Planning your career – a guide for doctors

This is Chapter 1, from our book, Successful Medical Practise - Winning Strategies for Doctors.

Many doctors naively believe that once they start earning lots of money and have a long line of patients waiting for them, they will have it made. Once they reach this point, many are quite happy to cruise on their reputation and skills for the rest of their lives. However, to judge the health of your career, it’s not enough to just look at your income statement – you need to assess your personal balance sheet as well. You are a professional and your major assets are your medical knowledge and skills. You need to keep on building these if you want to remain successful. The Japanese call this kaizen, which means constant improvement. If you do not actively work at it, your career prospects will decline, even when (or perhaps especially when) you are making lots of money. In fact, the more “successful” you are in later years, the greater the temptation to exploit existing skills - and the harder you need to work to make sure that you don’t just rest on your laurels. You have to find ways to continue to develop the knowledge that your patients value. Doctors get paid for their time, but that's not what we sell. We sell our medical knowledge and skill, and left untended, these depreciate in value surprisingly quickly ! This is especially true in medicine, where the knowledge base expands exponentially every year, and new discoveries are being made all the time. We all need a personal strategic plan for our careers, and the sooner you formulate this, the easier it will be for you to progress.

Most doctor’s careers have the following five stages:

* Entry, when you are starting out;
* Establishment, when you have created a name for yourself;
* Exploration, when you look for new fields to conquer;
* Specialization , when you settle down in your niche; and
* Mastery, when you establish yourself as the Expert in your area of interest.

Whether you are 25 or 55, you always need to think about where your career is headed. The one constant in life is change – and as medical technology , governmental regulations, insurance reimbursement policies and patient expectations change, you will need to change with them. As you think about your career, here are some questions to ponder:

* In what way are you personally more valuable to your patients than last year ?
* What specific new skills do you plan to acquire or enhance in the next year?
* What is it that you want to be famous for ?


Traditionally, doctors have adapted themselves to their jobs – and most have uncomplainingly and blindly done what the rest of their colleagues are doing. However, many are increasingly finding that this is a difficult burden to bear. This is why, rather than change yourself, it is better to create a job which is especially designed for you. A niche is “ any position specially adapted to its occupant” , and if can find your niche where you can practice effectively , this will help to make your career in medicine enormously rewarding. After all, we all have different interests and talents. Why not use these to stand out and shine - you need to play from your strengths ! Find your special interest as soon as possible. What turns you on ? What do you enjoy most ? What part of your work would you be happy to do daily without pay ? The secret for success is to find something you love doing and very good at – and then to attract patients who will pay you to do this for them ! A niche does not need to be some new thing imposed on you (unless you want it to be) nor does it need to be a whole new aspect of your life (again, unless you want it to be).

If you want to make yourself a truly valuable asset, then you have to focus your attention on building a highly specific set of knowledge and skills – you have to carve out a niche for yourself. With ever increasing sophistication in medicine, patients value specialization, and you have to consider what your patients define as value. For your patients, your asset is valuable only if you have technical skill as well as the ability to apply it in a customized way to their situation. It is important to make a distinction between knowledge and skill. Knowledge is relatively easy to accumulate, but it depreciates. Skills are harder to win, but keep their value a little longer. For most doctors, technical skill alone is rarely enough. To be a valuable doctor in the eyes of patients, you need to learn a wide variety of interpersonal skills as well, which allow you to communicate effectively with your patients.

Each patient encounter can teach you – if you are willing to learn. Many good surgeons will take time at the end of an operation, for example, to ask themselves, “What went well, and why? What didn’t go so well, and why not ? ” . This self-imposed discipline allows them to critically analyse their performance, so they can come up with ideas that will help them get better the next time. Keeping notes will also help you remember and apply the lessons next time. Take every opportunity to discuss your work with colleagues, so you derive value when they ask “Why did you do it this way? What would have happened if you did that?”

Although creating a niche for yourself can be a lot of hard work, there are ways to make the job easier. For instance, if you want to be known as an expert in a specific area of medicine, it helps if you give professional talks on the subject. Start locally and expand your horizons as word of your expertise travels. If you are inclined to write, publishing articles in peer-reviewed journals or the lay press will help to further establish your credibility as an expert. Join professional organizations that can provide valuable information in many forms, including publications, seminars and formal coursework. For example, if you are interested in writing on medical topics, you can check out the American Medical Writers’ Association (AMWA). If you are interested in becoming a hospital administrator, you can contact the American College of Physician Executives (ACPE). Having a niche allows you to differentiate yourself from other doctors, so that you can attract more work . Being different can be very helpful in becoming the leader, so don’t waste time trying to be everything to everyone and ending up becoming nothing to no one !

