"The afternoon knows what the morning only suspects."
"What lies behind us and what lies before us are tiny matters compared to what lies within us." - Ralph Waldo Emerson
Thinking and thinkers often get a bad rap in our fast-paced society. Action oriented as we physicians are, there is a high risk of speeding past this stage to get out there and start looking. I propose that the first productive phase of career exploration is one of contemplation and that this should take about three months. You’ll save a lot of wear and tear in the long run by being patient and deliberate.
I’ve been a sports fan and a keen reader of the sports pages since I first learnt my alphabet…... There are a lot of great lessons for life buried among the batting averages - for those of you contemplating a career assessment I’ve picked out 8 for your particular consideration. Read More
Establish the end goal of this phase. Thoughtful thinking about your career disillusionment and wish for change should allow you articulate to your spouse or another loved one:
Considering career alternatives requires being mindful of the challenges even if all goes smoothly.
If questions 1-6 indicate a lack of resolve, then you may do best by staying with what you’re doing and finding a way of restoring joy in it.
Keep a brief diary of those elements of your professional life that give you joy and those you find the most frustrating. Avoid casual surfing of the internet hoping the right answer will appear magically on your computer screen - it won’t.
We have all used informal paths across grass or other natural settings to take us between locations rather than use a sidewalk. You may not know, as I did not until recently, that landscape architects call these paths desire lines... Read More
Be mindful of the biases of outsiders with whom you might speak.
Periodically step back and reflect whether you are advancing towards your 3-month objective of being able to lay out the problem and avenues to its solution to your spouse/partner.
This second phase in the pursuit of an alternative career begins with an acknowledgement to self and others that you are going to undertake this process with gusto and persistence. If confident you want to explore an alternative career to clinical practice, I should be able to make the following assumptions:
In this phase you must envision yourself as a researcher, gaining increased understanding of self, how you might be viewed by individuals and companies outside of the clinical realm, and what career opportunities exist in the marketplace.
This is all achievable in approximately 6-8 months. It’s not easy, as you will simultaneously be spouse/partner, parent, and practicing physician. It will be worth it.
A great strength of clinical clerkships is allowing medical students experience some proxy of what life might be like as, say, a general surgeon or pediatrician. It is a pity then that as older adults considering a career transition it is harder to acquire similar proxy experiences which might teach us so much. These are harder both because of the absence of formal systems to facilitate new experiences and because we commonly wish to keep our cards close to our vest and share our concerns with few others. The paradox is we are much more in need of "testing out” roles as older adults than when we were students.
Challenging as the task may be, some degree of testing of potential new roles is to be encouraged. The goal in testing is to learn two inter-woven things about yourself:
It’s easy to underestimate the rewards from patient care after a rough week at the clinic or a difficult call night. I encourage clients to keep a simple diary (or just jotted down key words or names as triggers for your memory) of the most rewarding and most frustrating parts of your clinical life. Practical constraints make it very difficult to test out the realities of life out of practice – the release one feels from a vacation even of a few weeks duration risks giving a misleading sense, and sabbaticals are impractical for almost all but academics. Cutting back to 60 or 80% effort for a minimum of 3-6 months while imperfect may be the best that you can do. Should you scale back, be sure you don’t just drop the least appealing parts of your clinical effort or your least rewarding patients. Your goal is to know how you feel when you no longer see some of your favorite patients, or work with some of your most pleasant colleagues and support staff. Scaling back from clinical work is to free up time to ttake on and test alternative tasks to patient care, discussed below. Reducing your clinical time over the summer months to work on your golf game does not qualify.
Alternate tasks have to be engaged in with a sufficient degree of time commitment and enthusiasm to give you a worthwhile feel about what full-time work along similar lines might be like. Here are some considerations to get you started.
Committee work at your medical center where there is a substantial time commitment. I’m interested in you trying to replicate what life might be like if you were a physician executive serving as a staff member to the committee. Fields could include credentials, risk management, recruitment, formulary, education, quality assurance, IT, or others. Your efforts would require being involved in behind the scenes policy and procedural development, active leadership, and education (likely self-education). Exposure here should allow you feel how you might enjoy and contribute to work at your medical center in any of these areas, or what might life be like as a physician executive.
Engage in clinical trials with a substantial time commitment, ideally no less than 20%. This would allow you interface with drug companies [including their physicians], contact research organizations and colleagues performing studies at other clinical sites. How would you feel working in the pharmaceutical or medical device industries? What will be your tolerance for corporate life, the regulatory environment, the job insecurity, the travel on short notice, the reality that individuals in sales and marketing may have as much of a say in what compounds get pulled or pushed as you do?
