3 minute read
As I See It
From internal medicine training to deciding a career trajectory is complex – to say the least. In fact, I will never forget the craziest episode of my life, when nearly 50 years ago I was grappling with the next steps after residency.
Years later, as an internal medicine program director, I often advised our residents who struggled with these same dilemmas. I would tell them about my own conflicts with indecisiveness so many years before, when my initial approach had been to seek guidance from the ten or so physicians on our staff whom I most respected. They were all entirely well-meaning, of course, but each said essentially the same thing: You must do my subspecialty because… Recovery from their well-intentioned advice took a lot of time.
Now long retired, back in my working days I did also ask the fundamentals: What are your goals in life and what kind of work environment are you most comfortable in? How important to you are research, community-based work, hospitalism, and academics? Are you a depth vs. breadth person? Do you want to be a consultant, or does a piece of primary care lurk somewhere in your innards?
However, I was much briefer with advice: First, if you decided as a second-year medical student that you were going to be a cardiologist (hopefully not your mom’s choice), how about using your training to see what the rest of the medical world looks like? And therefore please don’t do all your electives in cardiology. Secondly, the reminder: don’t ask for career advice from your mentors who are established subspecialists. Instead, get a Socratic approach like that from Philip Masters of the American College of Physicians (ACP) [1] who has written a lovely summary of important, germane, and wise questions for dispassionate guidance on subspecialty choices. He avoids the burdens brought about in the formats of "Dear Abby" or even AI. Instead, he poses, is a fellowship right for me? It’s nuts-and-bolts material that provides the thought process and rational steps to pursue this elemental self-inquiry.
Once that semi-tortuous self-reflection is over, you’re on your own. Again, don’t listen to me or any other well-intentioned mentor, because the only initial guidance you can use is what feels right in your head. It’s different once you are now leaning toward a honeddown choice of fields. At this point, trying to decide what’s best for you includes the nitty-gritty of job availability, hours, salary, various settings, etc. This is when it’s finally time to turn to trusted mentors for advice. For residents who are still agonizing over decisionmaking, the reality is that half of the graduates will change jobs or even careers within five years after graduation. After all, there are no perfect medical careers.
So, to reestablish normal sleep it is essential to accept that a career decision is not a finality. If a prior infatuation with, say, the kidney seems to have lost its glory during the first year of fellowship, it’s alright to just turn the page and try something else. In the meantime, wherever the new career path goes, it will include valuable expertise gleaned from that year in nephrology. The bottom line is to listen to oneself and to appreciate that a career choice is not an irrevocable decision.
Joel Popkin, MD, MACPProfessor of Medicine, UMass Chan Medical SchoolProgram Director Emeritus, St. Vincent HospitalEmail: jpopkin6244@gmail.com
