Career Development: A Focused Plan or Serendipity?

Fifth grade is a wonderful school year and fifth graders are interesting, enthusiastic, and busy people, but conflicts can arise amidst their many activities. We discovered that our fifth grader could not finish his homework, play on 3 sports teams, take bass lessons (and practice), join the city chorus, play outside with his friends, walk his dog, spend quality time with his parents, and do his chores—much less eat and sleep. Choices needed to be made. Unfortunately, in our community dropping out of the premier soccer club probably limits future possibilities in the sport; nevertheless, it would entail 6 to 8 hours of game and practice time per week (plus travel), as well as multiple 3-day tournaments. Therefore our son dropped soccer, as we decided the best strategy for our fifth grader to develop and mature was to do his personal best at his schoolwork while also exploring a greater variety of less intensive extracurricular experiences.

Most dermatologists appropriately adopt a different strategy during medical school and dermatology training. An intensive, single-minded focus gets us through hours in the anatomy laboratory, the first difficult clinical rotations, sleepless nights, grand rounds quizzing, and board examinations. Completion of our training does not, however, signal that development and maturation are complete; rather, we must then choose among a new set of options, such as the basic questions of whether to practice in an academic setting or group or solo practice and whether to emphasize a subspecialty. These choices involve some mutually exclusive options and exist in a milieu of adult (ie, nonacademic) dilemmas concerning family life, community and spiritual life, avocations, exercise regimens, housing and material goods, and other routine aspects of life. The professional options that are available may be limited by the lack of community opportunities, geographic need, or job availability in a preferred location or institution.

So how do dermatologists manage to start their careers, then develop and maintain them? A best practice is to be both introspective as well as aware of our external environments. Good questions to ask ourselves periodically (having different answers at different stages is highly recommended!) include: What are my core values and what do I want to accomplish? Pay attention to your gut. When do you lose track of time and what makes you want to scream in frustration? Regularly take an inventory of your strengths and find opportunities to acquire the competencies that can take you to the next level. What skill do I need to finesse and how do I finesse it? Do an external scan and understand limiting factors such as geographic saturation in your desired practice type or the lack of appropriate collaborators in your preferred area of interest. Search out people who are doing what you’d like to do and then identify their paths and what you can use from their experiences to help with your career development.

Once you have identified a few professional goals to pursue, utilize all the resources you can find. You might find helpful seminars at an academic institution or at conferences. Do you want to become the regional expert in sarcoidosis? Check out what has been written and find other experts in the subject and where they are speaking. Many organizations have practice management or leadership development courses and seminars. There also are books for everything—those that I have found most useful include Douglas Stone’s Difficult Conversations: How to Discuss What Matters Most¹ and William L. Fisher and Roger Ury’s classic, Getting to Yes: Negotiating Agreement Without Giving In.² Have to give a talk? There is a PowerPoint 2016 for Dummies.³ The same series also includes a book on the Microsoft^® Excel spreadsheet. Also check out my all-time favorite—Brian Tracy’s Eat That Frog! 21 Ways to Stop Procrastinating and Get More Done in Less Time.⁴

It is important to experiment with different professional experiences and have an open mind when a new activity presents itself. Look for opportunities for new side ventures or interesting projects that will not take up much time so you can continue to do your best at your daily work. When I was a senior resident, a dermatologist from Maine asked me if I would help him find a dermatologist who would work regularly at a rural clinic in the northern part of the state. My answer was, why not me? For 8 years I worked in that clinic once to twice per month, seeing as many patients as I could for 8 to 12 hours a day on Friday, Saturday, and Sunday, and then returning to Boston, Massachusetts, for my normal work week. I even took my 2 youngest children (who were born during that time) with me and found a family there who took excellent care of them while I worked. It ended up being one of the most important experiences, both intellectually and emotionally, of my professional career. I learned how to diagnose difficult and complex dermatology problems by myself in an environment with few resources (the closest dermatologist was 150 miles away), how to use primary care providers to manage patients remotely, how to set up a clinic and manage staff (I hired other part-time staff to help me), and how to lead an effort that I felt passionate about. I sometimes even took on residents, which helped me finesse my teaching and supervision style.

