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​

• I have just started in a career that will last over 40 years and I want to know I am making the best choices for me
• I would like to spend more time with my family and do work I find satisfying 
• I do not get on with my partners - I think I need a change of location/ practice
• I have not worked for five years - how and where to start getting back
• My health has given some severe restrictions to working but I am still ambitious
• I want to start a portfolio career but don't know what to add in
• I don't know what I want from my career but my family keep pushing me to decide
• I am definitely at a crossroads but I can't see the way
• I have been forced into medical early retirement but I still have a brain and want to use it
• I want to work with the disabled but my current role does not allow that
• I'd like to spend some time abroad but I am worried I might not get a job on my return
• I enjoy my work but I often feel that I have some talents that are not used and I'd like to use them
• I don't feel I have yet found my "niche" and I keep changing route in order to find it.. tiring!!

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
Needlestick injuries
Burnout
Boredom
Some medics do get made redundant - it is rare but it happens
 https://www.bma.org.uk/advice/employment/redundancy/redundancy-guide

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
NOTHING

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.
Assertiveness.
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.

I am always fascinated by research that aims to demonstrate why doctors are stressed or why their job satisfaction should be high or isn't high etc. I usually find however that the conclusions drawn have somehow totally missed the point.

One such example https://researchspace.auckland.ac.nz/handle/2292/10034
has demonstrated that psychiatrists have more burnout but this is not correlated to job satisfaction as it is in most people.

Now forgive me if I have missed something but pretty much all of the conclusions they have made from this are just not valid or have gone entirely off beam.

I wonder if anyone else agrees with me.

The biggest omission being a very important issue - and it has been skirted entirely - does personality affect job satisfaction and tendency to burnout? I would say it very much does. It is not unreasonable to say that not only is a certain type of personality attracted to psychiatry but in fact to medicine as a whole.

I am not saying doctors are all the same - far from it - the diversity still amazes me 26 years into talking about careers with my clients. However as a group medics do tend to have some underlying characteristics which may in fact be contributing far more towards  collective burnout than anything else.

One such trait is the inability to or reluctance to say no or crib up when things are not "right" - possibly due to fear of letting patients down or fear of loss of job.

I am forever hearing stories from doctors who are working in situations which - having been away from clinical work for 26 years - I can honestly say I would not have accepted back when I was clinical and which I feel it would be reasonable to stand up to in some way or form.

A recent one was an ST4 who was covering four doctors. This is not acceptable - yet they quietly took it on and consequently was expected at regular intervals to be in four places at once. My advice would have been to not accept covering others - or at a push one. OR to take on the four but everytime bleeped to "be somewhere else at someone elses behest" instead of apologising or feeling desperate or guilty and having to deal with irate other departments ... I would say warmly and politely and immediately " I am covering four doctors  today and there is simply no way I can be in four places at once - so I think it is really important to call Mr Manager on extension 3003 and complain about this and explain to him just how important the task you need me to do is - then we might get some proper cover in this unit"

Ok - perhaps I am overly assertive or just plain bolshie (no surely not!) but... I would be thinking "I DID NOT DESIGN THE HOSPITAL OR ITS ORGANISATION PLUS  I am not responsible for how things run so the person who should be called is the person who is responsible for how things run.

It is a good thing I left when I did as I expect i'd have got the sack by now. But then I'd have probably fought for unfair dismissal if they had not followed the book. I've been against inequality and particularly unfairness in work and in learning ever since I was 12 years old ( the first time I really stood up to others) so thats not a trait that is likely to change soon.

However putting an employment law hat on - I think if a doctor did get the sack or had to resign due to stress of covering four doctors - then a case of constructive dismissal could easily be brought and most likely would succeed.

My career is not dependent on working to other peoples' warped and unreasonable expectations of me. However it still makes my blood boil when I hear about others who are experiencing such.

One skill that I regularly cover in career planning is thus - assertiveness. NOT to the point where a person will get a verbal warning of course - but just enough to "shake" the system a little. 

Part of the process of moving ahead when doing so has appeared challenging - is looking at why one is not already moving ahead. 

There are various ways forwards for letting go of stuck attitudes, beliefs and ties to the past.
​Things like NLP, CBT, meditation/mindfulness and yes - counselling ( although in rare occasions a psychotherapeutic intervention is the only thing that will really rebalance a badly listing career ship).


