Career Takeaway Themes: Part 3 - Career Decision Advice for Family Physicians

I’m continuing to highlight the takeaways from the Careers in FM Blog Series over the past four months, which highlighted 15 fulfilled family physicians with diverse career paths. A couple of weeks ago, I highlighted two major themes that ran through the series – Career Trajectory and Mentorship. Last week, I highlighted the takeaway themes of Finding/Creating Fulfillment and Joy and other significant themes. This week, I'm capturing the wealth of advice from the 15 physicians for choosing your first job and career pivots.

 Advice - First Job Choice

Several elements were recurring advice from the family physicians regarding taking your first job. I will summarize them here:

A wonderful statement that captures much of it came from Dr. Ehab Molokhia: “Pursue a career that you will enjoy on a day-to-day basis. A career is a lot more than merely an 8-5 job commitment. Finding a profession and a work environment that you enjoy being a part of is incredibly important for your wellness.”

Step 1 Self-Refection:

1. Know what your passions are in medicine. It was phrased – what you love, what you’re passionate about, what makes you tick.
2. Know your core values and what brings you meaning in medicine.

Step 2 Due Diligence:

Interview at several places/types. Go slow. Don’t rush the process. "Go on a few interviews for different types of jobs and see how you feel. It’s easier to do this if you don’t compare yourself to colleagues who are already signing contracts. Everybody’s path is different, and taking your time is ok." (You can also use this data for contract negotiation.)

Ensure you can pursue your passions in the places you interview. Ensure at least 20% of your job involves work that aligns with your passions. That 20% is protective against long-term burnout. (Shanafelt) You want to know that the organization and your colleagues will support you in the things that make you tick.

Look for alignment between the organizations' stated and lived values and mission and your own. 

Look for a place you can feel you belong, be part of something bigger, have collegiality and teamwork - a place you can enjoy.

Look for an organization to support you in your professional development – what is the mentor structure and other growth opportunities?

You do this not just in the interview but also in talking with staff and other physicians who work there and have worked there. Consider shadowing for a ½ day to really get the feel. Do they appear happy or super burned out. Is there office drama? How do they handle stressors as a team? 

Understand the care delivery and payment models along with your incentives and compensation structure.

Understand your commitment, non-competes, and bonuses that must be paid back. There is nothing worse than feeling stuck. 

Most recommend having a healthcare contract lawyer in the state you will be working in to review your contract. They can be instrumental in helping you truly understand the implications of what you’re signing. The AAFP has a great toolset in their Land Your Best Job section. 

Step 3 Negotiate.

Know what you need. Know your worth. Ask for what you need to make the job sustainable. "It’s impossible to know your range of options unless you ask. You should never wonder what might have been possible if only you’d asked."

Step 4 Decide.

There is no rush. But once you’ve done what you feel is the right amount of due diligence, you just make the best decision. Understand that the first job (or any job) is never perfect. Decide which is the best for you right now, knowing what you know at the time. Don’t decide from a place of fear.

As Dr Murray Buttner offered, “Also, don't feel like the first job has to be perfect, your forever job, because it almost certainly won't be.” Dr. Deb Clements reminds you, “You’ll never feel entirely ready for anything, so make the best choice possible for yourself at the time.” 

More on deciding HERE.

Step 5 Commit, Learn, and Grow

Sign the contract. (Some recommend not buying a house before you’ve tried the job out for a while).

Have your own back. And by that, I mean stop second-guessing yourself. Remind yourself you made the best decision you could based on the information you had on hand. If you learn some things you didn’t know, you take them as data. It's not as evidence to beat yourself up with. Use that data to ask, advocate, and influence now and/or for knowing you’ll do things differently next go round.

Remember that the first two years often have the steepest growth. 

“Once you have a job, continue to make connections with others through your own institution and organizational networks. Medicine is really a very small community, and these relationships will be important for your entire career,” advises Dr. Clement. Dr. Grace Shih reminds you, “Be open-minded and flexible as you navigate the early stages of your career. Embrace the opportunities for growth and learning that come with any job, and use these experiences to shape your professional trajectory.” There are no wasted experiences – it will inform your future choices.

Dr Erica Sweigler quoted some advice she had been given to have a rewarding career: “It included only three things: ‘that your job was intellectually challenging, that one had a sense one was helping people/had a purpose, and number three, that it was fun.’ Physicians are truly blessed in that every day, when we go to work with nearly every patient, we have the first two things. And then I think it's up to us to make our environment enjoyable and fun to be in.”

Advice - Job Pivots.

1. “Remember – the grass isn’t always greener.” More on this in a future blog.
2. “Also, don’t let social media fool you into thinking a different path is ‘easier.’ In terms of if you are thinking about pivoting, the most important thing is that there really is no ‘safe decision.’ There are always going to pros and cons to every decision, it just depends on what is your personal risk tolerance.”
3. Look for ways to invigorate yourself professionally within your current practice – ideas included professional development, contributing in new ways, teaching, leadership roles, advocacy, taking a sabbatical, and cultivating fun at work. Dr. Murray Buttner talked about working with residents and "stoking their enthusiasm when it was flagging and feeding off their excitement to be becoming physicians when my own energy was waning was a virtuous circle.”
4. Careers evolve toward new interests. There is no need for judgment. Know that you can pivot as many times as you need.
5. Be open to exploring new avenues until you discover your ideal setting.
6. Amruti Borad offered, “The keys are: A. Figure out why you want to pivot. B. What are your options? Have at least 3 in mind. C. What is the best- and worst-case scenario for each? D. Pick each option and consider what your challenges will be and how you will overcome them. E. Consider how this will positively impact your life.”
7. “If you’re pivoting, be as objective as you can and be honest about both the pros and cons of making a change. Without exception, the factors I knew would be challenging in a job always were,” reminds Dr. Clements.
8. John Brewer encourages us, “Try something interesting. We are eminently employable, so if you have a wild idea, go for it.”
9. “Give yourself time and space to think about what you want your future to look like,” recommends Dr. Kelly Derbin. “Spend time reflecting on what is important to you. Ask yourself what you hope to become with the change. Consider getting a coach!”   

There is so much wisdom in the collective. Next week, I’ll wrap up my Career Takeaways covering the topics of Balance & Sustainability and Other Advice & Lessons Learned from the 15 family physicians who offered such great counsel.

Until then - Have a Joy-Filled Week!  Tonya

My Enjoy Life and Thrive in Your Career coaching course for individual physicians walks you through detailed steps of ditching unnecessary suffering, protecting and increasing your energy, and fostering your ideal future. I'm happy to chat with you about it.