Unlike the achievement of becoming a board-certified dermatologist, a dermatology career does not develop in a straight line, and rarely at a steady pace. It seems to me that a shift from a single-minded focus during residency to the fifth-grade strategy of doing our personal best at the main tasks of everyday work as well as participating in a variety of other experiences successfully develops a career that encompasses excellence, enthusiasm, and the fulfillment of personal needs along with those of our practice or institution. When we do our personal best on the day-to-day matters, people will be beating down the doors to offer other valuable experiences. To paraphrase an old truism, if you want something done well, find a busy person who does other things well. Some of the experiences presented to us may question our basic assumptions and redirect our careers; others will fizzle out, but not before they garner self-confidence or even indirectly lead to something more substantial in our careers. Sometimes all that an experience teaches us is that we do not want to continue down that path.

Career development is a dynamic process. Strive for excellence in everything that you do, keep your eyes open for broadening experiences, and maintain your fifth-grade enthusiasm! I am not sure what I will be doing in 5 years, but I hope it will be fresh, varied, and exciting. Do dermatology careers develop through a focused plan or serendipity? At my mature age, with a well-developed career, my answer is mostly serendipity.

Fifth grade is a wonderful school year and fifth graders are interesting, enthusiastic, and busy people, but conflicts can arise amidst their many activities. We discovered that our fifth grader could not finish his homework, play on 3 sports teams, take bass lessons (and practice), join the city chorus, play outside with his friends, walk his dog, spend quality time with his parents, and do his chores—much less eat and sleep. Choices needed to be made. Unfortunately, in our community dropping out of the premier soccer club probably limits future possibilities in the sport; nevertheless, it would entail 6 to 8 hours of game and practice time per week (plus travel), as well as multiple 3-day tournaments. Therefore our son dropped soccer, as we decided the best strategy for our fifth grader to develop and mature was to do his personal best at his schoolwork while also exploring a greater variety of less intensive extracurricular experiences.

Most dermatologists appropriately adopt a different strategy during medical school and dermatology training. An intensive, single-minded focus gets us through hours in the anatomy laboratory, the first difficult clinical rotations, sleepless nights, grand rounds quizzing, and board examinations. Completion of our training does not, however, signal that development and maturation are complete; rather, we must then choose among a new set of options, such as the basic questions of whether to practice in an academic setting or group or solo practice and whether to emphasize a subspecialty. These choices involve some mutually exclusive options and exist in a milieu of adult (ie, nonacademic) dilemmas concerning family life, community and spiritual life, avocations, exercise regimens, housing and material goods, and other routine aspects of life. The professional options that are available may be limited by the lack of community opportunities, geographic need, or job availability in a preferred location or institution.

So how do dermatologists manage to start their careers, then develop and maintain them? A best practice is to be both introspective as well as aware of our external environments. Good questions to ask ourselves periodically (having different answers at different stages is highly recommended!) include: What are my core values and what do I want to accomplish? Pay attention to your gut. When do you lose track of time and what makes you want to scream in frustration? Regularly take an inventory of your strengths and find opportunities to acquire the competencies that can take you to the next level. What skill do I need to finesse and how do I finesse it? Do an external scan and understand limiting factors such as geographic saturation in your desired practice type or the lack of appropriate collaborators in your preferred area of interest. Search out people who are doing what you’d like to do and then identify their paths and what you can use from their experiences to help with your career development.

