Finding time for career planning
The biggest barrier anyone we see at Medical Forum has when thinking seriously about the trajectory of their career is without any doubt "time".
Without time for reflection - properly allocated and.... preserved - it is hard for anyone to make genuine progress.
The second barrier is fear. Of? Having to face things that perhaps one has been in denial about or which feel insurmountable.
The third barrier is structure - or rather lack of it. The process of reevaluating a career has various stages to it and if one launches in at the wrong stage without having done the preparation first - it is very easy to default back to take no action mode. When early forays into career development are unsupported and don't work out it is all too easy for the individual to give up at that stage and revert to tolerating an unsatisfactory situation. From here - it can only be a few steps away from chronic career disillusionment syndrome and possibly burnout too.
As a way of getting around these barriers - one of the first things we do is a preliminary phone call (after one of our questionnaires is completed) to assess whether burnout is present, whether no time is currently available for career planning and if the latter is true - how to engineer this into place. Where fear is present - we have an ebook which helps to turn that frightening uncertainty around into something more proactive... learning about how to culture the right attitude to career planning from a position of being extremely wary of it.
It is in fact all about putting some structure into the amorphous and at times overwhelming mass ( or mess) that career planning can feel like as well as making you feel supported.
When a career is ailing in any way at all - taking action is the key.
Waiting and waiting and waiting - without action can easily lead to situations where the sparkle is so far back in time and the energy so depleted that even beginning any form of proactive career reevaluation feels terribly painful or scary or both. This is often when burnout sets in.
The key is to start proactive career planning as a student, to learn the key skills required for doing it well and to realise early on that it is YOU who is the driver of your career. Yes other people will require you to jump various hoops if your chosen plan requires that. Yes there are limitations as to which rotation or location you can get an NTN or consultant/ partnership - but it is still YOUR plan and no one elses.
You hold the career chariot reigns. You make the decisions
The big challenges are
- the goal posts keep changing
- the workload keeps increasing
- unacceptable working styles and practices are evident
So how on earth to navigate this and if you are well enmeshed with a mortgage and responsibilities or already at the career points of GP or consultant or wherever you have aimed for.
The trick I believe is to do not just an annual career appraisal ( which is really for your position and effectiveness within the organisation that pays your salary) but an annual career review. This is an altogether different animal to the appraisal.
Firstly - you don't have to do a review.
Secondly - it is an optional expense for keeping your career on track at all times ( and thereby avoiding drifting into situations from which it is hard to back paddle).
Thirdly - it is 100% entirely for YOUR benefit - and not for anyone else and is thus 100% private.
My view is that people often book holidays and buy new cars - yet find their work is destroying their very enjoyment of life.
What is the point of having a fab holiday only to be dreading the return to work.
So I think it must be a perception for many doctors that they can't do anything about their working lives. A view that I think is very wrong but it otherwise doesn't make sense to spend money on holidays when your working life is slowly killing if not you - then the passion which you once had for your career.
I should point out here that our career review programme comes with a guarantee - you can fill in the workbook listen to the audio and read the guide and if you feel you have joined the wrong thing for you - there is a full no questions asked refund.
The NHS and the government has a tendency to think it somehow "owns" its doctors' careers.
It does not.
But it attempts to and everyone appears to assume that it does. This disempowerment has to stop.
Tying medical students into five years of contracts once they start work might seem a good idea but when the armed forces do this - they pay for the student training or offer tempting grants. So yes - by all means say that "if we pay everything for your training then you need to remain for x years". That sounds like a fair deal.
But to say that you pay for your training - you get the loan - you pay for the privilege of studying medicine, you pay for all the postgrad exams ( and often the courses) but ..... we then insist that you stay - is somehow wrong and will I believe backfire like has never been seen before in medical recruitment terms. It is an under sea tectonic plate just waiting to sublux.
Will that reverse the trend and make medicine an attractive career option again?
Err that'll be a NO then!
Conversely - make medicine ( as a purely vocational degree that has shortages of applicants and shortages of doctors) a grant supported degree with no fees.. and the numbers of applicants will increase and so will the quality and bredth of candidate applying.