Engage in consulting. This is different than fitting in a few extra hours a month doing medico-legal work. Have you some marketable skill that you can hone and sell? How about practice management, financial management for physician practices, educational programs to promote to the pharmaceutical or medical device industries, medicolegal work as a full time consultant, development of basic teaching courses in biological fields to local community colleges, or work for the medical insurance industry?
Can you
See a more detailed discussion about life as a physician consultant in essay III.2.
Successful testing requires you to know how much you’ll miss clinical practice and how you’ll use your professional effort otherwise. You may want to try out a number of different options, test and retest, always redefining your mental model of who the new professional you will be.
The next three essays provide further details on developing the toolkit you’ll need to formally explore job opportunities. Those are followed by two essays on expressing interest and job interviewing.
Many physicians considering other career options allow their aspirations wither thinking that their only skill is a professional métier like replacing hips or reading brain scans. After rigorous and lengthy training acquiring such expertise, we overvalue those clinical and procedural skills, and undervalue more personal attributes which may have broader application to the world at large.
This essay aims to help you recast how you consider your particular skills towards a viewpoint that:
Doing so requires an understanding of the concept of unique abilities and identification of what your particular unique abilities are. It also requires you to think more imaginatively and broadly how these and other talents may transfer and add value to the world at large.
Unique abilities are particular qualities and capacities that set us apart from almost all others and may be applied outside of a narrow zone of expertise. Typically they are carried out with an ease and grace that is especially striking to the outside observer. They may come so naturally to us that we consider them unremarkable. Technical or procedural skills rarely qualify as unique abilities, precisely because they may be applied only within a specialized milieu. Recognizing our unique abilities will give us valuable insights into what facet of our professional lives we should be emphasizing as we explore alternative career options.
I will use my own professional expertise as an example. A neurologist, my area of special expertise is epilepsy especially EEG interpretation. However highly skilled I may be in reading EEGs this talent is not useful outside of clinical neurology. However, my talent as a teacher and communicator in making the difficult field of EEG understandable and fun is. With strong speaking and writing skills I make the obtuse straight and the arcane mundane. This is my unique talent; de facto it is also my paramount transferable skill.
A useful method to help identify your unique abilities is as follows:
Dear X,
I am in the process of evaluating my professional goals and objectives, and would like to ask for your help. I’m interested in knowing what close friends, family and professional colleagues view as my special human talents, as distinct from areas of professional expertise. Some examples would be skills in conflict resolution, discussion of delicate or sensitive matters, building teams, or talent in speaking or writing.
I’d be grateful if you would let me know of 2 or 3 qualities that come most to mind when you think of me. The nice thing is you only have to think of positive attributes.
I’ll be amalgamating these with feedback from about 10-15 other individuals to whom I’ve posed the same question with a view to help me see myself as others see me.
Thank you for your help.
Ideally, you collect a list of talents identified by your colleagues and friends broadening your perspective on how you are viewed by others. This then gets added to your own individual considerations, your transferable skills discussed below, and what you will learn from your ensuing efforts at networking and testing out of alternative career options.
If committed to the idea of a non-clinical career in medicine, or a much reduced direct patient care load, you will ask which of your skills would interest an insurance, pharmaceutical, or consulting company.
However good you are at colonoscopies or cardiac anesthesia, these skills have restricted applications. How about the following attributes, present to one degree or another in virtually every physician, and highly honed in many?
Consider how we can group the examples I’ve provided above, and others you may be aware of, into more general categories.
If you are a whiz at laparoscopic cholecystectomy you may view the attributes above as nothing special/take for granted qualities that nobody would write a paycheck for. On the contrary, I believe these attributes become so highly honed through our education as physicians and years in practice that they are highly applicable to other work milieus.
Your role in considering particular career opportunities is to frame how your unique abilities and transferable skills add value to the new professional engagement you are considering.
"Knowing what thou knowest not is in a sense, omniscience." - Piet Hein
Networking is systematically seeking out and becoming acquainted with peers in different professional milieus in the mutual service of our professional goals. It can happen formally with one-on-one meetings or less formally at networking events.
Many of the networks we physicians move in are already an integral part of our educational and later career experiences. There are major flurries of action where we exchange ideas and ask for advice and opinions at nodal points like applying for medical school and residency, and when we commence a career as a staff physician, then relative inaction. We may then never master the art of networking - introducing ourselves to peers from different professional worlds and discussing opportunities where we might be of mutual benefit.
