Confessions of a career guide - BLOG

This blog aims to raise and expand upon important career topics and tips. We comment on matters arising in recent weeks which have inspired us to pontificate upon or present recurring issues worthy of sharing - for everyone's benefit. 

May 2013

But I dont know what I want to do

A common refrain.

One that I am always fasinated by. Does it imply that the person is expecting someone to find this for them?

The tone of this phrase usually has a twinge of helplessness about it

It appears to suggest that if only someone could tell them what they want to do - everything would be ok.

However it is indeed hard to start any career plan without knowing what it is one wants

But of course it is not anyone to tell anyone what they want.

However I can assist someone who does not know what they want to do the work that they need to do in order to be able to SAY what they want.

January 2013

What is career guidance REALLY about?

Someone asked me the other day what career guidance involved. There was obviously quite a lot to say on the topic but I found myself saying this

helping a person to develop the insight they need into their own motivations - which involves as much work on what is holding them back as it does on where they can go that is well matched

Certainly when I started Medical Forum I was under the impression ( wrongly as it turns out) that career guidance is all about matching a person with a job or career that suits them. Yes - this is part of it but it is a relatively superficial part.

What I have discovered over the years is that people are in various states of self knowledge and various states of self confidence. If one attempts to give career guidance as in pure matching without delving a little into the self knowledge and self confidence - the person might well move into a slightly better career situation but the problems they were facing in career number one are very likely to be taken into career number 2.

July 19th 2012

What is a career passion?

In my early career I genuinely thought i had a passion for ophthalmology but discovered I did not.... in my late 20s. I wanted a passion. I wanted to feel as fired up as a few of my ophthalmic colleagues were. I envied them. But when you have dug yourself down a deep dark (eye rooms are usually such!) tunnel it is often incredibly hard to think sufficiently out of the box.

I now have a passion for career guidance as it applies to clinicians of all ages and backgrounds. How did this transition occur? There is no easy answer to this that doesn't require a book (or at least several blog entries) to answer. However if I had the 25 years younger me sitting in front of me now - there would have been ways of detecting. Here are some of things that I now know pointed towards my current career. Its just that no one ever put these together. The key points include...

1) my mother commented many years after I had left my primary school that on following behind me on the walk home each day I used to size up all the girls in the classroom and the teachers rather effectively considering my tender years. I also showed some interest in patching up/assisting those pupils who were ill or hurt (this is where the "medicine" career stemmed from).

2) at senior school I tended to come to the aid of or befriend those who were disenfranchised or outsiders in some way or helping them integrate or reintegrate

3) as a medical student I had a diary with loads of business ideas in the back

4) as an 80 hour week neurosurgical SHO I attempted to start a small service to girls schools where young  female speakers from surgery, law, aviation and more shared their career tips. Needless to say it did not really take off as I was asleep all the hours I wasn't working.

5) as a trainee doctor I was forever going into personnel and, much to their disgust, quoting the red book employment guidelines to them when they had got it wrong

There is clearly a pattern here and medicine should indeed have been on the shortlist. Occupational health within that might well have been good. So would studying law (employment law). These areas might have encompassed the inherent interests emerging throughout my life. But the one career area that overlaps all of these (OH, employment law, business and career planning) is career guidance.  I know it is always easier to draw such conclusions with hindsight but I share this with you so that you can see that the way to finding passion is to look at the person beneath the medical qualifications and sometimes this person has been buried.

June 10th 2012

Why "finding" the right career is a misnomer!

Almost everyone I speak to in trainee posts talks about finding the right career. It conjures up a picture of going out for a walk one day and somehow stumbling upon the ideal career under a pile of autumn leaves. Firstly there probably is no such thing as the "right" career in terms of a 100% match. There is however a selection of careers and routes that may suit - to a greater or lesser extent - your values, skills and ambitions in life. The challenge is that if you do not KNOW your values, skills and ambitions how can you be expected to know when you have found a reasonable match. This tendency to want to "pick a career off a shelf" or somehow trip over it is a fundamentally flawed way of going about a career and it invariably leads to all sorts of problems. This approach seems to arise at school age when everyone is overtly or covertly putting pressure on to "choose". Choose a career, choose subjects (the "right ones" for that "right" career) and all when you are about 16 when you haven't got a clue who you are never mind what you would like to do. This is when pressured, default, to please others, to impress or grasp at straw career decisions are made.

