You are a physician – highly trained individual who spent years in training – your undergraduate degree, possibly graduate studies and of course medical training followed by some sort of residency – on average at lowest end we physicians have 10-15 years training (not including fellowships or other additional degrees before or after the core training. Just like that – you spent 10-15 years of your life training to be a doctor and your training was not just in lectures and memorization – your training included hands on procedures but also other skills – like negotiation with families and the nurses and other doctors and the insurance companies to get your patient what you need. Many of us have taken ongoing courses in various areas and some of us went on to get more degrees. Now, you have a wall of degrees behind you and you are a physician with possibly multiple letters next to your name. What is your “perfect job”? What drives your career choices and how do you transition if you did not get the job you applied for?
What is your “perfect job” or “perfect role”?
Some of us train for years envisioning exactly what we want to do – become chairs of departments, own a clinic or teach medical students. Some of us go with whatever becomes available or what others may tell us a “perfect job” is for us. Understanding what your “perfect job” or role is key in understanding your career path, what is a reasonable training and life investment and what truly may make you fulfilled occupationally. Ideally when we look at a career or an employment opportunity we reflect on our DRIVES, NEEDS, ABILITIES, LIMITATIONS.
Most physicians struggle with understanding themselves and what truly is motivating their occupational choices given our medical training system in its current state. Let’s start with understanding what DROVE your decision to apply for the job in the first place as we physicians don’t often stop and develop insight and clarity into WHAT really drives us. Given our medical training model, we have been trained to follow and value ourselves on what other people think is good for us or what our worth is. Other people’s opinions have been allowed to condition our self worth, usefulness and professional identity at times. Starting as a medical student when our worth and evaluation is truly dependent the daily variable opinions of the supervisor, senior resident, families or nurses around us with all their implicit and explicit bias that no one wants to admit they hold. Our supervisors and senior residents have been allowed to tell us what a is a good learning experience is (even if it is doing paracentesis at 4am) or being abused by a patient or patient family to “prepare us for the future”. Our supervisors often tell us what good “research opportunities are” for us to advance in a field rather than what our own research choices may be and we are conditioned to accept these guidances without regard for what we may want or not want. Some of us spend our whole residencies or careers following in the footsteps of our mentors and supervisors rather than truly pursuing our own interests and may feel unfulfilled despite the overt roles that we occupy or how successful we look to others.
Medical training and medical system indoctrinates physicians that our needs are not important, not even biological when we are hungry, sleep deprived or sick and we are ridiculed as weak, our sickness/medical condition is not valid enough to take time off and we are not going to “make it in the real world” of medicine if we are tired after working call shifts and long days. How are we supposed to remember that we all have various needs, like other humans, especially when it comes to work? Considering how a job may impact you physically, emotionally, financially, and intellectually is key in understanding how a job may meet your needs or further drain you.
Discussing our ABILITIES may bring up your training, your skills and whatever else you listed on your CV – but what about your actual ABILITIES – the ABILITIES of your body, your energy level, your life and family commitments? Your body may be able to work in a healthy way 4 days a week and not 6 days a week the way the job requires, your family may tolerate you being gone 7 days a week but for a healthy functioning your family’s ability to tolerate a job maybe 4 days a week at this point in your life/family stage/health stage of your family or yourself. Your ABILITIES change depending on your health, life stage, and other commitments. Unfortunately we are used to pushing past our ABILITIES in medicine – sure we can stay up for 24hours seeing patients, but are we ABLE to do good, safe care and still function and hold on to our health? Sure we can do call 1 in 4, but are we ABLE to sustain that without unhealthy impact on our health and family life at this point in our life (we may have been last year or 5 years ago but not now, or we may not be able to do it now due to childcare limitations but can in several years).
LIMITATIONS are another word that we physicians struggle to understand and accept with regards to ourselves without feeling defective. Your limitation is your boundary – it is not a defect – it is a limit that you need to have to protect yourself health-wise, financially, energy wise etc and it also maybe an external limitation. As an example, your limit is that you cannot do late- evening meetings as it interferes with your therapy appointments or family times and you helping your child with homework or teaching them a different language or you are visiting your elderly parents etc. You can also have financial limitations when looking at renumeration and the offered renumeration may misaligned with the financial limitation you have. Other limitations maybe having to move to a different city/state or country as it is going to impact your family.
