Editor’s Note: Copyright © 2001 by Medical Economics. Reprinted by permission from MEDICAL ECONOMICS magazine, https://www.memag.com. This article has been edited for length.
To find the right job in medicine, you’ve first got to know who you are. What revs your motor? What drives you to distraction? How hard do you want to work? What demands will family life place on you, and how will those demands mesh with a particular practice? What do you need from your work to thrive rather than struggle?
Until you know the answers, you’re not ready to begin your search. Look at it this way: A career in medicine is challenging enough. The more your job turns you on, the easier it will be to put the unavoidable daily hassles in perspective. But if you’re in the wrong practice situation, minor irritants will loom large. As frustration mounts, your performance can suffer, and your self-esteem along with it.
“”It’s commonly known among recruiters and industrial psychologists that success in a new job depends 20 percent on technical skill and 80 percent on the behavioral-cultural fit with the organization,” said psychiatrist Gigi Hirsch, MD, founder of MD IntelliNet, a Brookline, Mass., consulting and placement company.
But fit isn’t something that happens by chance. You have to make it happen, through a series of intelligent choices. The first step is a thorough self-assessment, followed by some market research to find out what the most attractive opportunities are really like for the people who work there.
Know Who You Are
When doing your self-assessment, there are five key areas:
- Values: What motivates you? What would make you feel you were devoting your time and talents to something extremely worthwhile?
- Skills: What’s your strong suit? Which strengths do you have that complement your medical skills? Are you skilled at something you don’t enjoy doing? If so, you’ll want to de-emphasize it so you don’t gravitate toward something you won’t like.
- Behavioral style: How do you approach problems, people, rules and procedures? What kind of pace do you like to keep?
- Cultural preferences: Do you like the intimacy of small medical groups or the anonymity afforded by a larger organization? Are you a traditionalist, or an innovator who prefers a fast-moving, entrepreneurial culture?
- Lifestyle: Are you family- and community-oriented? An outdoor enthusiast who needs the right setting to pursue other passions? A travel bug who needs to take vacations on your own schedule?
There are several ways to approach your self-exploration. You can make this a do-it-yourself project, talk with someone you trust, or pay a career counselor or coach to help you. Anesthesiologist Jan C. Horrow, MD, found that simply talking to a longtime colleague crystallized for him what made him happiest at work. Others who made dramatic changes say they couldn’t have done it without a coach.
To get started on your own, “ask yourself what the ideal nature of your work would be if you had no constraints whatsoever and anything were possible,” said pediatrician Todd D. Pearson, MD, director of the Center for Physician Renewal in Bellevue, Wash.
One way to zero in on your skills is to recall the work or volunteer experiences you’ve found most satisfying, and note the skills they required. If you look at a range of experiences, going back to jobs you held while you were in school, you may find a pattern-something you’ve always gravitated toward and been a natural at.
Consider supplementing your efforts with self-assessment toolls. These can give feedback on how you learn, relate to others, think, lead, work and manage. You can purchase these tools from career counselors, or you can find some of them on the Web, including the Keirsey Temperament Sorter www.keirsey.com, the Myers-Briggs Type Indicator, and The Personal Interests, Attitude and Values scale and the Personal Insights Profile https://www.ttidisc.com. There are also books like Career Renewal by Stephen Rosen and Celia Paul, which was written for scientists, engineers and medical professionals.
Reality Check
Once you know your preferences, gather “market intelligence” before you formally begin your search. This is the best way to test your assumptions about particular kinds of opportunities and communities. What you learn may surprise you, shifting you in an even more fruitful direction. If you don’t take this step, you risk projecting your desires onto a situation that is anything but what you imagined.
Start by talking with people in the know. Consider scheduling brief informational interviews with leaders in your areas of interest or clinicians in the practice settings you intend to pursue. The information you gain during these interviews can help you sharpen your CV and make you a more attractive candidate.