I won't even go into selections procedures for how to get the right sort of doctors who don't WANT to leave and what sort of career planning support should be given at medical school - I could write BOOKS on the topic. But 27 years working with doctors whose careers have in some way or other become stuck or drifting or on a plateau etc - probably makes me uniquely qualified to advise on what modifications to make to the curriculum and selection.
But of course - the medical schools, GMC, BMA and the government know best (?)
I should mention that I have been ever so slightly on the subversive side since childhood and just adore questioning the status quo - but they do say that it is people on the outer edge of the envelope who influence the tipping of the spinning plate - not the sheep huddled in the middle. I rest my case.
It is really easy - if ones career is not bringing joy - to view career planning with great suspicion.
How could it possibly make any difference to a drifting or stalling trainee or a plateau after CCST or partnership.
However, attitude to career planning is key here.
First and foremost career planning should be an enjoyable activity that one looks forward to doing from which one gets results that take one closer to where one would like to go.
It is vital that one maintains this attitude and realises that whilst you may be welded to your own idea of what a career in medicine should be - the scenery and systems change so fast that adaptability is fast becoming the top medical career planning skill.
People don't career plan for a number of reasons
They assume they can't change things
They feel trapped
They are exhausted and or with no time in which to do it
They think it means leaving what one has achieved behind
They feel it is financially unwise
They don't know where to start
They think it is somehow "not nice" to do so
However, well supported career planning addresses all of these concerns and encourages ways around them, attitudinal expansion and plenty of risk management. It is never ever about leaping into the blue yonder without a parachute.
By the time some people reach out to Medical Forum they can be quite sceptical about career planning - such is their disillusionment with where they are right now.
If there is a dissonance between where you are and where you expected to be - there is bound to be some dissatisfaction. However it can be even worse if you never had clear expectations and clear career goals in the first place. If the latter is the case - how on earth can one think one could end up somewhere that meets needs and matches what one wanst when one never defined these? It sounds such an obvious thing to say yet it seems many people step onto what they think is a training conveyor belt and hope that will take them to where they want to go.
You can take 100 trainees in the same specialty and not all of them will end up with the same careers. Far from it. The difficulty lies with lack of time being put to career planning, lack of training, lack of culture that s
"but I am planning to take my MRCP - that's planning"
Well yes and no
MRCP is a hurdle
A stage along the pathway
But it is not strictly career planning - it is about 5% of a career plan.
Doctors need far more help in steering through the career maze , defining their own particular blend of talents and how best to use these.
When I set up Medical Forum 27 years ago - everyone said "but doctors do not need career guidance".
The current burgeoning of career coaching and career conferences I think finally has proven me right.
But we were the first - by some margin!! (sorry but I think a wee trumpet blow is called for there).
What are your reasons for working?
The answer to this question ... apart from 'to earn money'
will be different for different people
To gain status will be important for some and bottom if the list for others
For others camaraderie/ belonging
For others independence
For some.,..solitude or to spend as much time as possible in nature
For stimulation/ challenges
For a worthwhile purpose
For a good pension/ provide for family
To experience learning
It is worth taking some time to think about your own personal reasons for working and if all the above apply - which are the most important.
And what are my reasons for working?
To experience passion and build / contribute something worthwhile
Here are just some of the reasons
As you can see from this small number of comments - career support is not always sought because radical change is wanted. It can be just as relevant for exploring potential in a current role or returning to work that one did before after time away from work. Thus career change is a much much broader term than most people use it for. It can refer to anything that makes a current career better. Changing attitude, changing location, changing hours - are all elements of career change.
Many times a medic will say they want a major career change when in fact what they really want is to find a way of working that enables them to gain satisfaction and feel they are making a difference. This may at times be achieved without a radical leap.
Are you procrastinating about anything? The chances are that you are. We all do it
I have a small pile of rotting vegetables near my back door that needs to go onto the compost heap - yet I put off doing it ( psychoanalyse that one if you dare!) and I am not entirely sure why.
This particular procrastination doesn’t have any immediately severe consequences ( mild odour when open back door - possibly of attracting rats or other animals perhaps) . However when procrastination is applied to some areas of life - there are major consequences.