Once you have identified a few professional goals to pursue, utilize all the resources you can find. You might find helpful seminars at an academic institution or at conferences. Do you want to become the regional expert in sarcoidosis? Check out what has been written and find other experts in the subject and where they are speaking. Many organizations have practice management or leadership development courses and seminars. There also are books for everything—those that I have found most useful include Douglas Stone’s Difficult Conversations: How to Discuss What Matters Most¹ and William L. Fisher and Roger Ury’s classic, Getting to Yes: Negotiating Agreement Without Giving In.² Have to give a talk? There is a PowerPoint 2016 for Dummies.³ The same series also includes a book on the Microsoft^® Excel spreadsheet. Also check out my all-time favorite—Brian Tracy’s Eat That Frog! 21 Ways to Stop Procrastinating and Get More Done in Less Time.⁴

It is important to experiment with different professional experiences and have an open mind when a new activity presents itself. Look for opportunities for new side ventures or interesting projects that will not take up much time so you can continue to do your best at your daily work. When I was a senior resident, a dermatologist from Maine asked me if I would help him find a dermatologist who would work regularly at a rural clinic in the northern part of the state. My answer was, why not me? For 8 years I worked in that clinic once to twice per month, seeing as many patients as I could for 8 to 12 hours a day on Friday, Saturday, and Sunday, and then returning to Boston, Massachusetts, for my normal work week. I even took my 2 youngest children (who were born during that time) with me and found a family there who took excellent care of them while I worked. It ended up being one of the most important experiences, both intellectually and emotionally, of my professional career. I learned how to diagnose difficult and complex dermatology problems by myself in an environment with few resources (the closest dermatologist was 150 miles away), how to use primary care providers to manage patients remotely, how to set up a clinic and manage staff (I hired other part-time staff to help me), and how to lead an effort that I felt passionate about. I sometimes even took on residents, which helped me finesse my teaching and supervision style.

Unlike the achievement of becoming a board-certified dermatologist, a dermatology career does not develop in a straight line, and rarely at a steady pace. It seems to me that a shift from a single-minded focus during residency to the fifth-grade strategy of doing our personal best at the main tasks of everyday work as well as participating in a variety of other experiences successfully develops a career that encompasses excellence, enthusiasm, and the fulfillment of personal needs along with those of our practice or institution. When we do our personal best on the day-to-day matters, people will be beating down the doors to offer other valuable experiences. To paraphrase an old truism, if you want something done well, find a busy person who does other things well. Some of the experiences presented to us may question our basic assumptions and redirect our careers; others will fizzle out, but not before they garner self-confidence or even indirectly lead to something more substantial in our careers. Sometimes all that an experience teaches us is that we do not want to continue down that path.

Career development is a dynamic process. Strive for excellence in everything that you do, keep your eyes open for broadening experiences, and maintain your fifth-grade enthusiasm! I am not sure what I will be doing in 5 years, but I hope it will be fresh, varied, and exciting. Do dermatology careers develop through a focused plan or serendipity? At my mature age, with a well-developed career, my answer is mostly serendipity.

Fifth grade is a wonderful school year and fifth graders are interesting, enthusiastic, and busy people, but conflicts can arise amidst their many activities. We discovered that our fifth grader could not finish his homework, play on 3 sports teams, take bass lessons (and practice), join the city chorus, play outside with his friends, walk his dog, spend quality time with his parents, and do his chores—much less eat and sleep. Choices needed to be made. Unfortunately, in our community dropping out of the premier soccer club probably limits future possibilities in the sport; nevertheless, it would entail 6 to 8 hours of game and practice time per week (plus travel), as well as multiple 3-day tournaments. Therefore our son dropped soccer, as we decided the best strategy for our fifth grader to develop and mature was to do his personal best at his schoolwork while also exploring a greater variety of less intensive extracurricular experiences.

Most dermatologists appropriately adopt a different strategy during medical school and dermatology training. An intensive, single-minded focus gets us through hours in the anatomy laboratory, the first difficult clinical rotations, sleepless nights, grand rounds quizzing, and board examinations. Completion of our training does not, however, signal that development and maturation are complete; rather, we must then choose among a new set of options, such as the basic questions of whether to practice in an academic setting or group or solo practice and whether to emphasize a subspecialty. These choices involve some mutually exclusive options and exist in a milieu of adult (ie, nonacademic) dilemmas concerning family life, community and spiritual life, avocations, exercise regimens, housing and material goods, and other routine aspects of life. The professional options that are available may be limited by the lack of community opportunities, geographic need, or job availability in a preferred location or institution.

