As a primary care physician's career unfolds, he or she interprets and responds to the world in ways unique to his or her own character. An understanding of evolutionary dynamics provides a road map in determining and guiding educational objectives allowing for successful integration into the practicing environment. Stern and Papadakis⁶ wrote: Constant, uncontrollable outside forces substantially impact the development of a medical practice. Such forces include personal, business, governmental, and legal issues (eg, pressures from rising malpractice risks⁷) along with consistent commercial and financial decisions. Internal forces facing the physician center on the successful integration and adaptation into multifaceted environments critical for a successful career. Certain regressive preoccupations may overcome the physician's urge to complete development as he or she struggles between progressive and regressive forces. An example of this struggle is the physician who, after 30 years of practice, tells his cigarette-smoking patients, “either stop smoking or find another physician.”^8,9 

Noteworthy transitions from a physician's early professional life to retirement age might be characterized by adjusting preferred modes of dealing with internal and external demands. Although such reorganizations may sometimes be regressive in nature, most result in heightened rather than diminished adaptability.^10-12 

The transition from 1 cycle to another is gradual, and the tempo may be distinct to an individual's character. The emotional and social development of receptive communication, self-understanding, intimacy, knowledge about other people, relational skills, friendships, and moral reasoning and behavior exist in the realm of evolution. Many professional and personal challenges must be overcome to conclude a successful career. Establishing a balance between helping people and making a living gives rise to tensions that must be mitigated. Learning to balance one's personal life and its influence on a professional career requires constant self-analysis and insight development. The ability to self-reflect and remain comfortable with seeking help in difficult professional life situations is essential. In primary care, learning how not to give up on resistant patients will be profoundly important, especially in the medical home paradigm. With the ability to reflect, question, and self-explore, primary health care professionals can develop the competency to structure and justify their own concepts (eg, whether to follow the US Public Health Service recommendations for mammography¹⁴ or those of the American College of Radiology¹⁵). 

The present commentary attempts to document developmental issues during one's career. To address these issues in the current medical training structure, educators have to look to the future. However, several limitations must first be acknowledged. The stages presented in this commentary are intended to represent an ideal physician's career and may not be reflective of all physicians' métier. Suppose 75% of physicians have career life cycles as described above and 25% do not—would this variation affect the design of educational interventions? Furthermore, with the Patient Protection and Affordable Care Act, the projected shortage of physicians,¹⁶ and the aging baby boom population,¹⁶ changes in US medicine are likely in the coming decades. These changes beg the question: Is knowledge of the physician life cycle still a determinant of professional behavior and attitudes? 

Unfortunately, research in this area is lacking. McSherry¹⁷ conducted an extensive literature search of the physician life cycle but produced no other investigations of this type of model. Future work in this area should include longitudinal in-depth interviews with physician cohorts. Other investigations must consider whether continuing medical education programs offered to physicians in different decades of their careers are beneficial. How these stages, if verified, might alter educational approaches for osteopathic medical students and residents and is another area for productive investigation. 

I call on others in the osteopathic medical profession with the knowledge, experience, and interest in this area to explore it further. Although the content presented here may change and can be expanded, it is the concept that is important. There is a relationship between the curriculum and the professional success of primary care physicians, and a curriculum that accounts for the personal growth, development, and maturation is essential for success.