Today, in my ongoing “Your Independence Day” series, I focus on the need for self-directed career management and why this type of mindset sometimes is missing.

I won’t keep you in suspense. My main message is contained in the title: “Only You Can Make ‘It’ Happen.” What is ‘it’? ‘It’ is your preferred career. Of course, it should be obvious that only YOU can guide YOUR career. And yet …

The way our education and training are structured can leave those of us in the medical field at a career planning disadvantage as compared to other professionals. Out of all career fields, including other professions such as law and accounting, medical training is particularly long, apprenticeship-based, and hierarchical. This structure has consequences, especially once training is completed.

Like all medical students, I spent by last two years of medical school in clinical training, moving through various clinical ‘rotations.’ Upon graduating and entering a psychiatry residency, I spent my first six months rotating through internal and emergency medicine placements. I then proceeded to complete the next three and a half years of my psychiatry training and then another three years as a ‘Senior Staff Fellow’ at the National Institute on Aging. All through these eight years of clinical (and research) training, my position in the hierarchy was clear and decided for me. The third-year medical student is lowest in the hierarchy and, with each subsequent year, rises in the hierarchy.

In this multi-year progression, much is decided for us. We choose some portion of our clinical rotations, of course, and we certainly choose our specialization. But once the rotations, residency, and fellowship are chosen, within them, what we do is, for the most part, decided for us.

This training process lasts many years, and the work is often very hard and requires long hours. While in school, our pay is negative, that is, we pay to be schooled. Upon starting residency and fellowship, our pay is positive but low. This large investment in time, money, and labor is seen as the price to pay to become a financially well-off and respected professional. (And, I believe, this trade-off is worth it.)

But these years of extreme and ceaseless effort – while we often watch our friends playing and partying their 20s away – leads to a false belief that we are involved in a type of agreement with our profession (or even the universe itself). This often unstated and unexamined expectation goes like this:

“I spend years and my blood, sweat, and tears working for you. In return, you take care of me.”

I’m sorry to tell you, this contract is in your mind. No one signed this contract you’ve made with your profession or the universe at large. This is one-way agreement, a contract between yourself and your expectations. There is NO counterparty that negotiated with you and agreed to your terms and conditions.

It’s not surprising that such an expectation exists and it’s not necessarily wrong or bad. Its benefits are that 1) it helps keep up our motivation as we continue working long and hard over all the required years and 2) during our years of training the expectation is more-or-less borne out: the people charged with our training do in fact guide us through all the stages of training. Some training directors and the others involved in our training are better than others. We certainly can receive better or worse training during these years. But at the end, if we keep up our end of the bargain, we do complete training and become that financially well-off and respected professional we strove to be across those many years.

But – and this is a major but – this implicit agreement between you and the phantom representative of your profession breaks down after training. Once you are fully trained and licensed, you are now a commodity. Some group or institution wants you so you can meet their needs. Many graduating residents and fellows, however, continue to believe that their employers, prospective and actual, will continue to guide them through their career analogously to how their training directors guided them through the stages of their training. The source of this expectation is not hard to identify. After all, through all those grinding years of schooling and training such an agreement was in place to a certain extent.

But now, after completing training? Now, that guidance is no longer in place. Now, the fully trained clinician is no longer under anyone’s care. They are on their own.

Don’t misunderstand. I do NOT mean to suggest that the senior clinicians, principals, and administrators at your place of work are bad people. They are not there – usually – to trick you. But they are there to optimally manage their organization. That is their primary responsibility and includes ensuring they have enough clinicians (and other staff) who are working hard enough to meet the organization’s financial and/or productivity benchmarks.

What these senior clinicians, principals, and administrators are not are your friends or mentors. They may be friendly and provide advice, even good advice. But their main relationship to you is that of boss to employee. In their eyes you are a producer and that is your main role in and contribution to the organization. If you are not a good producer or cause too many problems, these bosses’ friendliness and disinterested advice-giving will stop immediately. Why? Because they are your bosses and not your friends or mentors. They are friendly and helpful only when conditions are met, that is, you remain productive and don’t become too big a pain in the ass.

Where does this leave you? It leaves you with needing to Make ‘It’ Happen. In the 1970s there was a best-selling author, Robert Ringer, who wrote the book Looking Out for #1. The #1 was the reader. Mr. Ringer was somewhat notorious for use of such provocative book titles, a living embodiment of the narcissistic “Me Generation.” But his main message is that at work and in personal life, you and only you are responsible for guiding your life. He had a great phrase (a winning meme) that has greatly influenced me, especially when I made the decision to start my education company. His message: “Anoint Yourself.”

I dramatize this message with my expanded version: No matter how hard you wish for it, the Queen of England will never show up at your front door, ready to knight you as Sir or Dame of the Realm. Never! You must knight yourself!

And, as I focused on in my last missive, consider how you wish your career to unfold across the stages of your life. The decisions you make today can affect your career 10 or 20 years from now.

Thanks and let me know what you think and which topic you would want me to cover.

Dr. Jack

Language Brief

“If it scares you, it might be a good thing to try.” — Seth Godin

“Pulling in opportunities allows us to propel ahead.” ― Christie Dao

“Things turn out best for the people who make the best of the way things turn out.” – Art Linkletter

“We change our behavior when the pain of staying the same becomes greater than the pain of changing. Consequences give us the pain that motivates us to change.”  – Henry Cloud

“Paradise is everywhere and every road, if one continues along it far enough, leads to it.” – Henry Miller