Our drives, needs, abilities, and limitations are not as clear cut and often overlap and taking the time to understand them is key for physicians to make more insightful career choices rather than choices driven by external needs and expectations.
As an example, financial considerations when considering a job or a role will include understanding your drive, need, ability and limitations.
Financial Drive – as physicians, we have to be driven by financial gain and renumeration – we have to pay costs of living, tuition debt, provide for our families and be renumerated for our skill and training level. Financial drive is a normal healthy drive for adults and it is part of “adulting” or tasks of adulthood to meet our financial obligations to many parties (our families and children, the bank, save up for our retirement etc). How much are you driven to apply for a job or a role based on finances alone? Sure this job may offer good financial package or on the contrary this job/position offers very low renumeration.
Financial Need– your financial need is different than of other physicians of people because only you know what you need to achieve financial stability – you may have tuition debt, supporting your immediate family and possibly extended family, have important charity causes that you support and committed to supporting, monthly obligations to the service providers (i.e gas, phone, etc), mortgage payments, savings for your children if you have any, etc. How does this job meet your financial need?
Financial Abilities – what are your current financial abilities? Are you able to sustain loss of income if you have to build up referral base in the new position or adjust to the lesser monthly income with this position or potentially adjust to higher cost of living if your dream job/role is in a high cost of living area? Are you able to accommodate leaving this job if it does not work out till you find a new one (since you are not guaranteed that this new role will be exactly what you think it is or that you or your family will adjust to whatever geographical move you may have to take)
Financial Limitations – what are your financial limitations with regards to this new job? What is the lowest minimum offer will you accept? What is the most loss will you accept with the transition in terms of cost of living changes, hours unpaid that will go into role, cost of new attire (if moving up in leadership roles etc)? Hours you can do “free teaching” weekly to medical students vs bill for?
Other considerations we need to make is understand how much pursuit of a job or role is driven by internal factors (you, your needs and interests) vs external factors (the needs of others) and how often as physicians we confuse the two. Looking at internal factors is important and so is understanding external factors. What are the external factors you ask? External factors are factors outside of you that affect us, including our job search and idea of a dream job and role.
External factors may include the definition of a dream job from your supervisors that you internalized when you trained, definition of your dream job you may have heard from other physicians including how prestigious or accomplished it is to get a job at XYZ institution and potentially influence from your family about hours of work/type of work (i.e. your spouse wishing that you worked M-F 9-5 instead of shifts hoping that you are more present for dinner and family duties), social expectations of where you should be in your career based on your age or duration of career, externally driven changes to your current job/role that makes it unhealthy, unsustainable or unfulfilling and your family’s needs such as a needed move for a better school district or opportunities for your partner or being closer to extended family.
People around you may tell you that you are the perfect candidate for the job, you should go for that job, you would be great in that job – and it feels good, it feels so good that we may actually re-do our CV and apply for that job – everyone around you tells you how great you would be for that job! Most of us will think that others suggest we apply for a job because of our skillset or training – but what if their suggestions were driven by another external factor – their own needs? Your physician colleagues may suggest you apply for a job because they may want to benefit from your skillset in that job role (i.e. suggesting you apply for the chair, CEO or program director job) because it would be beneficial to them to have someone as skilled in that role, but does that mean the job is GOOD for you or your DREAM job? Others may encourage you to apply for the job given your record of assertiveness, problem solving, dedication, the hours you spent in your current position – again the skills of your that will benefit them if you get the job that may directly influence their employment. Others may want you to apply for a job that is “perfect” because that may reduce a chance of an unknown candidate getting it and bringing about too much change, because they perceive a special relationship with you (friendship or long-standing relationship), they want you to “carry on” their legacy and act as their extension rather than your own individual, you applying for that job and leaving opens up your job for them or gives them more shifts/OR time/clinic time that they themselves secretly wanted or allows to bring in a junior physician whom they will expect to do more work and get paid less, or because you now become their checklist in performative DEI (Diversity, Equity and Inclusion) hiring initiatives.
So..is this job you were considering truly your “DREAM JOB” or potentially a downgrade or a trap?
Stay tuned for part two on what happens when you apply and don’t get the “DREAM JOB”.