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
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.
Should I change career?
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
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
lack of autonomy
lack of career progress for any reason
job or job plan changes that you have not been a part of
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.
career responsibility - why people don't take it
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.
Struggling with your medical career choices?
The sort of career decisions that many people worry about for years include
choosing a clinical specialty ( even once one has been chosen - years later this can resurface)
taking time out of programme
letting go of a career dream
When faced with helping someone make a career decision that they are finding difficult - there are about 20 different methods and techniques or exercises that can really help the individual to confidently make a decision and feel happy about it - often after months or years of dilly dallying about.
A massive amount of emotional energy and time are literally sometimes completed wasted over a period of YEARS when in fact some straightforward career support would have resolved it quickly.
Thus the time spent in "panic/worry/stress" mode regarding the career - had it been spent in logical career planning methodology with some personalised reassurances via a neutral sounding board perhaps as well - there would have been a swift resolution.
Here are some of the basic career planning principles as applied to career decision making...
If the above is not helping - you may really benefit from an objective evaluation by an experienced medical careers adviser where we can apply the other 16 methods and offer a neutral yet challenging sounding board and an objective view of your career and how you fit it and it you. Book in for our Career Review Programme perhaps?
There are a myriad of other options for doctors - some involve clinical work and some like medical informatics may not - but the main thing to keep in mind is - what do you love doing and what would you like more of ( NOT what would you like LESS of - as latter is negative and one can not easily persuade a brain to work towards negatives - it is simply not motivating - Oh and that is technique number 5 !!).
or - why goal setting is hard
I speak to clients from time to time who appear to have a real problem with goal setting and it has prompted me to muse a tad on the topic.
I see it as absolutely critical to achieving progress in career planning.
It is a useful life skill to have.
So why would someone not wish to adopt it
A feeling that somehow it is not "nice" to set goals or to want or to achieved
Where might that come from - possibly parental attitudes, school experiences or religious influence inculcating that somehow it is not OK to earn a comfortable living or that one should not be motivated by money. I happen to disagree with the first point and agree with the latter but thats another blog post.
A dislike of the process of goal setting could on the one hand merely be a preference.
But given that it is a crucial part of career planning one has to question - why a dislike? It is perfectly acceptable to dislike things. I dislike the idea of jumping out of a plane - and I have reasons. I get very motion sick, I have a mild BPV which means that tumbling through the air might well cause me to become very unwell - not great if one has to recall to pull the parachute chord. Even if I didn't have a good reason I would still be entitled to not want to jump out of a plane - merely as preference. However if I wanted to get a certificate of skydiving - then one would need to examine in more detail the reasons to see if any of them could be overcome.
Similarly if a person dislikes making money - that is their choice. However in our society - most of us have to earn money and earning it in the best way for our particular blend of skills and wants from work will lead to a greater sense of satisfaction and enjoyment. This in turn increases our wellbeing outside work and facilitates work life balance and more. So it makes sense to like making money if it is a byproduct of a career one truly enjoys and feels well suited to in all aspects. Taking this a bit further - conversely not like making money could adversely affect ones ability to find the career that best matches as the attitude of "I don't want to make money - its bad to make money" could well be sabbotaging ones decision making regarding career choice or career planning or indeed setting career goals. Thus one possible cause of hating anything to do with goal setting is that it relates to achieving ( ie if achieving has been somehow programmed into you as something you should not aspire to)
I can think of many other reasons why a person might not want to set goals and whilst I am accepting that the whole world may not be motivated by goals - my own experience of setting them has been very positive, my experience of encouraging clients to do so has also been very positive too. Thus if a client appears to have some difficulty with or dislike of goal setting - I always feel I have to explore this further.
If there is resistance - there will be reasons for resistance as a person who is open to trying new things and learning new skills would normally accept that for their career path to be decided or to change direction - some goals are going to need to be set and that to attempt career planning or career change without addressing any rusty or vestigial goal setting skills is to court a very long drawn out career reevaluation and one that may easily drift off course.
One of many key techniques within goal setting is that of "writing them down". Rather simplistic you might think. However the process of actually writing them ( and I feel that handwriting them does more to imprint them than typing but each to their own - I also use a vision board app ) seems to do something interesting to the subconscious.
So why don't we all have our key life goals written down and refer to them daily? Probably because no one has suggested to you that it might be a useful thing to try. Or because you are someone who needs a bit of help with not only deciding what they should or could be but with the process of the setting them too ( there is a methodology).
Is there anything wrong with or painful about setting goals? Plenty. A whole separate article could be written on problems relating to goal setting. For example - one needs to know what goals to set and this can be a huge and anxiety provoking challenge for some people. Some people become obsessive about their goals - their choice - its probably what makes Olympian gold medalists. However there is so much more to career and life planning, feelings of contentment and happiness than merely setting goals and reaching them. This is why it is possibly to reach the pinnacle of ones career yet still feel empty and unsatisfied.
So my advice on goals is - learn how to set them - it is a skill - one of many that are needed for career planning but do not assume they are the be all and end all.
When I first set up Medical Forum - I was focused more on career change away from medicine because the people I was hearing from were experiencing major health or career obstructions.
The emphasis has changed and the challenge is now more about assisting doctors to remain being doctors or to use their medical and health care knowledge and skills in more creative and effective ways. There is still an element or "career change" but somehow more organic.
