Letters to the Editor  |   July 2012
Road Map for Curricular Development and Professional Success: The Life Cycle of a Primary Care Physician
Author Affiliations
  • Tyler C. Cymet, DO
    Associate Vice President for Medical Education, American Association of Colleges of Osteopathic Medicine, Chevy Chase, Maryland
Article Information
Medical Education / Curriculum
Letters to the Editor   |   July 2012
Road Map for Curricular Development and Professional Success: The Life Cycle of a Primary Care Physician
The Journal of the American Osteopathic Association, July 2012, Vol. 112, 406-463. doi:
The Journal of the American Osteopathic Association, July 2012, Vol. 112, 406-463. doi:
To the Editor: 
Lawrence I. Silverberg, DO,1 brings up some very important issues and questions in his letter to the editor, “Road Map for Curricular Development and Professional Success: The Life Cycle of a Primary Care Physician,” in the March JAOA—The Journal of the American Osteopathic Association. Balancing the professional self with the personal self is a constant challenge that physicians face. Becoming the best physician that an individual can be may infringe on the personal development of that individual, preventing him or her from becoming the best person, parent, or spouse that he or she can be. 
Not all physicians merge their personalities with their profession. Increasingly, in my observations physicians are moving immediately from the completion of their education to employee positions. How will the changing roles of the physician in the US health care system affect the life cycle model proposed by Dr Silverberg?1 
The stages that professionally focused physicians typically go through are documented well by Dr Silverberg.1 After primary care physicians graduate, most have the ability and desire to do everything that they were trained to do. In my experience, striving toward this goal takes from 7 to 10 years, with newly minted family physicians working and studying as hard as they can and focusing themselves on advancing professionally. Meanwhile, their personal development may be hampered or slowed. I feel that the osteopathic medical profession rewards and values osteopathic physicians who put their careers before themselves. 
I have observed that after the initial period of intense practice and learning about their professional selves, many primary care physicians evolve into focusing on more limited practice areas. This evolution may be conscious on the physician's part, or it may happen as a result of the interest the physician shows in particular areas of care. Some of this professional evolution is societal or cultural in nature. For example, it may be difficult to keep geriatric patients feeling comfortable in the same waiting room with pediatric patients. They may eventually abandon such a broad-based practice for a more focused practice that they feel is “their own.” 
What Dr Silverberg1 calls “regressive preoccupation” may also be thought of as a professional dematuring of a physician in practice. Alternately, it could be personal advancement in which the physician learns to compartmentalize pieces of his or her life to become more successful in multiple areas—or to reassess and reprioritize where he or she puts energy and focus. 
I would also like to discuss what Dr Silverberg calls “curricular development.” The term curriculum infers that there is an assessment method. Although assessment can take many forms, and profiling and comparing yourself to other people whom you admire is an acceptable assessment method, it does not address all of the domains in which we live our lives. Interests and skills change over time. A baseball card collector who no longer keeps his cards in proper order does not have to be a dematured baseball card collector; he may be a changed person for many other reasons. 
Assessment of self-confidence and use of pro/con grids are both reasonable ways of deciding the best way to act and respond. Other productive self-assessment techniques that can move an individual between life cycle stages include self-study time logs (for determining what to do when given the freedom to pursue what the mind is pushing toward), journaling and autobiographical sketching, and the creation of portfolios. 
I believe that when physicians feel that they are entering a stage of “regressive preoccupation,” they may look at opportunities for advancement or growth. Previously, these opportunities were limited, but with the restructuring of the US health care system they are becoming more common. For example, administrative and management positions that previously did not require a physician are increasingly performed by professionals with medical training and experience.2 The so-called church-state separation between hospital care provided by physicians and management provided by business managers is being replaced by physician-led management.2 Such dematuring may also sometimes be thought of as a “midlife crisis” that individuals experience when they have mastered a particular field and wish to transfer their skills to another level, rather than continue using their skills at the same level for the rest of their lives. 
I agree with Dr Silverberg's1 point that transitions from one life cycle stage to another can be gradual. Such transitions can also be different for different individuals, and how they occur may vary according to the environment in which health care is being practiced. The professional life cycle of today's primary care physicians is different from that of the generation before them. 
Silverberg LI. Road map for curricular development and professional success: the life cycle of a primary care physician [letter]. J Am Osteopath Assoc. 2012;112(3):113-115. [PubMed]
Center for Applied Research. Dilemmas of Physicians in Administrative Roles: Dealing with the Managerial Other Within. International Society for the Psychoanalytic Study of Organizations Symposium, June 20-22, 2002, Melbourne, Australia. Philadelphia, PA: Center for Applied Research; 2002. Accessed June 12, 2012.