missing compasses


This evening I met up with another young attending for a few drinks and a light dinner. Although we both brought our laptops with the intention of doing some multitasking (which is another issue all together), clearly the computers stayed tucked away in our bags. We spent the time instead discussing our mutual loss of a clear sense of direction after residency. Up until now, we had subscribed to the narrow definition of academic success. All we had to do was stay on the path leading from college to residency and fulfillment would be ours in the form of a contract that read “attending physician.” Unfortunately that path had ended rather abruptly for both of us and we were left wondering, “Well, now what?”

Stephen Covey, in his well-known title, “First Things First,” expands on the most important principle from his original bestseller, “The 7 Habits of Highly Effective People.” He reintroduces the concepts of the compass and the clock. Most people, he argues, have their lives ruled by the clock–trying desperately to work harder and produce more and more in any given 24 hour day. However, simply working harder in the wrong direction will not get us anywhere fast. This is at the root of much unhappiness, he believes. I’m getting more done in less time, but where are the rich relationships, the inner peace, the balance, the confidence that I’m doing what matters most and doing it well? Top five regrets of the dying? “I wish I hadn’t worked so hard” clocks in at number two–most likely because much of that time working harder never contributed to an overall sense of fulfillment.

“Our struggle to put first things first can be characterized by the contrast between two powerful tools that direct us: the clock and the compass.  The clock represents our commitments, appointments, schedules, goals, activities — what we do with, and how we manage our time.  The compass represents our vision, values, principles, mission, conscience, direction — what we feel is important and how we lead our lives.  In an effort to close the gap between the clock and the compass in our lives, many of us turn to the field of ‘time management’ [which is not an effective solution]. “

Covey makes many excellent points and both of his books are well worth the read. However, my friend and I both struggled with an even more basic concept than putting the compass ahead of the clock: we couldn’t even find our compasses. Until now, we had never had to use them and consequently, we had lost them along with the socks and spare change. So we spent the evening picking at appetizers and trying to find our sense of direction again.

Medical schools, in fact, do a great job of helping their students discover which specialty to pursue. Most schools dedicate almost half of the four years to clinical rotations designed to give students an idea of what it would be like to have a career in internal medicine or pediatrics or psychiatry. In an ideal world, residency programs would complement this practice by exposing residents to different types of career paths following graduation. While some programs do offer residency “tracks” such as administration or education, most rely on their residents to independently seek out the career information for themselves–much of which may be anecdotal and not apply to their specific situation. Although the decision to apply to a fellowship program seems like a specific career path, as I found out for myself, the same questions apply after graduating from fellowship as from residency. “So now that I have this additional board-certification in X, now what? Do I want to become a program director? Chairman? Dean? Administrator? Clinician? Researcher?”

Perhaps we should be offering more residency tracks. Or increase, broaden, and standardize mentorship from both junior and senior attendings. Or encourage all residents, from interns to seniors, to attend regional and national conferences with workshops focused on professional development. Should we require once yearly written career reflections? Or a dedicated rotation to career exposure in which residents interview administrators, researchers, educators, and clinicians? Although I certainly don’t believe that I have all the answers, I think that it is a worthwhile endeavor to consider and pursue. Would love to hear your thoughts below.

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