Does this mean that choosing medicine or a clinical profession is ever "wrong". Most likely not although it can certainly end up a poor match if.... IF .... there is no guidance along the way to find the route or match that best suits you. This is why doctors of all ages need to have open access to confidential "out of the workplace" career support. Occasionally we do see doctors at all ages wanting a radically different change and this may be for totally positive reasons. However, the majority of our work is in helping clinicians to understand any disenchantment, stress or mismatch in constructive terms and then build on that. It is more common for a solution to be found closer to home that one might think through measures such as reducing hours, negotiating different roles, adding in new roles and even financial planning.

March 20th 2012

Is career passion important?

Carrying on with the theme of falling out of career love - todays post is prompted by a locum GP who said that there are bits of the work he likes and bits he doesn't like but that overall he is bored by it. I felt a bit like saying "join the club" - there must be a huge percentage of society who could say this.

I love what I do - but there ARE bits I do not enjoy (anything to do with accounts - grrrr!). However, the difference between us (this GP and moi) is that 20 years after starting Medical Forum I am still "passionate" about it.

It is very VERY easy to lose passion for something even if you started out with heaps of passion (and for those who didn't have any passion to start with - well no wonder you are feeling without it now and perhaps it is time to start learning about this vital aspect of career satisfaction).

Career guidance to me seems to be a lot about helping someone "find their passion" and then "maintain it". I sense I am at risk of sounding like a marriage guidance counsellor here!

Anyway this prompted me to think more about this topic in general. Even "finding" your passion is a bit of misnomer but I think that's for another post! However, I can think of many solutions for the "slight bored GP locum" as doing locums is a marvellous vehicle with which to expand and develop your career (quite the opposite to the often held view that it is a "stop-gap") and there are many professional locums these days who have made it a proactive career choice. Do locums because you don't know what else to do = a recipe for boredom. Do locums because it fits into a longer term exciting career or life plan = passion (or some way towards it anyway).

February 18th 2012

From endings come new beginnings

Further to my last post I have had some more thoughts about the whole issue of falling out of love with your career.

Sometimes a relationship or a course in life comes to a natural end. It may be because external circumstances have changed, it may be because you have changed as a person, it may be because you had something you needed to learn or do first in order to move ahead.

Whatever the main reason for something coming to an end - it can be hard to let go. This difficulty letting go in itself comes from a lot of different sources but learning to let go is one of lifes greatest skills - especially to let go without looking back with regret and letting go BEFORE the new route has perhaps become crystal clear. Its a bit like sailing from the shore without being able to see another land mass to navigate towards. One needs courage, self belief and...... a good compass. I like to think Medical Forum fulfils some of the compass rolewhilst also boosting courage and enhancing self belief.

Oh and letting go does NOT mean tearing up the old map or the GMC certificate! All (and I mean ALL) career planning is about building on what has been before - possibly plotting a new course but definitely taking bearings! You'd think I had been on a sailing course (well I did last summer!)

February 15th 2012

Falling out of love

I have just spoken to a doctor who voiced a very thought provoking phrase "I have I think fallen out of love with my career - its a bit like being married to a reliable, upstanding but rather dull husband".

I have two totally contrary thoughts about such statements and neither is "right" they are merely opposing.

Firstly there are people all over the world living on less than a dollar a day - they should be so lucky that they can complain about not being fired up by their job.... if indeed they have one. Their lives are full of worry about water, shelter, safety and food.

The opposing view is that, having had the privelege of a safe and secure lifestyle and education - not having to struggle daily to put food on the table for your family - one does reach a point of (the luxury of) a strong desire for "self actualisation" . This is described by Maslow as being at the top of his hierarchy of needs. At the top is a feeling of becoming everything you could become.

How do I reconcile these two views as at first glance it sounds as if I am telling all my clients to bog off and stop being a wuss - not good for business!!!

The way I try to do this is to firstly point this out to people so that they gain a sense of proportion but NOT in order to make them feel guilty. It is important to understand where this desire is coming from and that it is normal. Then the right steps can be forged to deal with it. Secondly I do try (and with doctors this is generally quite easy as they are an altruistic bunch at heart) to raise the issue of putting something back or getting involved in some way with helping those who are less fortunate in their career potential by virtue of where they have been born and to whom.

It is perhaps a drop in the ocean but if every person who receives career guidance on the planet also had a small part of the process directed towards showing them where they could make a difference (from donating a small amount of their new salary to doing voluntary work to setting something up that will be of lasting help).... some good for others can come out of seeking greater self actualisation.