So how do dermatologists manage to start their careers, then develop and maintain them? A best practice is to be both introspective as well as aware of our external environments. Good questions to ask ourselves periodically (having different answers at different stages is highly recommended!) include: What are my core values and what do I want to accomplish? Pay attention to your gut. When do you lose track of time and what makes you want to scream in frustration? Regularly take an inventory of your strengths and find opportunities to acquire the competencies that can take you to the next level. What skill do I need to finesse and how do I finesse it? Do an external scan and understand limiting factors such as geographic saturation in your desired practice type or the lack of appropriate collaborators in your preferred area of interest. Search out people who are doing what you’d like to do and then identify their paths and what you can use from their experiences to help with your career development.

Once you have identified a few professional goals to pursue, utilize all the resources you can find. You might find helpful seminars at an academic institution or at conferences. Do you want to become the regional expert in sarcoidosis? Check out what has been written and find other experts in the subject and where they are speaking. Many organizations have practice management or leadership development courses and seminars. There also are books for everything—those that I have found most useful include Douglas Stone’s Difficult Conversations: How to Discuss What Matters Most¹ and William L. Fisher and Roger Ury’s classic, Getting to Yes: Negotiating Agreement Without Giving In.² Have to give a talk? There is a PowerPoint 2016 for Dummies.³ The same series also includes a book on the Microsoft^® Excel spreadsheet. Also check out my all-time favorite—Brian Tracy’s Eat That Frog! 21 Ways to Stop Procrastinating and Get More Done in Less Time.⁴

It is important to experiment with different professional experiences and have an open mind when a new activity presents itself. Look for opportunities for new side ventures or interesting projects that will not take up much time so you can continue to do your best at your daily work. When I was a senior resident, a dermatologist from Maine asked me if I would help him find a dermatologist who would work regularly at a rural clinic in the northern part of the state. My answer was, why not me? For 8 years I worked in that clinic once to twice per month, seeing as many patients as I could for 8 to 12 hours a day on Friday, Saturday, and Sunday, and then returning to Boston, Massachusetts, for my normal work week. I even took my 2 youngest children (who were born during that time) with me and found a family there who took excellent care of them while I worked. It ended up being one of the most important experiences, both intellectually and emotionally, of my professional career. I learned how to diagnose difficult and complex dermatology problems by myself in an environment with few resources (the closest dermatologist was 150 miles away), how to use primary care providers to manage patients remotely, how to set up a clinic and manage staff (I hired other part-time staff to help me), and how to lead an effort that I felt passionate about. I sometimes even took on residents, which helped me finesse my teaching and supervision style.

Unlike the achievement of becoming a board-certified dermatologist, a dermatology career does not develop in a straight line, and rarely at a steady pace. It seems to me that a shift from a single-minded focus during residency to the fifth-grade strategy of doing our personal best at the main tasks of everyday work as well as participating in a variety of other experiences successfully develops a career that encompasses excellence, enthusiasm, and the fulfillment of personal needs along with those of our practice or institution. When we do our personal best on the day-to-day matters, people will be beating down the doors to offer other valuable experiences. To paraphrase an old truism, if you want something done well, find a busy person who does other things well. Some of the experiences presented to us may question our basic assumptions and redirect our careers; others will fizzle out, but not before they garner self-confidence or even indirectly lead to something more substantial in our careers. Sometimes all that an experience teaches us is that we do not want to continue down that path.

Career development is a dynamic process. Strive for excellence in everything that you do, keep your eyes open for broadening experiences, and maintain your fifth-grade enthusiasm! I am not sure what I will be doing in 5 years, but I hope it will be fresh, varied, and exciting. Do dermatology careers develop through a focused plan or serendipity? At my mature age, with a well-developed career, my answer is mostly serendipity.