By far my own favourite and a technique I have used for over 25 years is "the Sedona Method"
The challenges of using this method include

• as with most techniques it needs practice - its no good thinking a "session" or two of Sedona is going to change the habits of a lifetime.
• having a Sedona "buddy"- someone else who is studying it - certainly in the early stages can really help.  The should ideally be slightly further ahead in learning about it than you and this person can be hard to find without going on a Sedona Course ( they are occasionally held in Europe)
• it is surprisingly unresearched - which means you wont find it in NICE guidelines
• a lot of people whom I think need it and would benefit from it - don't pursue it. It is almost as if they dont want to let their old habits go - well not as if - thats just it - old habits are often like addictions - in other words - they are hard to stop.

However if someone is really serious about changing either the way they work or what they work at or how much work they do or where they do it - and have found this is more than a little challenging - starting off with some Sedona learning concurrent to some career guidance is in my view a winning combination.

As part of any Career Review it is possible for me to identify specific aspects of a persons career that are holding them back and thus are ideal for applying Sedona Method.

It is far from mandatory to try the method - but for anyone feeling badly "stuck" I think it is a very useful additional tool for career planning.

Many years after I ceased clinical work I was still correctly informally diagnosing friends and family illnesses ( albeit advising them to see their GP as I was always very careful to say that I am not currently a practicing doctor).
I was in most cases correct
scabies
Churg Strauss 
Polymyalgia Rheumatica
Scleroderma
etc

The thing to realise is that once a doctor  always a doctor.
You can not stop thinking like one

But you can - if you are not enjoying your work choose to earn a living by doing something which is not your current role. Whether that requires a "leaving" or not depends
A) on how one looks at "leaving"
B) how carefully one has examined ones career to be sure that no stone has been left unturned before any radical or irreversible decisions are made

The reason most doctors studied medicine is - because they wanted to work as a clinician. It is an immensely rewarding privilege to work as one. However there are times when medics find the work is not fulfilling
overwork
lack of autonomy
lack of career progress for any reason
career plateau
career mismatch
job or job plan changes that you have not been a part of
etc

These are all good reasons to reevaluate where you are going , whether you are getting out of work what you need and why any state of discomfort exists. Merely exploring ones options does not have to mean taking them.

THe very act of career exploration can be hugely stressful for some people yet the processes one goes through to effect this can sometimes in themselves reveal issues that need to be addressed in the current career and at times no career change is needed ( although clearly some change WAS needed).

When one has spent many years achieving one career it can seem like a waste or heresy to question this but we find that career planning builds on all past experiences and that nothing one will have experienced in work is wasted. 

It is patently not heresy to question where one is going in life and in fact one is ill advised not to if one is not enjoying work or even worse - work is making you ill.

So the answer to "should I change career" is always no - there is NO "should" about it.
There is merely either a need to explore ones career position - or not.
The choice whether to act on that can only come once all options are revealed and clear and the various courses of action fully evaluated. Otherwise any career shift can be like jumping out of a plane without a parachute.

This is sometimes a challenge even though it sounds obvious.

Of course you have to take responsibility for your career.

Yet there are reasons why people do not.

* blaming others
* blaming the organisation
* feeling fearful about doing career explorations
* don't really realise quite how important this is
* a tendency to be a bit passive and ambivalent
( hoping that somehow somewhere else will do it all for you)
* don't actually know how

This latter point - not knowing how - arises predominantly because career planning and exploring how to develop ones career into new avenues is rarely taught. Goodness knows why not as it seems to me to be of the greatest importance.

Careers and the world of work are changing. They are not what they were even ten years ago.
So to feel on top of ones career plan and to have motivating, realistic yet also challenging and exciting career goals would seem to me to be absolutely vital.

However all too often the formulaic and highly structured medical career takes away or never provides the skills one needs to truly see where one fits in the world of work,  how to capitalise on ones skills if and when one either wants a change of direction or merely to add new strings to ones bow. Even just wanting to reevaluate ones current career without any major desire for radical change or additions - can really benefit from some early stage planning and looking at ones attitudes to work.

My ebook - Easy career change - good career choice  gives the initial few steps that many people leave out of career planning. Unless these early preparation stages are addressed - many people who think they are doing career planning - run out of steam or wonder why it doesn't seem to progress things along. 

When asked what action to take to further a new career option - 9 out of 10 people say "rewrite my CV" . However this ebook has 9 things you need to do way way before a cv even comes into the conversation. Jump to the CV and the basic preliminary stages will not have been addressed. 
For some people these 9 preparation stages may be useful but perhaps not crucial - however for most people they are completely and utterly mandatory and essential reading.