 February 8th 2012

Skiing and careers

I have just returned from a two week skiing holiday (bliss) and I was struck by how different personality types exihibit themselves on the slopes. Firstly there is the "leader" the one who either likes to be in front or if not quite so Genghis like - very much aims to set the goals for the day. Then there is the one who scurries about planning and collecting data - heights of mountains, distance of runs, run descents in metres. The "people" person is hardwired so that they want to ski with a gang or a minimum of one other and wouldn't ever be seen under any circumstances without his or her mates skiing along beside them. Finally there is the very creative type who likes to ski down tough reds one day yet is happy to ski with less able friends on easy blues the next, miss a days skiing to go swimming outdoors and then ski for a whole day on their own.

Why is this important? Because if you can recognise very clearly that there are different personality types about(the above descriptions only splits the human race into four but there are other personality tests which use 16) and that they like to do things differently - you will not only get along better with others, you will harness them better if you are in a role that needs to do that and/or you will make better decisions about your own career.

January 19th 2012

Changing career

What is it about the term "career change" that strikes strange emotions into the medical pyche? Is it the fact that it threatens the aura of dedication? Is it the fact that most doctors have at some point in their careers wondered whether they could - or should? Is it because there are social, status and self esteem issues with not treading the traditional pathways? The truth however is that many medics fashion unusual career pathways, have always done so and will continue to do so. The other key point is that "change" doesn't have to mean tearing up the GMS certificate and walking stage left with a dramaticly voiced Olivier award winning "I may be some time". Sometimes career change is in fact WITHIN the career you already have. Given that we live in a constantly changing world the ability to manage change in ones life and career is fast becoming THE number one skill in ALL doctors' careers. Yes there are a few who perhaps are not that suited to the work content, style or pace of medicine and those who become unwell either nothing to do with medicine or as a result of working in medicine . This group should be facilitated to happily reroute. There are also those who just need a change and those who simply want more strings to their every growing bow. And why not? Why shouldn't someone explore their potential. To those of you who may be thinking "ah but we need our doctors in the NHS" I would say "ah well if you don't give them the opportunity to carve the career that suits them - they won't stay at all". The way to keep the doctors who are suited to medicine and to facilitate those who are finding it does not suit into other productive (and often health impacting roles) is to listen to their career needs and to empower them to make the changes they feel they need to be able to continue their dedicated work. Of COURSE there is a service requirement - but given that appraisals are often so heavily biased towards service  performances - could this not be balanced more fairly by addressing how the NHS is fulfilling that person's career?  Nirvana beckons. You may laugh but unless someone somewhere has the "vision" of how it could be - there ain't a hope in hell that it will change. Twenty one years ago I had a vision that all trainees would have access to in house (NHS) and out of house (Medical Forum) structured career guidance. Whilst there is some way to go - the delivery of and understanding of career guidance is so improved compared to how it was when I trained - as to be unrecognisable. It may ave been nothing to do with me - but then again.......

There are other beneficial spin offs to experiencing change. Firstly the process of change itself - as long as the locus of control is within the individual - generally (perhaps through pattern interupt) brings a click on the "refresh" button (akin to moving the furniture around in your living room - try it !!). In addition those doctors who HAVE experienced time in non traditional roles who then return to medicine bring new skills and renewed vision. So rather than an indrawing of breath when the words "career change" (or perhaps more accurately - career change management) are sacriligiously uttered - a better culture would be a demeanor of interest and slap on the back. Ohhhhh - would that the world were such . I can feel the Oscar coming on already!!

August 20th

Translating ideas into reality

I recently spoke to a doctor who has been having some really great ideas about their career. As we talked I couldn't quite understand why he wasn't already doing one or several of the things he mentioned. As time went on it hit me - he was stuck in "brainstorm mode" - very effectively generating ideas.... so many of them in fact that he was stuck in a sort of Mobius loop. His technique was to dream for short periods of time (often a minute or two only) about one option - start to see the "reasons why not" and bounce Tigger like onto the next career dream only to poke holes in that one too. Talk about sabbotage! I pointed out that this was happening and they immediately agreed (so - good insight at least!). I then mentioned that "being creative" wasn't just one skill it is a set of skills and one can have some but not all of them. For example there is musical creativity, problem solving creativity, artistic creativity (drawing, painting), design creativity and more. Most creative types have little difficulty actually generating the ideas (whereas non creative types may struggle with this) but they can still get stuck on the "creative visualisation" of the idea either because they don't know what creative visualisation is or because they immediately default into internal self critic mode and shoot themselves down in flames. The trick is to not evaluate the idea but to simple move into dream mode (CV) but in a way that is consistent on one idea and stay on it for a while visualising the precise nature of how that idea would in an ideal world pan out. There is lots more to say on this topic and teaching this skill is probably one of the most common things we cover in a Personal Career Programme. It can revolutionise a career.

