The first of our interviews with Dr Anita Houghton looks at the special considerations of being in the medical profession – for doctors thinking about a change of direction (inside or outside medicine).
Q: After eight years in medicine a doctor told me recently he’d come to the conclusion that medicine wasn’t for him. He wondered if he’d wasted all this time or whether there was a career where all his experience in medicine would prove useful. What would your advice be?
A: I’m a firm believer that nothing you ever do is a waste of time. You pick up skills, experience and a better understanding of yourself and what motivates you every time you do a job. Knowing yourself very clearly and what you enjoy is a prerequisite for career planning. There is a belief in our society that you have to pick one thing and then stick with it for the rest of your life. It’s probably more realistic to think of a career as being like a marriage. Some people will stay married to one person throughout their adult life. Some won’t. Provided you have learnt, contributed and grown, whichever route you have taken, it doesn’t matter so much which route you chose.
Q: Do there seem to be particular stages when doctors are more likely to consider changing career?
A: Definitely. People tend to ignore warning signs until they reach a crossroads where they have to make a decision. Choosing a specialty is a time when people think, ‘what on earth shall I do?’ They may get into a specialty, do it for a while and then are unable to progress for some reason. Or they may say, I looked at my consultant and saw the kind of life he had and I thought ‘that’s not what I want.’
Changes in personal circumstances are another major catalyst for career change. It might be a geographical move, for yourself or your partner. It might be marriage, having children, illness. These are all factors that might lead doctors to consider changing career.
Q: Is this a natural process many people go though at some stage in their chosen career or are there particular problems for doctors?
A: There’s something about the main professions, like medicine and law. Parents love their kids to go into them. So do schools. This means there is pressure for academic young people to go into these kind of careers, so some people will choose them because they feel they ought to, rather than because they really want to. Doctors are bright people. They could probably do anything if they really wanted to but they tend to do what society values. Doctors also tend to be pretty driven, driven to succeed. Many will put their blinkers on and go for it, for instance to secure a consultant post, and completely ignore their own personal needs.
I had a client recently. She was an ambitious, academically driven young woman who did well at medical school and wanted to become an all singing, all dancing consultant – not just good in her field but an international expert. She ended up going for jobs miles away, never seeing her husband, whom she’d recently married. Going for gold, she forgot she was a human being with basic needs. I asked her to tell me about a time when she was really enjoying herself at work. She couldn’t think of an example. When you’re that driven, for whatever reason – to please your parents, your own self-esteem or whatever – it’s not uncommon for problems to arise later.
Q: A medical career used to involve a trade-off. You studied for at least five years as a medical student, then worked long hours as a junior doctor for not a lot of money. It took you quite a while to become a consultant and there wasn’t a lot of formal support along the way. However, once you made it to consultant you acquired a level of professional autonomy, of deference towards you and of public respect that made it all worthwhile. Changes in government, society and the NHS mean this kind of payback can’t now be guaranteed. Is this a factor affecting job satisfaction among doctors and, if so, is there anything an individual doctor can do about it?
A: I think it’s definitely true for those in their 40s and 50s. These were the kind of expectations they went into medicine with and that’s why I think a lot of doctors are taking early retirement. The autonomy is disappearing, there’s unprecedented monitoring control, and there’s also a general flow of criticism from every quarter. This has become very demoralising. A lot of those who came into medicine some 20 or 30 years ago have got to the stage where they’re just sick and tired of it.
It’s harder to say when it comes to people who are just coming into medicine. They may have different expectations. I suppose the flip side is that the hours are shorter, there’s far more emphasis on training and less on being a general dogsbody as a junior doctor these days. They’re not just thrown in the deep end, not knowing what they are doing. On the downside, there doesn’t seem to be the same camaraderie as there was when there was a doctors’ mess, or the same level of background services. One young doctor told me about being very busy all day on call, then going to her room late at night, exhausted, and finding the bed sheets unchanged. I think doctors used to be looked after better. I guess it’s a case of swings and roundabouts.
Q: There’s probably a spectrum of changes a doctor can make, from minor adjustments to total change. For example, they could remain a doctor but change their hours, the country they practise in or their specialty. Do you have any idea how many doctors are making these kind of changes and do you have any advice for them, to help ensure the change is for the better?
