Your Career Guide
Surveying the landscape

Knowing who you are and what you want

Much of your success rides not on technical skill but on the behavioral and cultural fit between you and your work. Here's how to get it right.

By Deborah Grandinetti
Career Guide Editor

To find the right job in medicine, you've first got to know who you are. What revs your motor? What drives you to distraction? How hard do you want to work? What demands will family life place on you, and how will those demands mesh with a particular practice? What do you need from your work to thrive rather than struggle?

Until you know the answers, you're not ready to begin your search. Look at it this way: A career in medicine is challenging enough. The more your job turns you on, the easier it will be to put the unavoidable daily hassles in perspective. But if you're in the wrong practice situation, minor irritants will loom large. As frustration mounts, your performance can suffer, and your self-esteem along with it.

"It's commonly known among recruiters and industrial psychologists that success in a new job depends 20 percent on technical skill and 80 percent on the behavioral-cultural fit with the organization," says psychiatrist Gigi Hirsch, founder of MD IntelliNet, a Brookline, MA, consulting and placement company.

But fit isn't something that happens by chance. You have to make it happen, through a series of intelligent choices. The first step is a thorough self-assessment, followed by some market research to find out what the most attractive opportunities are really like for the people who work there.

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?

There are several ways to approach your self-exploration. You can make this a do-it-yourself project, talk with someone you trust, or pay a career counselor or coach to help you. Anesthesiologist Jan C. Horrow found that simply talking to a longtime colleague crystallized for him what made him happiest at work. Others who made dramatic changes say they couldn't have done it without a coach.

Whichever route you choose, the object is to create a personal profile specific enough to help you focus your search, and then assess the resulting opportunities against that profile. Alternatively, you can use the information to create a position that's right for you.

To get started on your own, "ask yourself what the ideal nature of your work would be if you had no constraints whatsoever and anything were possible," says pediatrician Todd D. Pearson, director of the Center for Physician Renewal in Bellevue, WA. Pearson has used that question to good effect with many physicians. Your answer will help get to the essence of what you require to satisfy your need for meaningful work.

One way to zero in on your skills is to recall the work or volunteer experiences you've found most satisfying, and note the skills they required. If you look at a range of experiences, going back to jobs you held while you were in school, you may find a pattern—something you've always gravitated toward and been a natural at.

Look separately at areas such as job content, work relationships, job structure, practice culture, and overall organization, says psychiatrist Kernan T. Manion, principal at Work/Life Design in Concord, MA. If you've been practicing for a while, ask yourself what has and hasn't worked for you in each area for each job.

Consider supplementing your efforts with career self-assessment tools. These can give feedback on how you learn, relate to others, think, lead, work, and manage. You can purchase these tools from career counselors, or you can find some of them on the Web, including the Keirsey Temperament Sorter (www.keirsey.com ), the Myers-Briggs Type Indicator, and The Personal Interests, Attitude and Values scale and the Personal Insights Profile (www.ttidisc.com). There are also books like Career Renewal by Stephen Rosen and Celia Paul (Academic Press, 1998), which was written specifically for scientists, engineers, and medical professionals.

Once you're clear about what you need from work, think about how passions outside of medicine may shape your work needs. A doctor who has to commit to a specific schedule because of her children may not do well in a small group if her partners resent her lack of flexibility, says Judy Bee, a principal in the Practice Performance Group in Long Beach, CA.

One young family practice resident "who could have been a whale of a producer," says Bee, solved this dilemma by choosing lower-paying work in an academic setting. She loved to teach and wanted time with her young son, and felt that the academic environment would be more compatible with child care. An older orthopedic physician, whose grand plan was to tour the country, bought a motor home and pursued locum tenens work. "He had worked in a little bitty town, so he's comfortable doing 'nose-to-toes' orthopedics," says Bee.

Squaring your vision with reality

Once you know your preferences, gather "market intelligence" before you formally begin your search. This is the best way to test your assumptions about particular kinds of opportunities and communities. What you learn may surprise you, shifting you in an even more fruitful direction. If you don't take this step, you risk projecting your desires onto a situation that is anything but what you imagined.

Start by talking with people in the know (see "Job search strategies that really work"). Consider scheduling brief informational interviews with leaders in your areas of interest or clinicians in the practice settings you intend to pursue. The information you gain during these interviews can help you sharpen your CV and make you a more attractive candidate.

Another way to test fit is to do locum tenens work for an organization you're considering. You can make these arrangements yourself without going through an agency. Santa Barbara, CA, family physician Kevin M. Cook, who works full time in a university student health center for eight months of the year, arranges locum tenens assignments for four to six weeks each year. Cook helps employers verify his credentials by providing them with his CV, copies of his licenses, and the phone numbers for the right contacts at the AMA and National Practitioner Data Bank. He also supplies references from practices that have hired him in the past.