June 24th

Selling yourself

Why is it that people in general but particularly doctors have difficulty selling themselves? I see this almost every day in the workbooks, workshops and one to one career planning programmes at Medical Forum. It is a reflection of several things. Firstly "selling" in the NHS is almost a dirty word - partly because we feel we are above it (or maybe because we are naive and don't have day to day contact with the reality of money). Secondly, when one doesn't receive regular constructive feedback on ones skills, personality,day to day work etc it can be hard to know what these are. So many times I hear anecdotes about people's huge achievements but in a "put me down" or "lets minimise this" phraseology. Now I am the first to admit no one likes a braggard - but there is such an important though fine line between arrogant boasting that is not backed up with anything resembling reality and a genuine description of exceptional abilities. More often than not I hear descriptions which either grossly "big up" someones achievements (their attempt to "sell" but missing the point somewhat) or badly undersold massive achievements. This has important implications for career progression, career diversification (when the humdrum of an original route gets too much) and general all round self confidence. And what is more - merely telling someone to "sell themselves better" does not do the trick in general - perhaps because they don't understand the whole concept of selling - let alone self selling. If anyone wants to understand "selling" more than they do and are prepared to invest some time and money - I can recommend the "psychology of selling" audio programme by Brian Tracy. It can also help with persuading ones partner/spouse that one needs a new car/laptop etc ;-)

May 23rd 2010

Do you ever feel uncertain

Todays topic is all about uncertainty. Every day pretty much - I speak to doctors who are either havering about between two extremes or who can't seem to find a goal or vision that they truly want to work towards. They are thus uncertain which route to take or uncertain what it is they want. Both of these situations can be extREMELY disabling, very time consuming and very stressful. The reasons why they have got themselves in these situations are many (notice I say "got themselves" - 100% responsibility HAS to go to the individual). However the solution is  A) the same for everyone and B) dead simple (though not easy!!)...... turn off ALL programmes/beliefs/thoughts that are negative,stop looking naval gazingly like at the current "wrong-ness" and see solutions ahead - not disasters. Easier said than done of course! At Medical Forum we have a range of workshops, distance learning programmes, DIY learning materials and face to face consultations - all of which are designed to move you inexorably towards a greater self awareness - through which you can access thoughts of what you want. what would fire you up and stop you wasting time looking at the hole you are in rather than the rope ladder that is already dangliing elusively (or invsibly) within your reach. Career guidance therefore is as much about  helping an individual to disallow or stop old ways of thinking as it is about providing a structured approach to career planning. Do what you have always done - get what you have always got. So external change in circumstance generally starts with a change within (and not with ruminative, circuitous, trapped thinking and not by looking "out there" for a magic solution). All a bit philosophical perhaps - but the point I am making is absolutely seminal to gaining career progress down a route that is truly well matched. If you don't like treading water or feeling trapped in your own self generated uncertainty - I can recommend taking some action to change this as currently your energy is haemorrhaging down the plughole. If you don't know what to do - join one of our programmes as a starting point.

April 4th 2010

The issue of when to take a year out and relating to that -when to consider having career guidance to best effect - arose today. In fact it comes up quite regularly. On balance it is perhaps safer to take a year out when you already have a plan for returning. But not everyone wants "safe" - some enjoy the unknown so it is hard to be didactic about this.

When people take a year out of their clinical careers, they usually do so for one or more of the following reasons

* feeling too stressed by work life so far to continue (perhaps due to a personality-career mismatch or some bad experiences at work)

* thinking that deferring the decision will make it easier

* running away when there are significant career doubts

* a very strong pull towards travel and the personal growth and fun (and new work experiences) this affords.

* a desire to make up for the lack of gap year pre med school

So - a mix of potentially positive or negative reasons.

Whether to seek career guidance before the year out or on returning from it is a big question.

