of yourself—your knowledge, skills, and humanity—to do all you can to help them. What an extraordinary way to get to spend your day. That you get paid to do so, and in many specialties paid quite well, makes this all the more extraordinary.
You don’t gloss over anything in your book—from grueling med school study sessions, to crazy (both literally and figuratively) patients during various rotations, to narrow field of vision in each specialty. What made you keep going?
There are two answers to this question. One is the strength of will that I brought to the challenge of medical training. This is definitely a necessary ingredient. It’s why, I believe, organic chemistry is used as such a weeding out, make or break, course for pre-medical students. The only way to do well in organic chemistry is to commit to, and follow through on, arduous rote memorization of a large amount of information. This can only be accomplished with a sustained exertion of will. If you have the will to do this for organic chemistry, you likely will succeed through the challenges of medical training.
The second answer is that during medical training, at least once into the clinical rotations, most students encounter enough successful and satisfying experiences to make it feel worthwhile and keep you going. I’ve shared some of those experiences in Doctor Confidential, like the anxious woman with emphysema and the dying woman who was her roommate.
When you wanted to pursue psychiatry, was it coincidence that psychiatry was your first rotation, or were you able to plan it that way?
At Penn, we had the opportunity to list our preferences, and some computer somewhere did its best to optimize everybody’s choices. I was quite happy to do psychiatry first. We also had the option of doing a one month rotation in psychiatry at one of the general hospitals or a two month rotation at a psychiatric hospital. I chose the two month rotation, and had a much richer experience for having done so, as I hope comes through in the stories from that rotation.
After you attended Dr. Curry’s lecture, you had an epiphany about your career path. Do you think you would have reached the decision to pursue family practice sooner rather than later had you not attended that lecture?
First of all, it was not so much of an epiphany as an opening to a new possibility. It took almost two years and lots of other experiences before my choice became clear. Had I not “happened” to see the sign for the meeting or not chosen to go, I believe there is a good chance I would have ended up in psychiatry or perhaps some other specialty. I am struck with wonder at recognizing the degree to which serendipity plays such a role in how our lives unfold. At Penn, there was no presence of family medicine in the curriculum or the faculty. Only eight out of 160 students in my class chose the specialty of family medicine. Without that one chance encounter with Dr. Curry, the chances are small that I would have been one of them.
Would access to a book such as yours have changed your practice of medicine back when you started? Why?
I wrote Doctor Confidential in part to serve as a resource to physicians considering or going through medical school and residency that I wish I had had back then. It would, I believe, have made a difference. Medical training is a powerful socialization process. I was aware of this before entering medical school. For whatever reason, I attacked my medical training with a ferocious commitment to preserve as much of my humanity as possible through that training. In part I succeeded and in part, again as I describe in the book, I failed. I deeply hope my book will touch as many would be and developing physicians as possible, help them to preserve or rebuild their humanity as they undergo the journey of becoming a physician. I hope it helps them to become the physician they aspire to be.
Has your specialty met your expectations?
Yes. I found in family medicine all that I hoped I would in terms of personal and professional satisfaction.
Describe a typical day at work.
At various times in my career, my typical work day has looked very different. Depending on how you want to count them, I’m on my fifth career, all within medicine.
For the first five years, I spent most of my days in clinical practice, seeing patients in the office as well as caring for inpatients in the hospital. For the first three years I practiced obstetrics as a family physician. I took call, which varied from one in three nights and weekends, to one in nine over the course of my clinical career.
After the first five years I began doing more medical management, which grew to more than 50% of my time. Then, after a dozen years in clinical practice, my career shifted when I went into full time medical management as a vice president for medical affairs for a hospital and an integrated delivery system. Several years later I left that job to become an entrepreneur, launching CommonWell, a startup company to help health care integrate complementary and alternative medicine with conventional medicine. Then I became a consultant to hospitals and physician organizations, and finally a manager of a consulting company.
I went into medicine to heal and to teach. And through twists and turns of a career path I could never have planned, I have been able to do just that at every stage. Today, I find myself with what I can best describe as a national ministry, doing all the healing and teaching I can to help make healthcare work for all of us. Perhaps we could call writing my sixth career. And in my efforts as a writer I am still trying to heal, to teach, and to help make healthcare work for all of us.
What mix of clinical/research/teaching work do you do? How much power do you have to change that mix?
You always have choices regarding how much clinical, research and teaching work you do. There are tradeoffs that must be made with all career choices, such as income, lifestyle, time with family, and the level of commitment you make to achieve any given level of mastery and success. But choosing among these is almost always within your control.
Are you satisfied with your income?
I am currently satisfied with my income. I make more money as a consultant than I did as a family physician, but not as much as many other specialties make. It’s all about choices.
If you took out educational loans, is/was paying them back a financial strain?
Luckily I did not have to take out educational loans.
On average: How many hours a week do you work? How many hours do you sleep each night? How many weeks of vacation do you take?
