This is an exercise to help you get a clear direction if you're confused about your career path. Designing a new job or career is much like designing a custom home. If you hired an architect to design your dream house, he or she might ask you to remember previous homes and comment on things you liked or disliked about them. If you enjoyed having a sun porch, a walkout basement, and an oversize pantry, you could incorporte those features into your new place. If you disliked a musty basement and too-small closets, you could avoid those in the new plan. The purpose of this exercise is to design your next practice or non-clinical career incorporating your likes and avoiding your dislikes.

Sit back and remember all the things you've done before. Not all of the important things are necessarily in formal employment, either. Go back before medical school if you like—even back before college, if you did something then that really excited you. Write down your likes and dislikes about each of them. I like writing, publishing, and one-on-one consulting. I want to include them in any future job.

I'm less fond of interpreting financials and spreadsheets. I'll minimize my exposure to them in the future by having financial experts around. Those are clearly business examples, but remember that business mechanics are parts of any career: if you find you like them, you'll want to remember that; if you abhor them, remember that, too.

If you were very happy during your rheumatology fellowship, think about what made you happy. If you detested your first OBG practice, what did you hate? Physicians are trained to be practical and pragmatic. Doctors can't deal in what-if, because that doesn't solve the problem in front of them, and it doesn't matter here and now. Speculative thinking is an interesting exercise, but unless they're doing basic research, it doesn't apply to what they do. So, many doctors have trouble with open-ended, "let your kid out to play" projects such as this. If this exercise bothers you or just feels a little silly, try to put aside your objections, anyway. This is important.

How to Begin

Divide your work experience into short 3-5 year segments. Use any categories that make sense to you—kind of practice (group, solo etc.), academic vs. private, employed by group or hospital vs. self, non-clinical vs. clinical—whatever works to describe your situations. And don't ignore your residency, fellowship, or other training. The reason we divide your work into segments is that it's easier to remember short, specific time frames than the entire past at once. Include volunteer work experience, and even hobby or sporting interests, if you're considering them as career directions.

Don't be quick to rule out anything. Even though it's hard, don't be judgmental—if you're honestly a really good golfer, if the golf course, the putting green and the driving range are places where you like to be and where you do things that make you feel good, if you fall asleep thinking about new things to do in golf—there may be something there for you. But it won't be if you don't put it down because it's "frivolous." The rule is, "There are no rules." And there are no dumb answers.

Take a separate sheet of paper for each of these time frames, and divide the page into two columns. On the left side of the page, write down all the things you liked about the job or activity or practice. On the right side, itemize the things you disliked—and be as specific and detailed as possible. It's not too helpful to say, for example, "I disliked the people." That's much too general. It's more useful to say, "I disliked people who were pushy and rude."

Things to Think About

Use the categories below to guide your thoughts. Since every job—including medical practices—involves most of these items, try to include notes and comments about each:

• Boss/Top Management (if you were the boss, how did you feel about it; if you weren't, somebody else was; how did you feel about her or him?)
• The Company (or practice or hospital or clinic)
• Nature of the work, or the products if you have done work in a company (e.g., developing joint prostheses for Howmedica®)
• Organizational Structure (who was in charge, who was responsible for what, who answered to whom)
• Political Climate
• Culture (how the place "felt" to be in and work in)
• Compensation/Benefits/Rewards (remember that in medicine many of the rewards are intangibles, such as self-worth as a doctor, gratitude from patients, respect of colleagues and subordinates, intellectual or spiritual challenge)
• Duties and Responsibilities
• Geography
• Peers (both partners and other physicians)
• Employees (even if you didn't hire and fire, you dealt with subordinates who answered to you)
• Patients (the quality of their relationship, or lack of it, with patients is an important feature of most doctors' lives)
• Vendors/Consultants/Advisors (suppliers to your practice, accountants, etc.)
• Physical Space
• Facilities
• Tools and Equipment (if you love Cobe® Centrysystem 3 hemodialyzers, but dislike another product, that's a big deal)
• Stress Level (no, not all medicine is overstressful, but if you like or dislike high tension work, that's an aspect of any past experience important to think about)
• Tasks/Projects/Activities
• Travel/Commuting

At first, these may seem to be "businessy" questions that don't apply to you as a physician. But, if you think about them for a minute, you'll realize that they do. Whatever you select to do next—including the same thing you're doing now, but in a different environment—you will have these things to deal with.

This isn't a 15-minute exercise where you drain your brain once and for all. It's a "refrigerator exercise." You tape it to the refrigerator and make notes from time to time as you walk by. This is a "think piece." You mull it over in your mind for several days, or even several weeks. In general, it's better to make long detailed lists rather than short generic ones. The more data you have, the easier you'll see trends and patterns. This is about self-discovery. It's about finding out what you really want to have and to avoid in your work life. And if you're not satisfied with your work life (you're reading this, aren't you?), it's probably because you didn't know all the things that lead to happiness and satisfaction in your work, or you didn't pay enough attention to them last time you had the opportunity.

Liked about boss:

Disliked about boss:

Liked about the work itself:

Disliked about the work itself:

1. Review your lists and look for patterns. You might say, "I see I've always liked working on projects alone with no outside supervision. Therefore, I want to limit my people interaction in the future." Or you could observe the opposite about yourself: "I've never liked working on projects alone; I do best in a team-oriented environment."
2. Make extra copies of your lists and distribute them to a few trusted family members, friends, or practice acquaintances. Discuss your preferences with others to see what insights they have. Those who know us well often see connections we miss. Your spouse or significant other certainly does.
3. Begin to decide what you want in your next practice or work assignment—and what you don't want in the future. Begin to determine what you must have—these are the absolute essentials—then think about what would be fun, but perhaps frivolous. A window view of the ocean? Four weeks of paid vacation? The opportunity to work from home part time? The latest handheld PDA or electronic gadgetry?