The only way to define this is to look carefully at your reason/s for wanting a year out and to be very honest with yourself about your overall career strategy. The main advantage of seeking guidance before departing is that the time away can be more relaxed with less soul searching. It is also possible sometimes to use the year out in a productive way to enhance career pathways on ones return.

As it is possible to join a Personal Career Programme at Medical Forum at any time up to a year after a Career Review is completed - it is possible to do a Career Review at the start of a year out and progress to a PCP if this is needed -  on return.

March 2010

I have recently been referred (from deaneries) some doctors whose mental wellbeing was being adversely affected by work. On analysis of these situations several things become clear....

* at times the way in which doctors are expected to work is really not ok

* the doctors themselves are not always very good at or empowered to speak out when support or resources are grossly inadequate to allow them to do their work (and some doctors compensate for this lack by running themselves into the ground)

* at times there is a fundamental mismatch between the doctor's personality and the route they have chosen to follow . At times an unrecognised mismatch can literally cause (or tip a vulnerable person over into) mental illness

So when a career situation becomes unsatisfactory or performance is flagging one has to look at three things : the workplace setting - the ability of the doctor to speak up (and be heard AND be understood) -  whether the person is truly well matched to the work.

Without looking carefully at all three - one can easily miss the cause of poor performance, illness or deep career doubts.

December 12th 2009

Been a bit quiet on the blogging front - no point in writing if one doesn't have anything of great note to say. But now I do!

Someone I saw recently for some career guidance really sparked a strong realisation for me. And that is.... one needs three things to gain career success - a clear career "vision", the skills/talents one needs to make it happen AND (and this is where it seems most people get stuck) to take off the straight-jacket connected to a bungee chord that holds one back (better known as self esteem/self belief).

Lack of self belief is a MAJOR holding back factor in pretty much everyone's career... even those who are in fact doing pretty well.

Admittedly some are held back by the lack of "vision" (ie if one hasn't a clue what one is aiming for - this doesn't help in achieving it) and occasionally there are some skills that, if gained, would really help things along... but even then the issue that may well be holding the person back in even achieving a basic vision or attempting to gain an additional skill - is their negative thinking patterns.

This is all so very important that we have developed a new Personal Career Programme entitled "shaking off the beliefs holding back your career". It is the same price as the other programmes but for some people this one will produce results far faster than any of the others.

September 17th 2009

The sheer diversity of what medics want from their careers never fails to amaze me. Within clinical medicine what highly motivates one person is a nightmare for another. Some thrive in high risk life-death situations all day long, others want to handle end of life issues with sensitivity,yet others would find both of these immensely stressful but are in their element advising teenagers of STDs. We have had doctors become successful investment bankers or venture capitalists (and one who managed to combine this with a professorship) and those who become gardeners or dog walkers. 

And what of starting one's own business ? There are corporate raider/investors like Hugh Osmond (wealth over £300 million) who studied medicine at Oxford. At the other extreme we know a doctor who is marketing her own hand made cards through the web. Still further diversity is found in medics who combine medicine with another career. Radio programme director and part time GP, jewellery designer and full time GP to name but two.

What I am getting to in a roundabout way is that "take a 100 medics and you have 100 different individual careers, career pathways and career ambitions/needs". The point of all this is that a greater acceptance and even encouragement of medical career diversity would I think be of great value to everyone. However, there appears to be a cloning process going on with some of the training changes that have been afoot over the past few years. My prediction is that doctors simply won't be cloned and if they can't find the diversity they need and a tailored approach to their own career - they are sufficiently intelligent to find it outside medicine. All I know is that when I trip down the icy front steps of my cottage in winter and sustain a dinner fork deformity - I would like to find a hospital populated by doctors who are happy in their work, fulfilled and in the right job for them with sufficient career diversity of whatever sort floats their boat to remain motivated as doctors. Medicine has the potential to provide some wonderful careers but it also has the potential to become a ball and chain if one doesn't keep an eye on the individualistic requirements of medical career planning.

August 30th 2009

I met the brother in law of a friend at a BBQ this weekend. He was in a big city financial firm nine years ago and got totally fed up with internal politics and unmeritorious promotions. He took the almighty leap and left the security of a regular salary to "go it alone". By the sound of things this was not an easy thing to do. Nine years later however and his small investment firm is one of a handful that has not lost their investors money despite the finanical meltdown all around.