A: I was looking at an article in the BMJ Careers Focus, studying a cohort of doctors who qualified in 1995. After nine years, 89% of them were still practicing as doctors. I think the vast majority of doctors do stay in medicine. There has been talk of up to 25% attrition but this probably includes people who go abroad for a while, take career breaks, etc. I bumped into an ex-colleague at a conference a year or so ago. He asked me how many people I have counselled out of medicine. When I thought about it, not many.
Medicine is a very broad church. There’s such a range, from full on acute care to more slow paced chronic care. There’s the support services. There’s plenty of things to do if you don’t want to see patients. There’s strategic work in public health. There’s more creative work in research and academic medicine. There are opportunities for working part time. Most people can find a niche somewhere in medicine. The vast majority of people I see stay in medicine.
It’s interesting that people can get very tied up asking, What shall I do? They get very focused on this initial question, and yet often what people value in a job has little to do with specialty. I was talking to an SHO in surgery a while back. She was saying she was very good with her hands and always wanted to do surgery, but in practice she was hating her job. She kept going for different surgical specialties, hoping this would be the one. When we talked it seemed the problem was that she was finding it hard to get on with the people in surgery. She wasn’t getting any feedback or support and was feeling a bit isolated. Most people value support from colleagues, feeling valued, feeling competent at work. These things have little to do with specialty and much to do with specific departments.
There are some broad skills based issues. For instance, some people are good with their hands so for them a surgical specialty may be appropriate, and not everyone is suited, for example, to psychiatry. However, many of the things that people value at work can be found almost anywhere. Whatever you are like, whether good with your hands or good with your head, whether or not you like patient contact, and whether you like solving problems in an immediate, practical way or a more strategic way, the main determinants of happiness and productivity at work are finding the right environment and culture, and the right colleagues.
Q: Other doctors move into posts where they can still use an element of their medical experience, such as moving into medico-legal work, medical journalism, medical research or complementary medicine. What do you think they see as the advantage of making this kind of move and are there any pitfalls they need to avoid?
A: I’ve recently left medicine myself. After working in public health I moved into a non-medical post with the Audit Commission. Being selected in competition with 300 other applicants made me realise how valuable my medical skills and experience had been. It gave me a great sense of freedom to know I could apply for and get jobs on the open market. This is the case for doctors more generally. They have tremendous skills people value and which may be relevant in writing, research, consultancy, quango-related jobs and the Health Service. There are all sorts of things doctors can do which have a medical or Health Service focus, and where a medical qualification is really valued.
Some people like to stay in the same area of work for many years, but if you like change and therefore pick up a range of experience you can end up with a highly unique set of credentials.
As regards possible pitfalls, it is best to keep your options open for a while if you are exploring. Two years is probably a crucial time. For instance, if you move away from being a GP to a non-medical post, I wouldn’t recommend being away from clinical practice for more than 2 years if you think you might want to go back. Generally speaking, I would recommend that people move towards the things that interest and motivate them. That way you change gradually and one day you wake up and find yourself with a whole new set of options.
There are quite a few doctors these days with portfolio careers, for instance, as part-time GPs and part-time coaches.
Q: In some cases doctors have no choice but to change career, for instance due to serious accident, chronic illness or major career crisis. They are probably in a similar situation to army officers moving back into civilian life, having to think about how they can apply their skills and experience to create a completely new career. Do you have any advice for doctors facing this kind of situation?
A: When considering a major change, take some time to take stock. Go back over your life in a quite methodical way and identify what you have learned. When you stop and tease out all the experience you have picked up, you’ll suddenly realise what a wealth of talents and skills you can offer.
Think of education, management, the civil service, the Department of Health, patient advocacy and charities. There’s really an enormous amount you can do that isn’t clinical. Surgeons who become HIV positive, overseas doctors who find it impossible to practise when they come to the UK, these are groups who may find themselves having to make radical changes. It’s hard to recognise that you may not practise as a clinician again, and it’s easy to think that you’re not suited to do anything else. But overseas doctors, for example, often speak several languages. Refugees will often have unique experiences of life that allow them to support others in similar situations. We have a large immigrant population in this country where such knowledge skills and insight are invaluable.
Dr Houghton is the author of Know Yourself: The Individual’s Guide to Career Development in Healthcare.