Making the arrangements yourself guarantees you higher pay than if you go through an agency, which will give you only part of what it charges the practice for your services. An agency might pay $1,000 to $1,500 per week to an FP who doesn't do obstetrics, but physicians who make their own arrangements command a minimum of $2,750 to $3,000, says Cook.

If you can't find it, create it

What do you do if there's a gap between your vision and available opportunities? Create something new. Plenty of physicians have.

Perhaps you can create your own opportunity within a practice where others are sympathetic to your vision. Or perhaps you'll find a company that needs your expertise, as Kirkland, WA, internist Francine R. Gaillour did. She was able to talk a health care technology software company into hiring her as medical director, so she could participate in product development and serve as a liaison to the company's customers, health system physicians. She went on from there to create her own technology-oriented consulting firm, Ki Health in Bellevue, WA.

If you're looking to cross over from medicine into another line of work, you need to identify your transferable skills, then talk them up. When Philadelphia-area pathologist Kent Bottles lost his position after the Allegheny health system crashed, he traded on his talking, teaching, and writing skills to get hired by a Philadelphia executive search and development firm. Bottles held career symposia for physicians in transition. Now he's an executive with a Cambridge, MA, biotechnology company, Genomics Collaborative, but he continues to write on career topics.

Michael G. Kienzle, associate dean at the University of Iowa College of Medicine, says that new opportunities for physicians will be found where medicine intersects with business, technology, education, or literature. Kienzle, a former cardiac electrophysiologist, now runs the college's telemedicine program. The job is a great fit for an extrovert like Kienzle, who needs variety in his work. (His Myers-Briggs and TTI profiles both zeroed in on these tendencies.) Kienzle's position evolved over the years, as he pursued his interests.

Fit will change over time, of course, since it's natural to grow in new directions. But you're likely to find a central thread running through all of your work experiences. Such was the case for Fayetteville, NY, emergency physician Janice M. Scully, who found common themes in both her childhood experiences in her family's restaurant and the demands of practicing as an emergency physician (see below).

Scully, a former psychiatric nurse, became an emergency physician after completing her internal medicine residency in 1986. (She is boarded in both specialties.) She practiced emergency medicine for eight years, while caring for her two children. Then she opted for a position in occupational medicine, and next a related business of her own, so she could use her skills in a less stressful environment. Now she's reinventing herself as a writer, although she continues to keep a hand in medicine one day a week.

No one could accuse Scully of stagnating. Ultimately, fit is a dynamic thing. So reassess it periodically. The payoffs in personal satisfaction are worth the time.

Matching personal needs and style with practice setting

Okay, Doctor, you've done your self-exploration. Now it's time to apply your knowledge to specific practice settings. How do you figure out where you'll thrive?

This is an inexact science, at best. Certainly, it takes more than matching personal traits or lifestyle needs in Column A to practice attributes in Column B. You'll want to pay attention to all the factors outlined in the accompanying article. Still, the descriptions below can help you determine the kind of practice setting where you'll be happiest. Then, don't just assume that a practice that made your first cut shares your values. You'll have to ask the right questions of individual practices to assess compatibility (see "Acing the interview").

To help you think about where you might fit best, we turned to practice management consultants Judy Bee and Jeffrey J. Denning, and former emergency physician Peter Farmer, a performance coach who has studied workplace dynamics. Bee and Denning are principals in the Practice Performance Group in Long Beach, CA. Farmer is director of the Center for Performance Dynamics in Rancho Santa Fe, CA. We asked them to create a profile of the type of person who best fits into each of the practice settings below.

Solo practice. Bee's shorthand for folks suited to this kind of practice: "Control freaks." But they're usually right to be so, she adds. "They've got great instincts and know that if they follow their instincts, things will work out. These people have little tolerance for negotiation. They're apt to think, 'I know I'm right,' rather than 'the majority rules.' "

According to Farmer, the kind of doctor who would be happiest in solo practice has a strong desire to achieve a position of influence and use it to affect others. This physician finds it essential to get a good return on his time and money. Other adjectives that might apply: ambitious, pioneering, strong-willed.

If you're just out of residency and interested in solo practice, Bee advises working in a group practice first, so that you've got steady income to pay off your debts and get a chance to learn about the workings of an office.

Small-group partnership (typically single-specialty groups). "These physicians have to be willing to give up personal desires—such as when they're permitted to come off call or how many vacation days they have—for the good of the group," says Bee. A good fit here also requires diplomacy, plus flexibility in one's personal life, she observes.

An advantage of single-specialty groups, says Denning, is that they institutionalize call coverage routine and allow for ongoing professional contact with colleagues in your field. This style of practice can also give physicians the security of a formalized buy out arrangement in the event of death, disability, and normal retirement.