Anyway - his story reminded me of how precarious is was to "leap" from a medical career and set up something that had never existed before - a career guidance outlet for doctors (and now other professions too). So much of our stories were in parallel and I idenfied with every milestone he mentioned.

He also recommended a book " Who moved my cheese?" which I have just found was written by Spencer Johnson (a co-author of on the "One Minute Manager" series and with an MD  from the Royal College of Surgeons Ireland!). This little book is all about change. " Change can be a blessing or a curse, depending on your perspective. The message of Who Moved My Cheese? is that all can come to see it as a blessing, if they understand the nature of cheese and the role it plays in their lives"- says the blurb on the book anyway. It is available through us here (and every book ordered through this link will contribute a small amount into a charity fund we are starting to provide career guidance support to doctors and other professionals who fall on hard times).

August 18th 2009

I heard this week from a doctor who wants to be a musician. I was reminded of Hank Wangford - who appears to have been able to combine a musical and medical career very effectively.

This sparked me into considering the whole issue of combicareers (like combi boilers!) which I suppose impinge on the portfolio career model. The main difference being that the portfolio career - to me anyway - has a number of features/options within it - one of which at any time might be dropped or replaced by something else. Whereas the "combicareer" suggests two very serious interests - but the "owner" of them being unwiling to let either of them drop by the wayside.

I suspect the combicareer arises because of two strong passions - whereas the portfolio career is more likely to arise due to the need for flexibility or a strong desire to keep constant change and variety. Clearly the two career "modes" overlap somewhat. But defining the contrasts between them is interesting.

Are some medical career pathways more suited to the combicareer model than others. At first glance it would appear so. However, having come across a consultant surgeon many years ago who used to spend one night a week as a chef in a restaurant - I am reluctant to put constraints on people's dreams and creativity. The point is - if you are sure what both elements of the combi are - then the next step is to work out some ways forwards. However, for sure - many people don't know what the two passions are - even though the idea and concept of a combi career is appealing.

That all said - medical careers known to be more "sessional" are probably easier to link into a combicareer plan - but I wouldn't want anyone to think that eg. because they are a consultant surgeon that there is no way on earth they could spend a month each year working in underdeveloped countries. Or because they are a trainee in anaesthetics - they can't combine that with a career in international repatriation. Or because they are a pathologist they can't also be a journalist. We have examples of doctors doing just such things. Some degree of creativity,determination and flexiblity is required from the person - but when the goal is clear it is quite amazing what can be achieved.

August 11th 2009

Fast career decision making and personality. The speed at which some visitors make the decision to join one of our programmes sometimes blows us away. Career concerns are often big issues and it is understandable when someone takes weeks, months or even years to get around to accessing one of our services - even after having registered on the web site. Then every so often a visitor joins the guest reception, starts an e-course, orders a Career Review and asks when they can book a Personal Career Programme - all within the space of what seems like minutes! It is great to see someone so definite in their actions but it prompted me to ponder why some people seem so proactive and why others tread around the edges for what seems like ages before jumping in. My conclusion is two fold. Some visitors know others who have benefitted - so that increases their confidence. For those who don't know anyone who has been through our doors - then it comes down a bit more to personality. There are loads of different ways of categorising personality types - but we have identified the "director" - who is very goal focused and fast at decision making but who may occasionally benefit from slowing down; the "processor" who likes a lot of information before deeply analysing any decision pending; the "connector" who responds faster when their peer group approves or recommends or when they have perhaps met one of us in person at some point (eg a workshop or conference presentation) ; and the "explorer" who loves to dip a toe into any new waters at every opportunity but who can easily get distracted by all the options on this site. You might like to ponder which of these four main personality types you are and how this impacts on career decision making and planning all round (not just when visiting Medical Forum!!). We have some more blurb on personality in the memberships.

August 3rd 2009

This week appears to be a week of flexible trainee issues... one after the other in fact. Must be in the air.... both finanical irregularities/inequalities in payments and  in terms of part time trainees feeling that they have not been given equal opportunities to learn - it seeming that their full time colleagues are constantly muscling in on cases that should have fallen to the flexible trainee.

With regard to payments there are several steps you can take

* firstly, bone up and keep abreast of payment entitlements in flexible working. I know... it is not rivetting stuff (unless you love facts and figures and number crunching) and is very tempting to overlook - but if and when you discover that other colleagues are being paid more than you and it is partly your fault - that stings! The moral is - don't expect the system to be fair to you - it is up to you to see that you are being treated with equality.

