Over the years I’ve received many questions and requests for my thoughts on whether a clinician should pursue additional advanced degrees. For the purposes of this discussion, I will not focus on pursuing additional degrees, certifications, or training related to sub-specialization in your field. This approach not covered includes, for example, deciding to do a fellowship in Child and Adolescent Psychiatry after completing a general psychiatry residency. This category of training is the continuation of an upward trajectory on one’s already chosen path and, as such, is nearly universally applauded as a good idea. It can result in a more interesting and remunerative practice and in a renewal of interest in one’s work when, for instance, the mid-career ‘blahs’ set in.

Instead, I focus today on degrees partially or fully independent of your current degrees and area of specialization. Included degrees are MBA, JD, MPH, and others. For example, one of my fellow psychiatry residents ended up pursuing a degree in medical illustration, one that in no way required completing a psychiatry residency. Through this new degree, my friend was able to pursue her lifelong passion in the visual arts. Also, in the years prior to the acceptance and common use of telemedicine, she found a way to work from home.

There are, of course, Pros and Cons of obtaining an additional advanced degree which must be considered. In addition, though, one faces the choice of which degree to pursue and to what end. In this post I present several factors, including motivational ones, in the decision-making process of whether to pursue another degree and, if so, which one.

Push-Pull Dynamics

When adults seek further study beyond what they have already achieved and need to competently fulfill their work responsibilities, the question is what is their motivation? Why spend the additional time, money, and effort on this pursuit? I have found it useful to consider whether the reasons for further study are primarily push or pull reasons.

Pull reasons are those that pull a person to a new field of study and work. Perhaps you always wanted to be an attorney, but your parents pushed you to obtain a medical degree. Now that you have achieved emotional, as well as financial, independence from your parents, you wish to revisit your career choice. Perhaps, you are pulled to finally go to law school and obtain a JD degree. You realize the costs and are willing to put behind you the sunk costs of time, effort, and money in having become a medical provider, all in pursuit of starting over. Conversely, you may be primarily driven by push reasons, that is, you may feel pushed away from your current career. You may be experiencing burnout, stress, and low job satisfaction. Perhaps you’ve always felt uninspired in your career and are finally motivated to seek escape. Perhaps you are considering becoming an attorney and you spend evenings looking at law school admission requirements, facts about the LSAT, and imagining yourself as a law student or practicing attorney.

Both pull and push reasons are common and often occur together. In fact, a person who undertakes a change in career or, less drastically, a change in focus within their current profession, is likely a person who is both being pulled into a new career and pushed away from the current one.

There is one huge problem with push reasons though: a person burned out from their current career can leap into another career without doing the due diligence to ascertain if the new career being considered is a good fit. The person heavily focused on push reasons may be so desperate that they are willing to move into anything else. The goal isn’t a shiny new career but rather an escape from a dying current one. Unfortunately, the ‘anything else’ can end up a horrible fit for the person who leapt into it without adequately investigating it. For example, those clinicians considering law school need to know the following: lawyers have high rates of burnout, job dissatisfaction, underemployment, substance use, and suicide. In a 2016 survey of nearly 13 thousand licensed, employed attorneys, 21% endorsed engaging in, “hazardous, harmful, potentially alcohol-dependent” drinking, 28% suffered from some level of depression, and 19% had symptoms of anxiety (Krill et al, 2016). In another survey of Yale Law School students, 70% reported experiencing mental health problems (Agatstein et al, 2014).

Thus, the danger for clinicians seeking escape is that some escapes will land them in a situation worse than the one they escaped from. It’s a case of ‘jumping out of the pan straight into the fire.’ Given these risks, I advise everyone to follow these two steps prior to committing to a career change.

First, find out why and from what are you escaping. Is it from your career or from your job? A job is what you do in the setting in which you do it for the employer/organization you do it for. Some places of employment simply suck. I wish it weren’t so, but we all know such places exist. You may think you wish to change careers when, in fact, you just hate your job, probably with good reason. You may be unable to separate job versus career dissatisfaction if you have not investigated other job opportunities in your field. Please do so before you do anything else. It will help you decide if it is your current job or your current profession that is making you sick.  Also, related to push factors, ask yourself if your unhappiness is primarily work-related or life-related. Your work-related burnout, irrespective of whether it is more related to job or career, may be only one source of your unhappiness, perhaps not even the main one. You may not need a change in work, but instead a change in your life circumstances. If considering all this feels complicated and emotionally draining, it often is. So, please remember you don’t need to do this alone. Therapists and life coaches are standing by to help.

Second, please, please, please first investigate what the new career you’re interested in entails in its day-to-day activities. Before you start studying for the LSAT, interview two or three attorneys about their job. In particular, ask what they do all day. Do you think you know? You may be greatly mistaken. The reality is likely far from how attorneys on TV shows spend their work hours.

Hedgehog, Fox, and Squirrel 

One motivation you may have in seeking an additional degree is your need to understand and master. You simply want to follow your urge to learn more about something. You may have no other end in mind, such as career advancement or higher compensation. You may be a life-long learner and are ready for your next adventure. If this is you, you may already know clearly what area of knowledge you wish to pursue. Usually, what you want to pursue arises from what you’ve already been doing and learning. Now you wish to take that specific interest to the next level. This pursuit may or may not have any other practical benefit for you, financially or otherwise, but it does not matter because you are following your bliss and you have the resources of time and money to do so. If this is you, go forth and be happy.