I currently work between 55 and 75 hours a week on average, including my traveling across the country as a consultant. I sleep six to seven hours most nights. I take between three and five weeks vacation a year.
What advice do you have for medical students who are married/will become married during medical school?
While some of the stresses of medical training are less today than when I trained, the potential impact on marriages is very significant. There is no question that medical training is very hard on relationships. Some of the most successful relationships I saw occurred when both partners were in medical training, but some of these marriages also didn’t survive the training process (or the years afterward when the scars from that time play out). This is not a reason not to marry, but it is a reason to do so with your eyes wide open.
In your position now, knowing what you do – what would you say to yourself 30 years ago?
This question literally brought tears to my eyes. I would have so much compassion for myself 30 years ago. I would hope to help that younger self trust in the value of every step on the journey ahead. Experiences I thought most painful and difficult at the time have turned out to be my greatest teachers, deepening and opening my heart and helping me to find joy in living that I never knew possible. (This is actually the subject of the next book I’m currently working on.) Perhaps the most important message I would give is that what remains after all the rest has fallen away is the love you have shared with others. Never lose sight of this.
What information/advice do you wish you had known when you were an undergraduate? (What mistakes or experiences have you encountered that you wished you had known about ahead of time so you could have avoided?)
I sigh in response to this question. There is so much to say and nothing to say. On one level my advice is to pursue a wonderful, engaging, and exciting liberal arts education while also covering the pre-med requirements. Such an education will be a great resource to you for the rest of your life. Do not be afraid to love and lose love. That is what most helps your heart to grow.
On another level, the best answer is the story told by Dr. Wood, the grand, old, distinguished professor of medicine they trotted out my first day of medical school. Standing there in a starched, long white lab coat and brilliant silver hair, he told us of the grand old physician of the department of medicine when he was just getting started:
One day that physician was being interviewed by an aggressive young reporter who asked, “Why are you such a great physician?”
“Because I am wise,” he replied.
“Why are you so wise?” the reporter asked.
“Because I have good judgment,” came the calm response.
“How did you develop such good judgment?” the reported pressed.
“And how did you come by such marvelous experience?”
“Through bad judgment.”
What do you like most and least about being a physician and interacting with patients?
As I noted above, the experience of being a physician is that people come to you, entrust you, with their deepest vulnerabilities. You commit to bring all of yourself—your knowledge, skills, and humanity—to help them. This is what I like most about practicing as a physician. You get to touch each patient’s humanity and express yours as deeply as you can with every patient encounter.
What I like least about clinical practice is the pressure to see as many patients as possible in order to meet a particular income target. Once again, this is all about choices. Will I work with the day to day and minute to minute pressure to push myself to see more patients and do more procedures to meet a higher income target, or will I choose a lower income target and allow myself more time to breathe and just be in my professional work day? Never forget this a choice only you can make for yourself and your family.
From your perspective, what is the biggest problem in health care today?
Do I only get one? If I had to choose, it would be between two. One is the excessive value placed on technology and procedures (especially through reimbursement) compared to the time it takes for physicians (and others such as nurses) to spend truly listening to, understanding, and caring for patients. The other is the extent to which we have not made clinical practice adequately patient centered.
You discuss the potential for lawsuits frankly in your book (even your own close call). How do you not let the threat of lawsuits get in the way of practicing medicine?
This is a tough one. But as I wrote in the book, you will always make mistakes, sometimes major ones. The single best protection against being sued is a strong doctor-patient relationship. Never forget this.
From your perspective, what is the biggest problem in your specialty?
Family medicine is not adequately valued compared to other specialties. This may change over time, but as long as our society values procedures over the time physicians spend with patients listening, diagnosing, and caring, family medicine will remain under-valued.
What do you like to do for relaxation or stress relief? Can you share any advice on finding a balance between work and life?
Always remember that medicine is a bottomless pit. You can put all of yourself into it, 24/7, and never fill it up. Only you will be responsible for deciding when you’ve done enough and walk away. As a generation, young physicians understand this and are making different choices than did my generation, which in turn made different choices from the generation before us, but each of these choices comes with tradeoffs as well.
Now that my kids are grown and out of the house, to relax I love to ski, play tennis, sail my Sunfish on Narragansett Bay, and pursue what is becoming an increasingly rich but untraditional spiritual life (this last is the focus of the next book I mentioned above).
How have your colleagues received your book? Any criticism for going behind the veil?
No criticism of this at all. Most have said I told their story, and are grateful I have done so.
If you only have one takeaway for your readers, what would it be?
The truth I noted already, that in the end, what counts most is the love you share with others. Nobody on their death bed says, “I wish I’d spent more time at the office.” That’s why learning to open your heart and share it honestly and authentically with others is so very important. As the bumper sticker says, “Life’s the school. Love’s the lesson.”
The best way to understand my motivation in taking more than three years of stolen time nights and weekends to write Doctor Confidential is as an offering of love to each individual who reads it. I hope it is received in the same way.