Large group (typically multispecialty or staff HMOs). "In some respects, large groups can be very inflexible," says Bee. According to Farmer, physicians who'd be happiest in large groups aren't interested in achieving power or influence. Unlike soloists, they enjoy give and take with others. They prefer predictability and a steady, consistent work pace.

Such groups offer three main advantages, says Denning: a built-in referral network, the marketing boost from community visibility, and the professional stimulation afforded by cross-specialty colleagues. A fourth advantage, says Bee, is that it's possible to work part time.

Academic practice. "Although the environment is usually very structured, most physicians I know who practice in this setting are able to keep relatively short hours," says Bee. "They're almost never on call." But they do have to put up with a lot of bureaucracy and political infighting, she says.

The kind of physician who thrives in academia, says Farmer, is someone who places the highest value on knowledge, whether discovering something new, systematizing information, or analyzing it.

Hospital-based practice. "This can be hard work," says Bee. "The advantage is that it provides steady income and a good introduction to the community. If you're a foreign doctor and you want to see how welcome you'd be in an area, this might be the way to go. If things don't work out, it's much easier to leave a job like this than to sell a practice." Physicians who are happiest here are comfortable following rules and procedures set by others, says Farmer.

Hospitalist practice. You've got to be excellent at communicating with patients, families, and the referring physician," Bee says. "Otherwise, nobody will send you patients." Physicians suited to this work, says Farmer, really enjoy people, but don't need to be leader of the pack. They tend to be careful and exacting.

Independent contracting. "This is good for physicians who are quickly bored with any one thing," says Bee. According to Farmer, the independent contractor needs to work efficiently and be a shrewd negotiator, or he won't earn enough to survive. Physicians who prefer a steady, consistent work pace are ill-suited for this kind of work, he warns.

Locum tenens work. These physicians are confident enough to "come in and assertively take over," says Farmer, yet they don't care about achieving a position of authority. Physicians with dominating personalities would find themselves constantly butting heads in this situation, he adds. Locum tenens work requires someone who has good people skills and is magnetic, warm, and persuasive.

Public health clinic. Physicians who are most satisfied here place a high value on ideals like social justice, equality, and protecting the welfare of all. These points were borne out by a study published in the Archives of Family Medicine in March 2000.

Physicians who are happiest in government jobs, in general, says Farmer, tend to prize security. However, that may not be true of those who work in public health clinics, where the funding is frequently in jeopardy.

At your service

By Janice M. Scully, MD
Emergency Physician/Fayetteville, NY

Of all the specialties open to me, why did I end up choosing emergency medicine?

For many years, I assumed it was mainly the flexible schedule, good salary, and ample vacation time. Those things were important, of course. But there was something else, too. I was somehow comfortable with the routine of emergency medicine—the way patients appeared as if out of nowhere and called upon us to help them with their problems. The routine was unplanned, often chaotic, which unnerved some physicians, but not me. Then I realized: Wasn't my life in the ER reminiscent of my early days in my family's restaurant? The common threads were unmistakable.

Scully's Restaurant lay just beyond Route 42 in New York's Catskill region. A large red neon sign announced our existence to passing motorists, and a red canvas awning led to the front door. Our family lived in an apartment above the restaurant, and as teenagers, my four siblings and I took turns pitching in.

This was a family business that went back to my grandfather. Like him, my father was devoted to his customers. He and my mother worked most of their waking hours. We were open days, evenings, weekends, and most holidays. I remember thinking my mother was beautiful in her white utility apron. No matter how often she washed her hands, though, they always smelled of onions.

Our customers seemed like extended family. And as with most families, sometimes they amused me, and sometimes they were so rude and unpleasant I was glad to see them leave. I remember salesmen, local ministers, electricians, construction workers, somber alcoholics, golfers, and teachers stopping in to have a beer.

And then there was the race crowd, who came in before going to the nearby track to see if anyone wanted to place bets. Some days were hectic, others so deadly quiet the waitresses sat around and talked or filled salt shakers. It was very hard to predict the course of any given day, though we all speculated how the weather or a holiday would affect business.

A part of me longed to be a member of a "normal" family—one that wasn't working all the time, one that had more hours for the kids. But, despite the frustrations, the joy of serving others remained. And so in time, I became a doctor.

One evening in the ER hallway, I was greeting an elderly patient as she reclined on a stretcher. "I remember you!" she said unexpectedly. "You waited on me the last time I was here!" I understood her choice of words perfectly. Suddenly, I was transported back to my family's restaurant.

As physicians, we often recreate in our practices the habits and patterns of our earlier lives. Though we take pride in moving beyond our families, we often end up discovering their spirit within us—and see our pasts reflected in the very work we choose.

 

Deborah Grandinetti. Knowing who you are and what you want. Medical Economics 2001;1:47.