Career Focus

Do it yourself career guidance

BMJ 1996; 313 doi: (Published 10 August 1996) Cite this as: BMJ 1996;313:S2-7053

Dr Sonia Hutton-Taylor, a consultant in career guidance, thinks that the time has come for the medical profession to learn a bit of DIY

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Why is career guidance needed?

Those outside the medical profession often sound astonished if the issue of career guidance in medicine is raised. They simply cannot understand why a doctor would need career guidance - presumably because medicine is a vocational degree. In the past the choice was more straightforward - hospital or general practice. This tradition is now long gone with over 70 specialties to choose from. The career options within and surrounding medical practice are now so diverse, the goal posts changing, and opportunities emerging so fast that it is becoming hard for anyone to remain on top of it all.

The difficulty arises in not only finding sufficient information about the main specialties but also in knowing enough about yourself in order to be able to match your talents and abilities with the options both clinical and non clinical

Why DIY?

It will hardly have escaped your notice that there are insufficient resources in the NHS, and medical education or career planning is no exception. The other problem is that when you ask most other doctors for careers advice there is a tendency to offer biased views and judgemental opinions. You would prefer objective advice or some facts laced with a bit of positive feedback about your current performance, strengths, and weaknesses. So the more you can do for yourself in terms of career researching and planning the less dependent you will be on the hearsay and opinions of others.

The four most underestimated elements to career management are information gathering, networking, planning, and creativity - all of which you can obtain only in small doses from others. Most of the time you are on your own. This is not to say that you should disregard others' opinions. Your role in DIY career planning is a bit like taking a history from a patient - you have to become adept at picking out the salient points.

There is another good reason to develop some DIY career skills - career planning is a lifelong and a continuous activity. But it tends to be indulged in when crises, dead ends, retirement, stress, ill health, or closing dates for applications emerge. Last minute attempts at improving skills are often a recipe for disaster. Strategic planning with continuous review is the key to effective career management. For example, if you have had trouble with your interview performance you should not leave it until your tenth failed consultant interview to tackle this.

There are at least eight key areas to address in making good career decisions (see above).

Things to watch out for

There are some common pitfalls to avoid in making sense of the career market: undue pressure from others; making decisions without adequate information or getting distressed because you cannot seem to make a decision when things are not at all clear; seeking advice and then taking it form biased persons who pay scant attention to the eight key areas mentioned above; choosing a direction merely because you experience a happy attachment or post earlier in your training (and vice versa with an unhappy one); forcing yourself into dichotomies or “do I or don't I take that route” - as neither constitute real choice; using the ostrich technique until you are in a cleft stick or an urgent decision must be made; or allowing low morale of those around you to affect your career choice.

Key areas for career planning

  • Skills - innate and learnt

  • Personality

  • Academic ability

  • Motivations

  • Ambitions

  • Social situation (including health and family)

  • Values

  • Self esteem/confidence

Finding the right career

There are still many happy and fulfilled doctors in medicine and it is interesting to examine what it is they do differently from those who are not so satisfied. It seems that the content doctors have generally taken the trouble to find the right niche for them; identified their best skills at an early stage; developed and capitalised on their skills, motivations, and ambitions; had clear career goals formulated by research properly combined with vision; negotiated and been willing to compromise; and learnt how to set clear boundaries as well as goals

There are many reasons for feeling unfulfilled. None of these are reasons for leaving medicine or the NHS but too often these situations do lead to doctors rejecting a clinical career. The recruitment crisis is due partly to the inaccessibility of basic career guidance. If you do fall into one or more of these categories it is not your fault.

Tools for career planning

(1) Visualisation

There is no such thing as an ideal career but there is such a thing as visualising what the ideal career for you might be. Unless you have a vision of where you would like to be you cannot end up there or even get closer to it. For example, the general practice registrars who apply for partnerships in a particular location but without clear criterion for what they are looking for in a practice could easily end up in a partnership that does not reflect their own philosophy. In the medical recruitment market the boot is increasingly on the foot of the doctor so defining what aspects of your career you enjoy or wish to develop is increasingly likely to become an option.

(2) Psychometric tests

These are of some but limited value. If your self perception is inaccurate from long hours or years of feeling undervalued the validity of these drops off dramatically.

The typical psychometric tests used in industry, which are supposed to tell employers who to promote or recruit, will not have been normalised and validated on a medical population. Although they may make an interesting talking point in the process of career guidance, they are time consuming and can be expensive on manpower.

(3) People in the know

These include clinical and general practice tutors; regional and medical school deans; royal college regional advisers; associations, such as the BMA and the Medical Women's Federation; your own consultant (if you are a junior doctor); and independent career counselling organisations.

It is advisable to shop around until you get a decent conversation that takes into account your needs and concerns. If none of the key areas mentioned above come into the discussion you will know that you are either getting the bare facts or opinion, which may be biased.

There are some groups of doctor who find it harder to obtain effective career guidance than others and for whom the DIY version might be even more relevant.

Locums often fall into a career guidance “no mans land” as they are not entitled to study leave or the postgraduate education allowance and may not be encouraged to join in continuing medical education events. They may not be in a hospital or practice long enough to find out who the clinical tutor or regional adviser is.

Overseas doctors often find career guidance hard to come by. They do not have any pre-existing network of colleagues, past bosses, or medical schools to access.

General practice partners and consultants may find it hard to seek careers advice as it is assumed that they have achieved what they set out to do and they may feel awkward in approaching peers.

Doctors who have been ill or have been away from clinical work for a while may also find it difficult. This group includes married women returning to work, those recovering from illness, or those who have been overseas, on sabbaticals, or in a purely research post.

Reasons for needing career guidance

  • You are perhaps in the wrong post/hospital/location

  • You are merely in the wrong specialty for maximising your potential

  • You are basically in the wrong career

  • Your confidence has not been built up

  • You do not know where your career is going

  • You are shattered by unreasonable workload

  • You have experienced illness that has altered your capabilities

  • Your personality would not allow you to be happy in any post

(4) Publications

The BMA's Medical Careers: A General Guide (£10; free to BMA members)

The BMA's Guidelines for the Provision of Careers Services for Doctors (£4)

The Medical Forum's Career Guide (£10)

First Steps in General Practice by D Gallen, W Coulson, and G Buckle (£10.95)

Health Trends from the Department of Health

The Good Hospital Job Guide (due to be published in 1996)

Making Your Career in Medicine DoH NHS Women's Unit

Be liberated

Career guidance is not something that you should consider only when you meet a crisis. It should be an ongoing process that keeps your career on track. Taking greater responsibility for your own career development can be liberating as it puts you firmly in the driving seat - something that most doctors seem to crave for and which all could and indeed must achieve if the profession is going to retain a collective responsibility for its direction.

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