Thus, networking, whether done via individual meetings or at networking events, requires:
Start with individuals whom you know, even if obliquely, and ask if they would be willing to meet you to comment on career changes you are contemplating. Initial exchanges should be low key, with face-to-face interactions over a coffee, lunch or breakfast [you pay] preferred.
It’s advisable to have a summary of your career exploration goals on the tip of your tongue to break the ice, to bring contacts up to speed, and grease their thinking about how they may best help you. A slowed down, softened up version of your elevator pitch, discussed in the next essay, is a great place to start.
Keep your discussion broad based; many individuals are put off by too pointed an agenda. The aim of networking is to gain information, not asking for a job. Expand your network by asking each contact to recommend one other person you should connect with and if they would agree to facilitate an introduction.
Many of us experience a form of paralysis in the midst of a crowd of relative strangers, and cling either to the wall or the side of the one person in the room you already know. Especially when feeling vulnerable, we convince ourselves we’re clumsy with small talk, are middle-aged and unglamorous and we don’t know anything about the professional world that this person inhabits.
Relax; many others in the room are also uptight and wishing they were better at small talk. This is one more reason to have a somewhat toned down version of your elevator pitch ready as it gives you something to lead off with. I strongly encourage bringing your spouse, best friend, or a close professional colleague to a networking event with you to provide moral support, or meet with you immediately before or after a one-on-one networking occasion.
Think of your network as organic, dynamic and needing ongoing attention. There will be active and fallow periods. Stay connected and as interested in your contacts, their lives and careers as you hope they will be interested in you. A lot of good things will happen just by staying engaged.
Résumés and elevator pitches are succinct summaries of who we are, where we’ve been and where we want to go, geared to catching the attention of someone with a short attention span and encouraging them to want to know more. I like to think of them as opposite sides of the same coin; heads - written, tails - spoken.
The CVs we polished up as residents and young staff physicians are not particularly relevant to the greater world especially to employers in healthcare related industries. If considering roles outside of the clinical arena, it is more important to have a well polished résumé.
My CV has detailed lists of my education, professional experiences, lectures, publications, etc. A reader must infer what I accomplished in my professional roles, or what my particular talents and abilities are. My CV states I was a Department Chairman, but my resume indicates how large a faculty I managed, the programs I developed, year over year growth in grant support, physician productivity and other measures. The résumé, not the CV, gives a dynamic picture of my activities as department head.
Your CV’s length is in part because it catalogs everything. You send the same CV to each and every job you are applying for. Your résumé hits the highlights, concentrates on your most recent work experiences and should be tailored to the particular job you are interested in.
Lots of "how to write a résumé" pieces are on the internet. Here are the critical elements:
You’ve probably heard the term ‘elevator pitch’ in the context of a venture capitalist or CEO giving someone the length of an average elevator ride to pitch their business idea. It’s an excellent way of making a company or individual focus on who they are, what their key mission or product is, and why they are better than the competition.
We should all have an elevator pitch. Your research during this phase of looking at alternative careers should be geared to developing your story.
You say:
I’m John Brown. I practiced general internal medicine at a 500-physician strong multispecialty clinic with a group practice model in the Southwestern United States for 20 years. I developed workshops to educate peers and support staff in improved billing and coding practices resulting in steady year over year improvement in our reimbursement rates with other factors held constant. I’m interested in a career change allowing me to work as a physician-executive in the medical insurance industry.
They hear (and would also see in your resume):
You did not tell them, nor did they want to hear (what they’d find in your CV):You did not tell them, nor did they want to hear (what they’d find in your CV):
Where you went to medical school or did your residency.
How many papers you wrote, grants you held, or lectures you gave.
As a teenager, I was in awe of the guys who always had girls hanging off their arm. I was the shy, awkward, bumbling type, facile with words until standing in front of some pretty girl when I was instantly reduced to the manners and vocabulary of a village idiot.
There are useful parallels in how we express interest in new career opportunities and how we express romantic interest in another. In either circumstance there are ways of being a star and ways of being a clod. Some of us are naturals, others must learn in the school of hard knocks or risk being perpetually awkward and clumsy. What follows is a series of recommendations about how best to proceed in the career department. Let me know if you think I’ve potential as an agony aunt.
Mantras like ‘know yourself’ or ‘love yourself’ with their new-agey feel are unappealing to many but hold a kernel of truth nonetheless. Until you’ve carried out the background exploration discussed in earlier essays in this section you should not be out campaigning for a job. These are the steps that prevent you from ending up a stuttering suitor.