* secondly, tie up payment agreements ideally before you accept the post. You will find that there is more incentive for HR to resolve issues if there is a risk that workload won't be covered than there is once you are in post.

* finally, when discrepancies do seem to have arisen - put this in writing (letter not email) to A) your deanery flexible training person and B) cc to HR. Make sure that where possible you quantify the issue clearly and make a clear request to either have it rectified immediately(with backdating) or to have a meeting if there is something you have misunderstood.

* if you believe the discrepancies are not being dealt with appropriately, fairly or swiftly enough - it is possible to involve the BMA industrial relations experts. This is obviously escalating things to a level where it all gets more involved and time consuming for everyone - so there is merit in trying to resolve it by diplomatic means yourself and where there is little response - making it clear that you have no wish to escalate things but that seems to be your only option

With regard to getting an equal bite of the cherry on training - the first time you notice this happening - do not ignore it. Document it and when you have some evidence that this is a consistent problem - alert your supervisor verbally initiatially and then in writing (written not email) with a cc to the flexible training deanery person. We have seen several cases of doctors approaching CCST who are feeling very anxious about their lack of experience and who are now blaming this on the full time trainees. This is something that could have been prevented if the right actions had been taken and assertive communications delivered early on. It is very hard to suddenly "make up" years of deficiency just because CCST is now looming. We have an e-coaching programme that would very much help this sort of situation (or rather prevent it arising) but it has to be joined near the start of the problem - not when only months away from consultant applications. Blaming others is not taking full responsibility for ones career.

So if you have been a flexible trainee and recognise these issues - please alert other flexible trainees you come across that these issues CAN be dealt with and should not be ignored or brushed under the carpet with feelings of "I don't want to cause any trouble".

 July 21st 2009

Repeating contact with Medical Forum yet never taking the plunge. I recieved a phonecall message, about 9pm this evening, from a doctor who has called Medical Forum roughly every 9-12 months over the past five years. Each time they go through the same information in the same dissatisfied way - never seeming to be making any progress although apparently feeling "a bit better after talking ". This time they sort of demanded to speak to me directly and urgently (which given the time of their call seemed particularly out of order). However for once I decided to draw a line and rather than returning the call I ensured they received a message back saying what I have said annually - that before any useful career discussions can take place - it is essential for us to receive the workbook back as part of a Career Review Programme. Needless to say - we have not heard back from them.

But my final conclusion (and not only from this one situation either) is that having free telephone chats with people generally achieves little once significant career concerns have arisen. This is because the individual has not spent any structured, sensible, reflective time on their career thinking before we speak. They have not "invested" in their career - in terms of time preparing or financial - so they have not fully engaged in the process and thus can not benefit. The moral of this story is that preparation is key to seeking effective career intervention. Picking someone's brains (or offloading ones lot) for a few minutes on the phone shows a lack of understanding that accessing expertise for chronic career situations that have taken years to arise is not something that can occur through a brief chat. Harsh but true.

July 14th 2009

Today I received an email from a doctor who had - purely through using the facilities in the guest membership - managed to find and forge an ideal career route for herself outside medicine. This had been something she wanted to do for years but just didn't have the inspiration or "permission" perhaps, until she had engaged with our web site.Sometimes remarkably little career support is needed.

Does it please me that a doctor has left medicine when that happens? Yes and no.

Yes if they have intelligently utilised some simple tools to facilitate career dreams

No because I do feel that there are options in and around healthcare where, given the right career support, doctors can find their niche.

Yes because each person must determine their own route in life - it is up to no one else to define or attempt to unduly influence

No because the health service and society spends a lot of money training its medics

Yes because if the selection and training system hasn't provided sufficient support for the person to make a decision to move towards career goals that inspire them and to which they are suited - then the system doesn't deserve to keep them

No because when I fall off my garden pruning steps and break a bone - I would like there to be a happy doctor who is happy doctoring - willing to put me back together again (rather than all the King's horses and men who presumably wouldn't know what to do!)

Yes because sometimes people choose medicine when in fact it is totally the wrong route for them

So - you can see that I have very mixed feelings about the "leaving" angle (or am I just confused of Hampshire!!?)

It was a little unusual to find someone  who had taken such affirmative action whilst not needing to access the more personalised career support programmes we offer. But it just goes to show that some people need the minimum of career support to instigate changes and others need more. We are all different in how we view the world and in what skills we already have.

Creativity and careers