However, perhaps you don’t yet know or only vaguely know what you wish to pursue. You may know you wish to pursue some discipline from among the three or ten candidate degrees vying for your attention and commitment. It might help you decide the best one for you by categorizing yourself as a hedgehog or as a fox (Berlin, 1953/2013). A person who is a hedgehog wants to know as much as possible about one narrow area. Hedgehogs dig deep. Foxes, on the other hand, want to know about a lot of things at the expense of knowing everything about one thing. Foxes go wide. These two human learner types lie on a spectrum. One person wants to know 99% of everything in their narrow specialty, another prefers to know 80% of what is known across several specialty areas, while a third person simply refuses to be pinned down with percentages and says, “I really only want to know what many fields have in common and the ways they differ. I want to be an expert in comparison and not in any particular field.” The first person was a true hedgehog and the last a true fox. Many of us lie somewhere in the middle of that spectrum.

Neither hedgehogs nor foxes are better than the other. The human community of experts needs both types. Foxes, since they know a fair amount about many things can identify ‘best practices’ or ‘useful concepts’ used in one field that are absent in other fields to which they can port them. The hedgehogs know their fields deeply enough to then incorporate these new ideas into their field. (One problem is that hedgehogs can be territorial and reject ideas not developed within their field. They don’t suffer interlocutors gladly. This is a different story though.)

So, if you are a hedgehog clinician, your best choice would be to pursue education that will deepen understanding in your existing area of interest and expertise. You may wish to sub-specialize and pursue courses in pharmacology, genetics, psychoneuroimmunology, or psychotherapy, for example. Here is one example in which a hedgehog approach would be welcome. Let’s say you work in a community mental health center that has few clinicians yet needs to serve thousands of people in the community. You work hard but are disappointed and frustrated at how many members of the community cannot receive mental health care due to resource constraints at your center. Perhaps, you can decide to delve deeply into how group therapy can be more universally deployed or how you can incorporate self-help groups into your clinic’s services. There are relevant certifications and degrees you may wish to pursue.

On the other hand, if you are a fox, you may wish to extend your studies into other fields, either ones adjacent to your area of interest or far removed. Some clinicians, due to burnout or the realization that they made a career mistake, may wish to pursue studies that would take them away – far away – from their current profession and acquired expertise. This might entail pursuing one of those dreaded JD or MBA degrees.

Before I end this section, let me mention the concept of a squirrel. Squirrels gather nuts and acorns for the winter. A squirrel may seek foremost to optimize their financial standing. Their choice of further study is not driven by their pre-existing interests but rather by career or financial advancement. This is an entirely fair path to pursue. As individuals, we differ not only in our expectations of wealth attainment, but also in what degree of wealth will make us feel safe and secure. Money meets emotional needs too, after all.

Opportunity Costs

Now, let me raise a third and last concept for consideration. Opportunity cost refers to the fact that if you do one thing you cannot do another thing during that same time. Of course, you can juggle and switch between one activity and another, but the total amount of resources you can deploy in time, energy, and money is limited. If you choose to pursue two goals, you likely are giving each of them half your available time and attention. Usually, the more effective approach is to focus on a single goal at a time and complete it before starting the next one.

For clinicians, a common dilemma is whether to devote more time to working at their current job or to pursue study in new areas. The second approach can lead to greater financial or career rewards but at a later date. Here, again, you should identify the core need you are seeking to meet. Is it more money? If so, you can calculate direct cost of further study—an MBA could cost you $100k or more—plus the opportunity cost of not seeing patients during the time you now devote to study. Of course, your studies could be done in the evening, a time of day during which you are not treating patients. Even in this case, you are trading leisure and family time for study time. Fair enough, but just be aware of what personal need you are filling. Being open and accepting of your needs, fears, desires, and ambivalences can help you clarify your motivations and improve the choice you ultimately make, including being thrilled with where you are right now and pursuing nothing at all.

Good luck,
Dr. Jack

Language Brief

“Strive not to be a success, but rather to be of value.” — Albert Einstein

“If you hear a voice within you say, ‘You cannot paint,’ then by all means paint and that voice will be silenced.” — Vincent Van Gogh

“Nothing will work unless you do.” — Maya Angelou

“If you’re going through hell, keep going.”— Winston Churchill

“Always hold fast to the present. Every situation, indeed every moment, is of infinite value, for it is the representative of a whole eternity.” — Johann Wolfgang von Goethe

References and Resources
  1. Agatstein J, et al. Falling Through the Cracks A Report on Mental Health at Yale Law School. A Report by the Yale Law School Mental Health Alliance, 2014.
  2. Berlin, Isaiah. The hedgehog and the fox: An essay on Tolstoy’s view of history. Princeton University Press, 2013.
  3. Krill, Patrick R. JD, LLM; Johnson, Ryan MA; Albert, Linda MSSW The Prevalence of Substance Use and Other Mental Health Concerns Among American Attorneys, Journal of Addiction Medicine: January/February 2016 – Volume 10 – Issue 1 – p 46-52 doi: 10.1097/ADM.0000000000000182