Understanding Modern Career Theory

Physicians raised in the 1950s, ’60s, and ’70s grew up with a set of assumptions about life and work. The most important of these assumptions was that careers were linear — that the harder and longer one worked, the greater the rewards from work. This Linear Rule is no longer valid in today’s rapidly evolving workplace. In its place is the Circular Rule, which stipulates that careers are cyclical over time and the phases of the cycle are predictable.

CAREER TRANSITION THEORY: THE CAREER CYCLE

To be more effective in the workplace and in managing their careers, physicians should understand this career cycle, which is illustrated by the Cycle of Renewal (Figure 1-1).

Figure 1-1. The Career Cycle (Reprinted with permission from the Hudson Institute of Coaching, www.hudsoninstitute.)

The Cycle of Renewal is a conceptual representation of how careers and relationships change with time. Largely the work of Frederic Hudson,(1) the Cycle of Renewal includes four quadrants that represent career phases:

Phase I: Go For It

Phase Two: The Doldrums

Phase Three: Cocooning

Phase Four: Getting Ready

The following is a description of each phase, as seen through the lens of a practicing physician.(2)

PHASE 1: GO FOR IT

This is the first phase we enter when we’ve completed our training and education. It is the phase during which we land our first “real” jobs and are excited about our career and what it holds. It is a time of building our practice. We have all the new knowledge, are energetic, and love what we are doing. Physicians often buy their first home and have their children during this phase.

We are living the American dream and believe that it will go on like this forever — and no one tells us otherwise. However, for 95% of us, the bliss of the Go For It phase does not go on forever. Eventually we reach a plateau. Things begin to change for the worse and we slowly begin to move into Phase 2.

PHASE 2: THE DOLDRUMS

The Doldrums phase usually begins with a subtle shift in attitude. What used to be an exciting job starts to become dreary, dull, and boring. The partners we used to enjoy and find stimulating are beginning to become a pain in the rear. We no longer agree with the decisions and directions of our work partners. We lose interest in reading our medical journals. We find ourselves antsy with patients, lacking empathy, distracted. We get into conflicts with our co-workers and patients more often. We blame the system, hospital managers, and managed care.

We feel like victims, powerless to change the system. We long for things to return to the way they were in Phase I. We secretly feel guilty and depressed for having these feelings and are reluctant to discuss them with colleagues and friends. Or, we deny these thoughts and feelings as long as we can, preferring to suffer in silence.

Eventually we may begin to self-medicate with work, alcohol, prescription drugs, sex, gambling, or other unhealthy behaviors to escape the feeling of being trapped by our lifestyle and our own expectations and those of others.

Some stay stuck in this stage for many years. Others eventually “hit the wall” and experience a crisis of self-confidence and self-doubt that erupts into their work and relationships. We ease into Phase 3.

PHASE 3: COCOONING

Cocooning is a phase of low energy in which we reduce our commitments to career and devote an increasing amount of time to self-exploration. It is a time when we deliberately slow down and work less. It is a time for thinking and being, rather than doing. We spend time alone in quiet reflection.

For some, it may mean taking a sabbatical; for others, it may mean taking an extra day off each week, taking an extra hour each day at lunch and going for a long walk alone, or reading alone for an hour or two each day. Some physicians participate in psychotherapy or career coaching.

This is a time to reevaluate and decide what is truly important in our lives. What is our purpose? What are our values and passions? What is our calling? These are questions we may not have thought about since our college days. We have not taken the time to allow our life experience and personal growth to catch up with our vision of who we were in our 20s. For many of us, our values and purpose have shifted and left us out of synch with the values and expectations of our current workplace. As we explore and re-familiarize ourselves with who we have become, we slowly enter Phase 4.

PHASE 4: GETTING READY

Our self-assessment has uncovered past interests, hobbies, and passions that we had to abandon during the rigorous years of education and training. Perhaps they are things we had always intended to learn about, but ran out of time and energy. In Phase 4, we begin to explore them.

We take night classes at the local community college. We read books. We find that we have aptitudes we never knew we had. We re-engage with old interests, hobbies, and sports. We discover new talents, abilities, and passions. Some of these bring such joy that we want to do them more regularly. Some of these things may even open the door to potentially profitable new careers!

Intrigued, we begin to network with people who are doing those things as a career, learn how they got their breaks, what the outlook is for these careers, and how much money can be made — this is called informational interviewing. We make new commitments to move forward with those new dreams. This may require more education, perhaps a master’s degree, a new residency, a new professional degree, or some form of professional certification training.

This career change fills up Phase 4. Eventually, we are retrained and acquire new skills and abilities. We begin a new career, a substantially different clinical career, non-clinical career, or a new career outside of healthcare. As we put that new training into action, we find ourselves back in Phase 1 again. But this time we’re older, wiser, with new skills, and enjoying a career that is substantially different than the one we began many years earlier.

BACK TO THE BEGINNING

For most professionals, a trip around the periphery of the career cycle map takes a couple of years — although for some, the trip is shorter or longer. What is certain is that working with a career coach or career counselor will shorten the duration of your trip around the cycle to get back to Go For It.

There is the option of cutting across the career cycle, going directly from the Doldrums back to Go For It, in a move known as a mini-transition. Mini-transitions have one important advantage over full-career transitions: mini-transitions typically take six months or less.

Knowledge of the four phases of the career cycle, the direction of movement on the cycle, and the two types of transitions that evolve from cycle theory enable physicians seeking career change to manage their transition more effectively and with greater confidence. Using the career cycle map to your advantage, you will recognize when your career gets stuck in the Doldrums, and what to do to get unstuck by moving on to a mini-transition or a full-career transition. And, you won’t even need Google Maps to get yourself back to Go For It!

Excerpted from The Three Stages of a Physician’s Career: Navigating from Training to Beyond Retirement (American Association for Physician Leadership, 2017).

References

1. Hudson, FM, and McLean, PD. Life Launch: A Passionate Guide to the Rest of Your Life. Santa Barbara, CA: The Hudson Institute Press; 1995.

2. Moskowitz, PS, Blau JM, Harris, SM, and Paprocki, RJ. Medical Practice Divorce: Successfully Managing a Medical Practice Breakup. Chicago: American Medical Association Press; 2001.