A blueprint for career change when you don’t know what you want to do

A blueprint for career change when you don’t know what you want to do

Anna Navarro

What do you do when you are unhappy with your job but aren’t sure what you want to do next?

This is a mind-boggling question for anyone. But especially for physicians, who have invested so much of their time, money and effort to get where they are and, consequently, have so much at risk in making career changes.

If you find yourself in this situation, there is a three-step process to help you out of this dilemma. The steps are challenging but doable. They provide a road-tested method that has helped many physicians find their way to satisfying work.

Step 1: Figuring out what you want

The best clues to your future career path are hidden in an unvarnished review of your history and an honest assessment of what you want–and want to avoid–in the future. Stepping back to get perspective is the foundation of a good solution.

Ed, a gynecologist who worked in an academic setting, found that the insights that came out of this introspection freed him to move in the right direction for the first time in his life.

When we explored his past he admitted to himself that he went to medical school because he did well in science and was attracted to the elite status of being a medical student. But the truth was that he had been bored with patient care from the very beginning and he didn’t have much interest in his research projects. The part of his work he most enjoyed was lecturing and politicking to win grants.

Though it wasn’t easy to acknowledge, Ed came to terms early in our work with the reality that medicine was not the right career for him. But what else could he do?

A careful analysis of his natural abilities revealed he was good at thinking on his feet, quantitative analysis, negotiating, public speaking and persuasion. Investing was one of his passions and acquiring wealth was a life priority.

Additional insights came from exploring working conditions. He had a preference for fast, competitive environments where he was in control of his own work. He worked best as a solo operator who didn’t have to engage in teamwork or manage more than one or two support staff.

These clues, and others that emerged, eventually led Ed to becoming an investment banker specializing in the health care industry. He manages initial public offerings, puts together mergers and acquisitions and financing deals for companies that are expanding. In steps 2 and 3 we’ll discuss how he figured out what he wanted to do and how he achieved it.

For Janice, an internist who found it very difficult to blend her roles as a physician and single mother of three boys, the clues were very different.

Despite the demands of her situation, she was still fascinated by medicine and the workings of the human body. Like many physicians today, however, she had to work at an ever-increasing pace to make a living in a world where her costs were escalating and reimbursement was declining.

That pace created enormous stress for her at work and at home. She lived in fear of making a serious mistake some day because of the speed with which she had to work and the exhaustion she experienced on a daily basis.

Many of the things she most wanted in a work situation had to do with balancing being a mother and being a professional. Attaining her desires seemed so totally unrealistic to her that I had to constantly urge her to articulate what she wanted, even though she saw no practical way to achieve it.

Her life priorities showed she’d like to be off work by late afternoon when her kids got home from school and that she wanted to be free on weekends, as well. Her job as a mom meant not traveling for work. She also couldn’t relocate. The terms of her divorce required her to stay in the same city as her ex-husband.


Unlike Ed, money was not a central issue for her. She did need to work for a living and save for retirement, but she was committed to living modestly. Her ex-husband covered the kids’ needs, including college expenses.

When we analyzed her natural skills, we discovered that she had a knack for writing and really enjoyed it. Our exploration of Janice’s passions revealed that patient education and translating technical information into terms patients could understand were tasks that turned her on.

Today Janice is a medical writer who specializes in patient education. She writes pamphlets, books and articles for magazines. She also devotes much of her time to writing for the Web. She works at home before her kids get up and while they are in school, takes a break from late afternoon until after dinner, then sometimes works again for a few hours after dinner. Her weekends are free, except for three or four conferences a year. She makes somewhat less than she did as an internist, but the loss is offset by not needing to pay for childcare after school.

For both Ed and Janice, the clues to their ultimate solutions came from an in-depth analysis that covered their work, education, leisure and social history, as well as their natural and acquired skills, preferred working conditions, financial needs, passions, life priorities, dreams, constraints and location desires.

When we completed this analysis, we boiled it down to a wish list of 15 items. This wish list served as a template for what each of them was seeking and guided our efforts in the next steps of the process.

Step 2: Translating what you want into a practical goal

Once you have that template in hand, you are ready to start brainstorming and researching alternative career solutions. This stage of the process requires both patience and persistence, because it is often necessary to explore as many as eight or 10 different career paths before finding a solution that works. Ed is a good case in point.

By the time we finished step 1, we had a pretty good idea that he wanted to be in the world of finance. But we still didn’t know exactly what he wanted to do or how to get there. To figure that out, we began brainstorming possibilities and systematically investigating them.

We started with a list of nine ideas:

* Venture capitalist

* Finance manager

* Technology specialist

* Industry economist

* Finance professor

* Derivative analyst

* Investor relations manager

* Corporate finance consultant

* Stockbroker

Interestingly, the list didn’t include investment banking, the field he eventually pursued.