I still say to people "its not about changing career - its about finding out what you want more of in life and then getting a plan for achieving that". Of course at times this incorporates change. But at the end of the day - most doctors did medicine because........ they want to work as doctors. Not rocket science you may say. The trouble is that so much of how people are expected to choose careers and then work in them is not addressed in the career guidance or recruitment process.
But I could write about this until the cows come home. In summary - career change doesn't always mean radical change but it does always mean changing "something" - from location to attitude, from colleagues to work content. from workstyle to hours worked. Radical change has its place but is not something anyone should leap into - so career planning "prior to any resignation" is always my preferred way forwards if only because at times the resignation is not timely or not even needed.
The first thing to say is that you are not alone if you feel in distress regarding your career. You are not the first and you won't be the last.
The second is that if you feel things are in an unsustainable situation or that your health is deteriorating you must seek help. YES - seek help.
A trusted colleague is often the best but if that feels as if you are letting the side down or risking anything - then the following could be considered.
Visit to GP
Visit to Occupational Health
Start taking care of yourself better ( fit in a weekly yoga class if you can or an art class or similar)
Obtain our eworkbook "easy career change good career choice"
It is far better to take these steps than
go off sick ( though that may sometimes be needed - though its best taken under the umbrella of a supportive clinical consultation as you may not take long enough to recover otherwise)
to resign prematurely or out of desperation ( there is a place for resignation but it is so much better done under controlled conditions rather than knee jerk)
At Medical Forum we have an occupational health consultant who works for us and who can provide a half hour phone consultation in complete privacy and confidentiality. So if there is no OH where you work or you don't feel comfortable going to see your GP/local OH you can still access some OH support.
This sounds like a crazy idea and what would they all do. However it is possible that they could sell their services back to the NHS on contracts that each one of them negotiates separately. This of course would be an adminstration nightmare but it means that not only would the health service return to its previous state but also that 20,000 juniors do not flood the market for jobs that are non medical.
I have been mulling the huge dilemmas faced by both sides in this crisis and its not an easy situation to resolve.
With regard to doctors changing career - I have never found any difficulty helping a medic diversify their career - portfolio wise or radical change away from medicine. However - could I do this for 20,000 all in one week - or even staggered over 6 months - no. At the end of the day most medics just want to be good clinicians and do what they have trained to do. It would be a soul destroying task to attempt to redeploy that number of medics.
What would need to happen for mass resignation to take place? Firstly trainee hands in notice then goes away for a short sabbatical or holiday at the end of their notice period ( for some this will be one month and for many - three) and writes to their department to say that they are available for work from x date and here is a provisional contract.
Is this a good idea? Well it has pros and cons.
Pros - trainees cost a lot to train - so it makes sense to retain them
Trainees would get contracts that they themselves have negotiated ( with help from BMA perhaps)
Cons - a hiatus where trainees not earning and most will have outgoings and not have huge savings so this will be difficult for some, impossible for some and possible for some
The negotiation of 20,000 different contracts would not happen fast.
Having everyone on a different contract is not going to make life easy for anyone.
Is the whole situation merely going to lead to privatisation?
But- mass resignation does achieve one thing - the boot on the other foot.
However its outcome is unpredictable.
Bit like Brexit
Only this is Docxit.
The pull of the clinical career - the worthwhile nature of the work combined with the status and security and demonstrable evidence of ones "stickability and brain power" can all combine to make it almost like a drug. One that we can easily get dependent upon.
However laudable and rewarding being a clinician is - at the end of the day is it not "you" . You are not "a doctor". You work as a doctor. Your income comes from your role caring for the health of others. Studying and practicing medicine may be a vocation but it is also merely a vehicle - one in which you have chosen to travel through life.
I always recoil very slightly when I hear school children say they want to "be" a ......
Whether that is a fireman or a train driver, an astronaut or a doctor.
You don't "be" a career. You do, work in, study, earn from a career. You "be" who you are. A career is not who you are and does not have to be your identity. In fact having worked in the field of medical careers now for 26 years I am pretty sure that it is NOT healthy to have a self image that is totally embroiled within ones work and that it is perfectly possible to be very dedicated to ones work without it becoming who one is or taking over ones identity.
There are all sorts of psychological overlays and interactions going on if one over identifies with the activity one does to bring in income. A big one is - if you find that the workstyle or role no longer suits you for any reason - because you have a young family, your health has changed or the job has changed - then it can be extraordinarily difficult to even begin to think about an alternative career. Trying to give effective career guidance or coaching to someone who is in some ways addicted to their self image being a certain way - is a very challenging and usually fruitless task.
Given that anyone can be placed in life changing situations through illness, injury and social change - it makes sense never to be "chained" to the self image and identity of ones work. Yet people do immerse so deeply in the self image of doctor that if and when the time comes to need to look at life and work differently - this can precipitate huge anxiety and deep depression. This is not just true for medics I am sure - but it is quite common amongst medics. I can even confess to having had a touch of it myself a few decades ago.
I am not saying that every medical person wanting to diversify their career a little ends up unable to do so because of their medical self image. For some people however - the merest thought or hint that they might need or want to do something different sets of a level of denial and resistance that can completely sabotage any normal career exploration and catapault them into years of procrastination.
Thus a person's level of "weldedness" to their career and how much of "them" it has either consumed or swamped, hidden or replaced - is for some people a major element of the work we need to do with them before career options can be unearthed and pursued.