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In the second part of our interview, Dr Anita Houghton explores the practical ways that personality and work-life balance are important factors in considering career direction.
Q: In your book Know Yourself you explain how our personalities probably influence our career choices, starting with introversion and extroversion. How might this be relevant for doctors and their career options?
A: When you go into a specialty it’s helpful to understand what comes naturally to you and what will be more of a challenge, and to think how you will cope with or manage this. For instance, introverts like to have time in their work schedule to reflect and focus. Extroverts are very action orientated and like to work in open areas, so are likely to fit in well in A&E but find it difficult to sit down and write or study for long periods. This doesn’t mean introverts shouldn’t do A&E, just that they need to be aware of potential difficulties, and build in some time for being alone.
If you’re an extrovert, how would you handle being in pathology – just you and your microscope and writing reports? So you may like to build in a clinical aspect. It’s really about understanding yourself and what you find easy and challenging.
Q: You also talk about sensing and intuition. What is the difference between these, and what difference might this make for career choices inside and outside medicine?
A: This is probably the most interesting distinction and the most important to understand. In medicine, those who prefer sensing prefer hands on, immediate problems with early solutions, as for example in A&E. In general practice they are likely to prefer the acute side. They are less likely to like complex, psychosocial problems and are less likely to be drawn to public health and strategic work, with medium- to long-term consequences.
Intuitives on the other hand like complexity, strategic approaches, medium- to long-term problems and solutions, and are more likely to be drawn to general medicine and psychiatry.
Q: The one personality difference you describe as having a slight gender bias is thinking and feeling. Medicine used to be a predominantly male profession but a majority of medical students are now female, suggesting some movement away from thinking towards feeling. What career implications do you see this having in the years ahead?
A: This has potentially huge implications. Medical education has a strong science basis, with interpersonal skills still a minority part of the curriculum. Medicine is very much a thinking culture. So if you have a strong feeling preference you need strong thinking skills to fit in. This is particularly obvious in surgery where 80-90% of surgeons have a thinking preference. Feeling types tend to be deterred from going into surgery because of the culture. They may have a pretty tough time. If you’re a feeling type what you bring to a job includes being good with people. If you go into a culture where this isn’t valued, despite its importance, this can be demoralising. So, if you have a feeling preference and are going into surgery, it helps to understand that, although your skills are rare they are therefore especially valuable. This can help you stay and stick it out.
Feeling types are likely to feel more at home in general practice or palliative care medicine. Feeling is important when dealing with patients. A thinking type will deliver a logical solution for patients but this may not take account of the patient’s needs, circumstances and beliefs.
When I was at the London Deanery I ran a Myers-Briggs session for new consultants. One said she wasn’t sure which she was between feeling and thinking. In the group exercise I asked her to just sit with one of the groups and see what happened. She chose the thinking group. Part way through she realised that a) she was a feeling type and b) the people in the group epitomised the attitudes she found difficult at work.
Q: The fourth area of personality you refer to is judging versus perceiving. What does this mean in practice, and what implications might there be for choice of career both inside and outside medicine?
A: The terms here can be a bit misleading. Judging doesn’t mean judgemental. People who prefer judging like to be in control of their work, to plan, to schedule, to meet deadlines in good time. People who prefer perceiving prefer to live life in a more spontaneous way.
Medicine is more a judging culture so perceivers tend to have to develop good judging skills. People who prefer perceiving are well suited to emergency and acute work. They don’t mind swapping rotas and filling in. They are adaptable although they can have a bit of a rough ride in a judging culture.
Q: Are there any factors affecting career choices for doctors we haven’t discussed so far but which you think are important?
A: One factor is the data comparing the number of people applying for training in each specialty and what appears realistic.
However, it is important to recognise that advice based on this kind of data can have its own impact. If the advice is not to go for specialty X because it is too competitive then, over time, people may be put off from applying and in five or so years’ time this may no longer be such a competitive specialty to get into. The result is that what is oversubscribed one year can be undersubscribed a couple of years later. It’s therefore dangerous to opt for something purely because it is easy to get into. If there is something you really love to do, go for it, whatever the data says. The chances are you’ll get there in the end.
Also consider what kind of lifestyle you want e.g. what kind of lifestyle does your consultant have and is this what you are looking for?
Q: In your book Finding Square Holes you describe the key to healthy career development as balancing focus with variety. You talk about keeping focused on your current career while keeping options open for the future. What might this mean for doctors who are reading this today?
A: If you are making changes then move towards what you enjoy but don’t burn all your boats. For instance, if you are a GP and have a special interest in dermatology, then go on courses, liaise with relevant contacts, read about it, tell colleagues you have a special interest in this. This doesn’t mean giving up being a GP and becoming a dermatologist. Do what you do and move towards the things that really appeal to you. By the end of, say, 5 years, you would be a GP and a good dermatologist. Suddenly you have choices in your life that you didn’t have before and that make you a bit special.
Career development is an evolving process. Some people don’t like change and some like regular radical change. One doctor came to see me. She had done quite a variety of things: Obs & Gynae, medical journalism, psychotherapy. Her dilemma was that she had quite a lot of skills but no clear career ladder. This is inevitable if you take an unorthodox route, and you need to be prepared for it. If you’re someone who likes to follow your own passions you have to recognise that you’re not going to be a very recognisable beast within the NHS system, but on the other hand you will develop a unique set of skills for which somewhere there will be a home.
Q: You also quote Michael Portillo as saying “along the way I discovered that life and career are not the same thing.” Many people are miserable until they find that out. Does this suggest that thinking of changing careers may well be part of something larger in people’s lives?
A: Goodness, yes. One of the reasons people get into such a stew if their career is not going well is that they have put all their eggs in that one basket.
It is important for people to be able to step outside their specific career situation and look at the broader perspective. Although it is important, a career is a bit of a game, like a board game. You may have an idea of what you want to do but every so often things happen. For instance, you may fall ill. However, at the end of the day, these experiences give you different challenges and different options.
Q: What would your top three tips be for a doctor wanting to make a successful career change?
A: First, if you’re thinking of making a career change, be very clear what it is you’re running away from. For instance, in one of the cases I mentioned earlier, the young woman doctor wasn’t trying to get away from surgery but from the way surgeons treated her. Unless you can tease out what you do and don’t like to do you’re not in a good position to make an informed choice. There’s a risk of lurching from crisis to crisis if you don’t do the basic groundwork and understand what is important to you.
Second, cast your net wide when thinking of options, not just two or three options. Don’t be unnecessarily narrow, not just in terms of job/career direction but also ways of working. If you enjoy teaching, for instance, what opportunities are there for teaching via colleges, deaneries, online, and so on? Suddenly you may be able to see all sorts of possibilities and be able to mix and match, combining work in your specialty with teaching.
Third, you can do most things if you want to badly enough. It’s really a question of what you want to do and what you’re prepared to do to get there.
Dr Houghton is the author of Know Yourself: The Individual’s Guide to Career Development in Healthcare.