As physicians and other health care providers age they often become wiser, but not always. I like to think I am one of those who is self confident enough to take an honest look at my experience objectively as it developed and evolved over the years. Like many colleagues I am often asked for advice by those who are in the medical profession or considering joining it about the current status of their careers and/or what steps one might take to advance a career.
Because I have a consulting business, I receive calls from physicians or nurses asking if they could hire me to consult with them on their careers. My answer is also no about "hiring" me-I would never charge for providing career advice or for putting someone in contact with an institution or medical group that might be a better fit for his or her career. Providing this advice is a way to pay back the kindness of the many people who have offered free advice to me over the years. I believe that helping others navigate a career in such a complex profession is part and parcel of our professional responsibility.
Most professionals who have been active for many years in the field are asked for career advice. Unfortunately, some of us should not give career advice because we have serious handicaps-for example, anyone who falls into any of these categories:
* People who have been in the same institution for their entire career including residency and fellowship. Their advice may be OK, but their personal experience is very narrow and they may reflexively recommend that the advisee remain in the same institution, even though that may not be the best fit.
* People who cannot keep a counseling session in confidence. Too often a professor has a session with the advisee and casually drops bits of information in the cafeteria or elsewhere-"Hey, did you know John Smith is looking for a job at the University of Norwich?" This is a breach of trust, unless the advisee gives permission to spread the word, which is unlikely because it may tee off his immediate superior.
* People who have strong biases in favor of one career direction. A common example: the advisor is an academic and the advisee is talented and it is likely that he/she could make it in academia, so the advisor leans heavily in that direction. But what if the advisee has a family to support and is deep in debt for his/her education? What if the advisee has a handicapped child who needs special schools? The correct approach is to learn as much as possible about his/her needs and family situation, as well as the type of career the advisee prefers before narrowing the choices.
A potential advisor should consider himself or herself as a confidential counselor, like a good lawyer, whose role it is to help the advisee arrive at the best solution for that particular person. The counselor asks questions to understand the advisee's circumstances, desires, and talents, and to raise red flags that the advisee had not considered. Here is where the advisor draws on a long experience and knowledge of institutions and their leaders. There are institutions that are considered "career killers" due to poor leadership, a lack of resources, rapid turnover of staff, or a lack of any extraordinary medical or nursing programs.
An advisor's approach is determined in large part by where the advisee is in career development. For example, the advisor may be asked to advise a professor in the later part of his/her career; a mid-career faculty member who believes it is time to advance where she is or move on to another institution; a junior faculty member seeking an opportunity to become more independent in his professional progress; a trainee who needs help learning the basics of assessing and getting a faculty or partnership position-or, lastly, the advisee may still be in college or medical school, a scenario I was asked about recently:
A good friend of mine who lives nearby has a daughter who is in college on track for a bachelor's degree in nursing. She is bright and has done very well in school, so some of her teachers are urging her to apply for medical school. She doesn't have enough experience to know what that means and whether that track would be satisfying. Her father asked me if I would meet with her; I agreed, but suggested that we invite my daughter, who is a physician (she is a big shot at the CDC and my buttons are popping!), to join us to balance our viewpoints.
The four of us, she and her father and my daughter and I, sat around a table and started to chat. She told us about her current course in college and wanted some advice on nursing versus medical school. My daughter and I both described our views of the experience of medical school and the training that comes afterward. She asked a number of questions. The next step was to ask her what drew her to nursing and what part of nursing she liked best. At first she said public health was attractive because one can influence the health of a large number of people. My daughter then described the type of work nurses do when recruited to the CDC.
Then we asked what I believe is the most important question-whether her ultimate goal is to work directly with patients or was it something else, such as an administrative role. She said she leaned toward working directly with patients. Then my daughter explained that nursing opportunities include nurse practitioners and physician assistants, some of whom specialize in one aspect of medicine and nursing and advanced training was available in all. The downside of medical school is that she would need to take extra classes to qualify for applying and the number of years required after medical school to then become a specialist in medicine.
The discussion lasted over an hour, and neither she nor we arrived at a decision. But that was not the purpose of our meeting, which was to provide her with ideas, information, and vignettes from our own careers, and to offer a place to go (us) to discuss any of the issues that may come up in the future She is clear-headed, smart, and realistic without the fanciful pie-in-the-sky ideas that we sometimes hear from people her age.
She left us feeling that she would make her own decision based on what she learns at school and from people like us, and most of all, based on what she believes is likely to make her happy in her career-which is exactly the way these advisory chats should end.