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What will your children be when they grow up? Do you want them to be physicians?
Before you answer, you might want to analyze the mealtime ambience in your household.
Is the experience enriched with wellness or burnout? It was only recently that I began to fully appreciate the novel connection between career choice, burnout, and dinner.
Mark Hamilton’s father was a physician. Hamilton, a 2020 medical school graduate and former professional baseball player, recalled in an April 21, 2020 article for Medscape that dinner table conversation had piqued his interest in medicine: “Dad never held back. He didn’t obscure details. I was always curious about his work.”
Dinner conversation was quite different in my household.
Rose, Bud, Thorn
My wife and I frequently struggled to get our kids to recount their days over dinner. One would monologue in minute detail. Another would sum up their day in one word: “fine” or “ok.” My youngest introduced us to the “rose, bud, thorn” concept to recap the events of the day. The rose was the best thing, the thorn was something that bothered you or the worst thing, and the bud was something you looked forward to. While it was permissible to not have a thorn, the rose and bud were mandatory. To avoid ending on a negative, the thorn could never be last in the sequence. We rapidly adopted the concept and continue to this day.
Patterns quickly developed in our household when we initiated our rose, bud, thorn tradition. Both daughters adapted easily, gladly sharing the happenings of the day. My son and I had similar responses night after night. For my typical teenage son, his thorn was school, his rose was seeing his friends, and his bud was the weekend. We could occasionally get him to divulge a few more details.
Day after day, my rose was dinner with the family, my thorn was work, and my bud was either the weekend or being off call. My kids would recite my predictable answers with me in unison. It didn’t matter what we served; the food was regularly flavored with burnout.
Spreading Positivity
Motivations for a career in medicine are multiple and extend beyond shared experience at the dinner table. Individual aptitudes and interests differ. Nevertheless, being from a medical family is recognized as a component in the decision to apply to medical school (BMC Med Educ. 2006;6:11), and medical students have a physician parent approximately 15-20% of the time (ibid; J Med Educ. 1977;52:541-547).
While it may be difficult to quantify the exact degree of correlation, positive attitude and experience can encourage and motivate offspring toward similar career paths. Conversely, the thorn experience can also be passed on, and can negatively impact career choice. It’s unrealistic to expect a career in medicine (or any career) to be a consistent rose without any thorns. However, it’s critical to recognize if your career has become more of a thorn than a rose.
I always felt being a physician was one of the most gratifying career choices, and I don’t regret having chosen this career path. My previous practice struggled over time to meet the needs of the community, as we were unable to recruit additional providers. I felt helpless under the weight of increasing patient loads and frequent on-call sessions. The thorns gradually overgrew the daily roses of helping and healing, and I had no desire or energy to talk about my day over dinner. My regret is that my thorn grew unfettered for so long, and my kids remember a burned-out physician from their formative years, likely suppressing their curiosity about my career path.
Plucking the Thorn
Transitioning to a new practice environment two years ago helped to finally eradicate my consistent thorn. The current culture is team oriented with fewer on-call demands. Days no longer feel overwhelming. I look forward to teaching, departmental functions, or time to write and reflect. (I also couldn’t help but notice the high incidence of my new colleagues’ children following in their physician parent footsteps.)
On the home front, dinner options have remained stable, but the flavor is now one of fulfillment. The proof is in our nightly rose, bud, thorn: My responses have changed and are no longer predictable. My thorn is rarely work, and sometimes there’s no thorn at all. My rose is even sometimes work related—positive patient interactions in the office or successful cases in the operating room. My bud no longer focuses on being off call.
Even though I envision occupational following by children as a true testament to how much you enjoy your career, my goal isn’t necessarily for my own children to follow in my physician footsteps. But we can’t expect the children in our household to follow in our professional footsteps (or regret if they don’t) when the mealtime career capital we transfer is negative.
A persistent thorn grows internally and externally, adversely affecting personal well-being and the emotions of those around us—including the potential occupational trajectories of our children. When a thorn can be extracted at its roots, a rose can grow and flourish. The positive transformation will be felt by family, friends, and patients alike. If the effect is dramatic enough, it might even inspire children to follow in a parent’s career path.
My ultimate bud is my kids remembering that I was ultimately happy and fulfilled as a physician. Regardless of their career choice, I now hope to pass down the legacy of a career enjoyed. Now that would be a rose worth sharing over dinner.
Dr. Greenberg is a clinical assistant professor with the department of otolaryngology–head and neck surgery at the University of Michigan in Ann Arbor.