Since our focus is on “Your Independence Day,” today I cover the topic of managing one’s career over the entirety of that career. As physicians and other medical professionals, we have complex careers that, especially in the field of mental health, can span deep into older age. After all, our work can be mentally and emotionally challenging, but it is not usually very physically challenging. Thus, many psychiatrists and therapists work into their 70s and 80s.

Over my years working in academic settings and supervising residents and fellows, I noticed that often not much attention was paid to helping early-career clinicians, such as residents and fellows, think about their careers as an evolving whole. A whole which could be planned and guided over time and in relation to changing life stages. After all, a person who is single and without children has different concerns and desires than does a person who is married with children. And, because of this lack of thinking about a career as one that unfolds over several life stages, most early career decisions were not undertaken with that type of longer-term perspective. Given this common oversight, if we now do turn our attention to career management as a lifelong project, what insights could be gleaned and shared? How should a clinician think about their career to maximize their satisfaction and avoid that all-so-common career burnout? Here I share some factors that can affect decisions and that should be taken into account.

  • Extrinsic vs. Intrinsic Focus: Extrinsic factors relevant to career choice include salary/compensation and time commitment. When the focus is on these external factors, then a person may choose work that pays the best and that has the lowest time commitment or the greatest scheduling flexibility. Intrinsic factors include the opportunity for self-expression, diversity in one’s treatment population, the intellectual challenges that work with patients provides, and the growth in competence and mastery that can be achieved. Over time, the focus of intrinsic vs. extrinsic factors can change. For example, early in a clinician’s career, perhaps related to the need to pay off student loans, a clinician may choose a more remunerative job. In later stages of the career, once a clinician has achieved financial stability but is also facing boredom at work, intrinsic factors of self-expression and opportunity to work with ‘interesting patients’ can become more highly valued. When a clinician becomes a new parent or has to care for aging parents, then scheduling flexibility and higher income for (less) time spent at work can take on greater importance.
  • Camaraderie vs. Independent Work: For some people at certain points in their career, working surrounded by other clinicians and in collaboration with them is valued. This may be most prevalent early in the career, when clinicians are completing their training and have known no other setting than a group setting, and when clinicians are in the end stages of their career and wish to exchange solo work and return to a less stressful and more collaborative setting. The benefits of a group setting, such as ease of formally or informally consulting colleagues, dividing incoming patients into areas of specialization, and having lunch or chats together, can be outweighed by perhaps a larger and less flexible organizational structure, higher paperwork load, less discretion in which patients to treat, and lower compensation. Both independent work as a solo practitioner and work in a group setting have attractions and repulsions, and both can be paths taken by an individual clinician at different career points.
  • Wider vs. Narrower Scope of Work: Some mental health clinicians feel most enlivened when working with patients. Getting sucked into meetings, administrative tasks, or teaching trainees is highly unattractive to these individuals. For other clinicians, having a wider scope of work is welcome. For example, what is a deathly boring administrative meeting for one person can be seen as an opportunity to affect the entire structure or direction of a clinic or larger organization. For others still, an opportunity to teach trainees may be the only reason they remain in an academic setting, or where involvement in research is seen as a great opportunity.

In addition, to these choice ‘content’ factors, there are structural factors that affect decision-making. Let’s look at them now.

  • Decisions Based on Prior Exposure to Work Settings and Structures: Oftentimes graduating trainees will choose a job with a work setting that is of the type they have been exposed to in their training. For example, a resident who has worked in a private practice setting as part of their training may have the comfort and connections to start their own private practice immediately upon graduating, while other residents without that kind of exposure will likely find the thought of setting up a solo practice as too risky and not in the realm of possibility.
  • Decisions Based on Contingent Factors: It is not uncommon that a person will choose a career or work setting based on factors that were present in the circumstances in which they made the decision, even when those factors are not likely to be present in their chosen (upcoming) work setting or career choice. For example, a resident may choose to apply for a geriatric psychiatry fellowship because the geriatric psychiatry attending in their required geriatric rotation was particularly inspiring. This circumstance of having a particularly charismatic coworker or boss is unlikely to recur in the new setting and, without the presence of such an inspiring person, working with older people may no longer be motivating or the preferred choice to the resident. Thus, their decision was based on passing and contingent reasons. Of course, having an inspiring teacher at one point in time MAY be meaningful in the longer term; for example, it may open up the eyes of the resident to the joys of working with older people, a realization that endures for years and years. But generally, it is best not to rely on such contingent factors when weighing decisions.

I’ll end here and wait to hear from you. Please share your thoughts and experiences on this topic. What can we do in our profession to raise awareness of the unfolding nature of a career and how to use that awareness when making career decisions early on?


Dr. Jack

Language Brief

“The future depends on what you do today.”Mahatma Gandhi

“A mind that is stretched by new experiences can never go back to its old dimensions.”Oliver Wendell

“It’s not what you achieve. It’s what you overcome. That’s what defines your career.”Carlton Fisk

“The career of a sage is of two kinds. He is either honored by all the world, like a flower waving its head. Or else he disappears into the silent forest.”Lao Tzu

“Success is personal, so stop comparing your apples to their oranges.”Yohance Salimu