I recently saw a doctor who had never enjoyed medicine
From joining as a medical student to a recent resignation from GP registrar training.
Representing over ten years of not feeling on the right track
Not having a sense of working towards something that was inspiring
Feeling as if the career was a complete treadmill and / or a ball and chain
Trying to do as little as possible and scraping by
With the resultant low performance, low self esteem, low mood and lost confidence that goes with the above cycle.
All this in the face of a bright and talented person underneath the mask and cloud of disillusionment. Awareness of these issues had festered beneath the surface for years and a sense of guilt for “not fitting in “ also pervaded.
The default approach that emerged over the years - one that was on retrospect dysfunctional yet also understandable - was one of chronic and very resistant procrastination. Put off dealing with it.
This is an extreme example of course but it demonstrates what invariably happens if a person does not feel well matched in their career and then takes no action.
One has to ask why this doctor did not take action sooner?
The answer to that question is surprisingly complex and I could write several articles on the reasons why doctors don’t address their career concerns . The deep reasons behind each person’s procrastination are different.
The main point I'd like to get across is that procrastination about ones career can be overcome. It is not a quick fix mind! But there are ways of encouraging a person to limit or even cease procrastination.
Now where is that compost bin?
If you needed to change where or how you work - tomorrow - do you know what you would do?
I have long thought that medics need a plan B career and possibly a plan Z
There are lots of risks to being a medic
Some medics do get made redundant - it is rare but it happens
Most people only think about the career back up plan AFTER something has happened to force their hand but at this point the time and resources to put into steady well planned career diversification may not be at hand. Career planning under pressure is nowhere near as easy or as fun or as effective as career planning done at a steady unhurried pace.
Medical career planning is something that at Medical Forum we encourage ALL THE TIME
I don't meant 24/7 but certainly between 1 and 4 hours a week ( former - maintenance level and latter when things need to crank up a bit)
There is a tendency to assume that one's employer is responsible for ones career
The truth is - you are the person with the most vested interest in your career your finances and your future.
For some people career planning comes naturally but for others it is an area of mystery or even strikes fear into the heart.
However for everyone - a slow steady approach to career planning ( over years) is the most effective way of gaining back up plans or steering diversity and change and new challenges into ones career.
Zero career planning on the other hand - the more passive approach to ones career - can lead one into career plateau, career spirals ( downwards) and career crises or an unsatisfying sense of career drift.
People often state that they don't have time for career planning - busy weeks and all.
I ask two questions
A Would you feel more secure with a back up career plan?
B Do you spend any time each week moaning about or feeling deenergised by your career?
If the answer to both of these is yes - then merely shifting the time spent in B into time spent in A will most likely mean that career planning can be time neutral.
The most common response to the question "what is the biggest thing holding back your career at this moment in time?" is the option ....
So busy I can't think straight
This lack of time for general routine career "maintenance" is sometimes why careers get into this situation in the first place.
The challenge is somewhere between
I am able to allocate time to career planning
I am unable to allocate any time at all to career planning
So a first step in getting a career from the point where it is lurching either from crisis to crisis or where the person supposedly in control of it is controlled BY it - is.... to find ways to allocate that time.
How much time? This depends but initially I'd say for most people aim for four hours a week.
Now saying this to someone who has just stated that they are so busy they can't think straight is likely to get a negative comment.
But say it I must because without that time NOTHING is likely to change
Time management might be an issue but most doctors I see are state of the art time managers and work very hard too. Being asked to do too much is common too - and you could be a state of the art time manager and still struggle is there is literally just too much to fit in.
The skill many medics REALLY need to master is more likely to be one of saying no.
My ebook "how to say no without upsetting people" will be available later this year but for those who can't wait - the career review programme invariably assesses and highlights assertiveness problems if they are there and the PCP invariably incorporates some assertiveness training specific to that person's situation.
So - if you feel so busy you can't think constructively about your career, whether you are enjoying it, whether you want to see some changes, whether it is affecting your quality of life or even your health - the very first thing is to allocated regular time to career planning ( and for some - initally this four hours should go entirely to self care - NOT career planning). If you can not allocate that time - the next thing to consider is having some feedback on your assertiveness.