The secret for planning your career is to pick a clear focused personal professional goal. As physicians, we aren't used to choosing our own professional goals because they were usually chosen for us. Throughout our training, we were told what we were going to do, and when and how we were going to do it. But by not setting our own career goals, we have no direction—which is why, after 10 or 15 years of practice, some physicians end up saying, "Is this really what I wanted to do? Did I train 16 years to do this?" When you set a goal, and every day do some work toward reaching that goal, you begin to take control of your professional life. That's why choosing a professional goal is the most important single thing you can do—it starts to put you back in control of your career. Each year, perhaps on a specific date such as your birthday, you might want to reflect on the path your career is taking. Think about what things you can do in the coming year to further define your niche. As time goes on, you will develop new interests. At some point, you may even want to move in a completely different direction. Taking the time to reassess what you are doing on a regular basis allows you to incorporate these new interests into your life , and to get rid of things that you really don’t want to continue pursuing. Discovering your true mission in life, and then allowing that to frame a career that is specially designed for you, can help to make you a true healer. Both you and the people whose lives you touch will reap the rewards of the careful thought and planning that go into creating your own personal place in the world—your niche.

The most important factor in your career design is to shape your practice around your abilities. In doing your self-assessment, five areas are key:

* 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 a family- and community-oriented person? An outdoor enthusiast who needs the right setting to pursue other passions? A travel bug who needs to take vacations on your own schedule?


Thus, if you are an orthopedic surgeon and find you are technically clumsy in the operation theatre, it’s better to stay out of the OR and not botch up surgical operations. Instead, you could choose to specialize in medical legal work, by providing advise to lawyers in medical compensation cases - a very remunerative field. If you enjoy what you are doing, you will do a much better job at it !

You don’t have to limit yourself to medicine either ! Many doctors have successfully pursued careers in many other fields, such as information technology, writing, law and business management. Some start coaching classes to teach medical students, while others serve as consultants to the pharmaceutical industry. In today’s world, your options are limited only by your imagination. Other doctors have been even more enterprising and have a portfolio of careers – after all, there is no rule which says that you have to slavishly do one job all your life ! Having a career portfolio can add colour to your lives , because it ensures you have multiple interests to pursue, which keeps you on your toes; and also allows you to create a financial buffer, in case one career is not doing well at a given time.

Remember that you are your most important asset . You can think of yourself as a small company – You, Inc, which you need to nurture. It’s no longer enough to just become a doctor and work hard anymore. You must do something you love, have outside interests, participate in your community and continue learning throughout your life. These are investments in your future, which help you lead a life full of purpose and meaning. Unfortunately, too many doctors (especially those with successful careers) have forgotten that there is more to life than just earning money. Finding a second source of income, which comes from something you love to do, will make life much more interesting – after all, medicine can become very monotonous if you don’t explore new options. As you get senior, it’s the quality of your patients which counts, and you are not going to be very excited about doing your 500th appendectomy.

Finding a mentor who can give you the benefit of his experience can also help you achieve your goals. This is why every athlete has a coach – to drive them, to make suggestions, to help encourage them to better their best. Coaches know exactly how to get their "stars" to work a little harder, to stretch their horizons, to try things that they ordinarily wouldn’t have tried left on their own. Many doctors hate the business side of practice, but that is exactly where profits are made or lost! So, what’s a doctor to do? Simple - put a knowledgeable coach on your success team, and maybe you’ll win the Olympics of success in practice ! How do you find such a coach ? If you have a friend or relative who is a successful businessman, ask him for help. Many successful people are very happy to share their secrets of success with others. Another useful source is your patients. Pick your most successful patient, and ask for help. Most patients are more than happy to help their doctors !

In his book, Finding Your Niche, author Laurence Pino suggests trying this exercise. “Visualize your own funeral. There will be four speakers at the service: a family member, a friend, a colleague , and an associate from your community. What would you like these speakers to say about you and your life?” This might seem a morbid thought to some, but it’s worth considering Pino’s point. What exactly is it that you hope to accomplish in your lifetime? You then need to plan your life so that you can achieve these goals. Planning backwards works much better than stepping forward into the unknown. If you plan well, you can lead a life which you can look back upon with pride and joy.