Create Your Ideal Job
What do you do if there’s a gap between your vision and available opportunities? Create something new. Plenty of physicians have.
Perhaps you can create your own opportunity within a practice where others are sympathetic to your vision. Or perhaps you’ll find a company that needs your expertise, as internist Francine R. Gaillour, MD, of Kirkland, W. Va., did. She was able to talk a healthcare technology software company into hiring her as medical director so she could participate in product development and serve as a liaison to the company’s customers, health system physicians. She went on from there to create her own technology-oriented consulting firm, Ki Health, in Bellevue, Wash.
The Right Setting
Okay, doctor, you’ve done your self-exploration. Now it’s time to apply your knowledge to specific practice settings. How do you figure out where you’ll thrive?
To help you think about where you might fit best, we turned to practice management consultants Judy Bee and Jeffrey J. Denning, and former emergency physician Peter Farmer, a performance coach who has studied workplace dynamics. Bee and Denning are principals in the Practice Performance Group in Long Beach, Calif. Farmer is director of the Center for Performance Dynamics in Rancho Santa Fe, Calif. We asked them to create a profile of the type of person who best fits into each of the practice settings below.
- Solo practice. Bee’s shorthand for folks suited to this kind of practice: “Control freaks.” But they’re usually right to be so, she added. “They’ve got great instincts and know that if they follow their instincts, things will work out. These people have little tolerance for negotiation. They’re apt to think, ‘I know I’m right,’ rather than ‘the majority rules.’ “
According to Farmer, the kind of doctor who would be happiest in solo practice has a strong desire to achieve a position of influence and use it to affect others. This physician finds it essential to get a good return on his time and money. Other adjectives that might apply: ambitious, pioneering, strong-willed.
If you’re just out of residency and interested in solo practice, Bee advises working in a group practice first, so that you’ve got steady income to pay off your debts and get a chance to learn about the workings of an office.
- Small-group partnership (typically single-specialty groups). “These physicians have to be willing to givee up personal desires-such as when they’re permitted to come off call or how many vacation days they have-for the good of the group,”said Bee. A good fit here also requires diplomacy, plus flexibility in one’s personal life, she observed.
An advantage of single-specialty groups, said Denning, is that they institutionalize call coverage routine and allow for ongoing professional contact with colleagues in your field. This style of practice can also give physicians the security of a formalized buy-out arrangement in the event of death, disability, and normal retirement.
- Large group (typically multispecialty or staff HMOs). “In some respects, large groups can be very inflexible,” said Bee. According to Farmer, physicians who’d be happiest in large groups aren’t interested in achieving power or influence. Unlike soloists, they enjoy give and take with others. They prefer predictability and a steady, consistent work pace.
Such groups offer three main advantages, said Denning: a built-in referral network, the marketing boost from community visibility, and the professional stimulation afforded by cross-specialty colleagues. A fourth advantage, said Bee, is that it’s possible to work part time.
- Academic practice. “Although the environment is usually very structured, most physicians I know who practice in this setting are able to keep relatively short hours,” said Bee. “They’re almost never on call.” But they do have to put up with a lot of bureaucracy and political infighting, she said.
The kind of physician who thrives in academia, said Farmer, is someone who places the highest value on knowledge, whether discovering something new, systematizing information or analyzing it.
- Hospital-based practice. “This can be hard work,” said Bee. “The advantage is that it provides steady income and a good introduction to the community. If you’re a foreign doctor and you want to see how welcome you’d be in an area, this might be the way to go. If things don’t work out, it’s much easier to leave a job like this than to sell a practice.” Physicians who are happiest here are comfortable following rules and procedures set by others, said Farmer.
- Hospitalist practice. “You’ve got to be excellent at communicating with patients, families, and the referring physician,” Bee said. “Otherwise, nobody will send you patients.” Physicians suited to this work, said Farmer, really enjoy people, but don’t need to be leader of the pack. They tend to be careful and exacting.
Deborah Grandinetti is a former career guide editor of Medical Economics magazine.