From these we picked the three that were most intuitively interesting and launched a plan to investigate them in some detail. This involved doing library and Internet research as well as talking to people in the field.

I guided Ed to find names of people to interview through newspaper archives, Internet research, professional associations and his personal network of family and friends. I coached him about how to approach strangers, how to persuade them to talk to him and what to say during his meetings.

This research process was rocky for Ed, as it is for many people. Several of the ideas he was initially attracted to dropped out because they required too much people management. Others didn’t pay well enough or required too much retraining. But as ideas dropped out, new ones emerged. That’s typical.

The template of what he wanted in an ideal work situation drove his research. I had cautioned him not to expect to get 100 percent of it, but to persevere until he found a set of tradeoffs that worked for him. In practice, I have found that most career changes can bring about 80 percent of what the job seeker desires.

Ed investigated being a venture capitalist and discarded it because it seemed too risky for him. But the idea of investment banking emerged during his meetings with venture capitalists. And as he investigated it he concluded that it was a good fit for most of his criteria.

Step 3: Obtaining your goal

Once you identify your goal, the next step is to make it happen. If you have enough transferable skills to persuade employers you can do a job for them, you may be able to go directly to job hunting. Other implementation strategies include education, starting a business or modifying your existing work situation to meet more of your needs or to serve as a stepping stone to where you want to be.

Once Ed got clear about where he was headed, we were able to put together an action plan for getting there. He kept his job at the university while getting an MBA with a focus on finance. The tuition was free.

Then he took an entry-level job in investment banking, starting as a financial analyst and rising quickly to become a dealmaker. His income took a hit for about 18 months after he entered the field, but within a few years his earnings surpassed what he was making as a gynecologist in academia.

The research he did to zero in on being a dealmaker in investment banking had many side benefits besides helping him get clear about a goal. He also learned about what entry-level jobs led to the kind of position he ultimately wanted, what employers look for in candidates for those jobs and how to use his MBA research projects to open doors into the field. By the time he graduated, he already had an entry-level position lined up.

Janice, on the other hand, needed to launch a business as a freelance writer. And she needed to hone her natural writing talents. How was she going to find the time to do that?

Once she did enough research to convince herself that she could make her living as a medical writer, she took the risk of quitting her medical practice. She focused all her time and energy on taking medical writing courses offered by a professional association and landing paid writing assignments. She did a monumental job of networking and publishing articles to develop a portfolio.

While she was getting her business off the ground, she drew on her savings to help meet living expenses. Within two years, her freelance medical writing business was supporting her comfortably.

Sometimes it is possible to make dramatic shifts in career direction without losing income by using an existing job as a stepping stone.

Antonia, a cardiologist, realized as a result of her work in step 1 that she enjoyed leadership and influencing others in a large organization. She also got a kick out of conflict resolution and negotiating. Both of these skills surfaced in different management roles she assumed in her large multi-specialty group.

While she was definitely tired of direct patient care, she was still very much interested in health care delivery. After extensive research, she concluded she wanted to become a chief medical officer for a hospital or health care system.

The feedback she got from her research interviews was that to become a CMO, she needed both an MBA and more administrative experience. So she enrolled in an MBA program at a prestigious business school that offered distance learning.

Simultaneously she volunteered to be part of the disease management committee of the hospital with which she was affiliated, part of a very large urban health care system.

Just before she got her MBA, she became chair of the disease management committee, a post she held for nearly two years. During her stint in that position, she began to join professional organizations and to network with CMOs about entering the field.

After an intensive search, she landed a job as the CMO of a small hospital that was part of a large rural health care system. In two or three years, she’ll be ready to go after a CMO job in a large urban system.

Antonia has been fully employed the entire time. Clarity and conviction about her goal and a practical action plan sustained her through all the many changes she undertook in her path to becoming a CMO.

Here are some further examples of changes physicians have made as a result of working through these steps:

* From cardiologist to physician executive recruiter

* From gerontologist to medical director for a pharmaceutical company

* From pediatric emergency medicine to medical director of informatics for a large national group that contracts with pediatric hospitals

* From internist to medical director of an insurance company

* From high level administration in a medical school to being an entrepreneur

* From cardiac surgery to intensive care specialist

* From internist to medical director of a sleep clinic

* From family practice to urgent care physician

The solutions are as different as the individuals who pursue them. And while the process is not an easy one, years of experience shows it can help you find a career that works well for you.

Anna Navarro is president of Work Transitions, a career counseling firm located in St. Louis, Mo. She can be reached at 314-367-0008 or Worktransitions@aol.com


COPYRIGHT 2004 American College of Physician Executives

COPYRIGHT 2004 Gale Group