Thus, you must have thought, researched, tested, networked, and prepared succinct oral [elevator pitch] and written [resume] summaries of your career to date and your future professional aspirations.
Armed with that knowledge of self and of possible opportunities, and with the enhanced confidence that stems from this knowledge, you are now a suitable suitor.
Every interaction, irrespective of mode, needs to be considered an audition. This won’t raise your blood pressure if you’ve done your homework and if you accept that every audition is not going to lead to a call back. Approach your opposite number as one of two equals. They may have attractive qualities but be the wrong fit for your skills and goals. Or, close inspection may reveal a reliance on the institutional equivalent of BoTox and you know you’ll want to take a pass.
Your communications should possess four elements.
In summary –
We’ll proceed to discuss interview preparation and techniques in the next essay, and close with handling those inevitable rejections for they are as sure and certain as death, more sure and certain than taxes.
Interviewing for a new career opportunity in middle age, especially if considering a career tangent, can be a little daunting. Here are some tips for success.
Scrupulous attention to your homework, as discussed in the preceding essay, is crucial. Ask yourself how many exams you failed in your student days when you were well prepared? Exactly the same applies with job interviews. Provided you prepare in advance, and are as realistic as possible about whether the fit is right, you’ll interview successfully and succeed in your new career role.
Consider every exchange with a potential new employer or supervisor as part of the interview process – thus, whether via telephone, email or conventional mail, be on your toes. Consciously or not, you are laying out the opening bars of an impression.
Why are your earlier assignments with respect to thinking/researching/testing, networking, identification of unique abilities and transferable skills, preparation of a resume and an elevator pitch so important?
Rehearse a particular listening and answering style so this appears natural at the interview. Practice with your spouse/partner or a close friend. Talk out loud to yourself in the shower or car.
There are specific ‘of-the-day’ considerations to address which I lay out below. I’m not here to tell you to wear a suit and tie, shake hands firmly, to smile and be friendly.
Allow yourself the right to be nervous, and flub an answer or two. Would you want to work for an individual or organization who expects you to be superhuman?
Consider the formal interview as a dialogue not a trial. It is usually reasonable to assume that you meet the basic qualifications of the role you are a candidate for. Now at issue is a reciprocal ‘goodness-of-fit’.
Bring your best mindset to the table.
Listen attentively to the interviewer’s questions or comments for clues as to what they think are important. Your answers should affirm that you heard their message.
Your responses should be to-the-point, and draw straight lines between your past experiences and your expertise and your potential new responsibilities. Avoid verbosity which risks being interpreted as a lack of self-confidence.
Discussion about salary makes most of us nervous. You can reduce this anxiety by framing matters differently.
The closing minutes of an interview are your opportunity to reinforce your interest and particular skills you will bring. Ask the interviewer if there is additional information they’d like and what their normal interview follow up process is. Leave the meeting with as clear a sense as possible about their timelines and modes of communicating with candidates.
I recommend approaching interviews following the 80/20 rule. Preparation will take you 80% of the way to ultimate success. Good luck, the saying goes, occurs when preparation meets opportunity.
"Can't act. Slightly bald. Can dance a little."
- Comments made about a screen test of the young Fred Astaire
Most doctors are champs at the gritty grind it out persistence through late nights, critical attending physicians, innumerable exams, or difficult patients that is so much the stuff of a life in medicine.
And
We deal well, or at least well enough, with rejection when we engage in what I term the application without expectation - what the hell I’ll give Harvard Medical School a shot.
But
When it comes to unanticipated rejection, where our application has been with expectation, the wind goes completely out of our sails and we struggle to persist.
Accustomed to sequential success, physicians are not optimally equipped for the rejections, false starts or dead ends that are part and parcel of life for most of humanity
Practicing medicine today has its woes but to an overwhelming degree we are in demand, valued, respected and well compensated especially in comparison with individuals in most other occupational fields.
Physicians who want to put their toe into water at some distance from direct patient care arena must expect to experience more rejection than they’ve met before. They may encounter:
The playing field and impact of these rejections can be disorienting the first time through. Prepare well in considering alternate careers than clinical practice. Get and take advice. Yet, accept-expect that times 1, 2 or 3, you may despite your best efforts come up short. Learn from the experiences and stay with your plan. Einstein said: "it’s not that I’m smarter than anyone else, it’s just that I stayed with problems a bit longer." Good enough for Einstein, should be good enough for you.