Making the most of your career--and your life. (Career Management).

Career fulfillment is tough any time, but it's especially challenging in the current health care environment.

Physician executives face the difficult job of balancing clinical imperatives against shrinking resources and it's hard to find career satisfaction. They regularly ask me for career advice--not about new positions, but about their current jobs.

They dream that things could be better--and they can be.

Work can be terrifically exciting and thrilling. Hasn't everyone experienced occasional moments when everything just goes perfectly? Some individuals are able to string those moments together into a career.

We all know people who seem to get a kick out of their work most of the time. Although they have hard jobs, they're productive, happy folks who don't appear to mind long hours. They show both ingenuity and tenacity while completing their tasks.

Are they just lucky? Perhaps.

Or, more likely, they rely on their own instincts and intuition to achieve their greatest satisfaction. They've looked closely at their talents and skills to match them with the right job.

There's no mystery. Taking charge of your career can have great results, although it does require effort. The core idea is simple: take stock of your situation by assessing what your job asks of you and how you feel about it. Then figure out a way to do more of what you enjoy and do well.

Taking stock

Most people have at least some things they enjoy and do well.

Really happy professionals are doing what they like and they excel at their tasks at least 70 to 80 percent of the time. Can you match that?

Of course, there is a small, unhappy group of people who don't like their work and aren't good at it either. They find life difficult. Here are two ways people get into trouble:

1. Doing things they don't like, but doing them well

2. Doing things they like, but doing them poorly

If you're operating in one of these modes even 20 percent of your time, you know how unrewarding it can be. It leads to long-term, low-level, career restiveness--not bad enough to make you go out and find a new job, but enough to make you wonder if there isn't something better out there somewhere.

Fortunately, some modest refinements can change the situation dramatically.

Taking action

To get started in an organized fashion, take a sheet of paper and divide it into quarters with these headings:

Then make note of tasks that are required by your job, listing each in the appropriate category. If necessary, make this a two-step process; decide first if you like a task and then determine how well you do it. Be honest.

Consider everything you do including, all the tasks associated with managing large groups of people, handling paperwork, developing alliances, cutting costs and planning strategies.

Don't hold anything back. There are no wrong answers. Much of this you already know, but there will be new information for you here.

At the end, you'll see a fascinating picture emerge from this dissection of the various aspects of your job. There won't be many surprises--you already know what you like to do and what you don't, although you may not have looked at it this way.

So, you created a graphic demonstration of the categorized tasks. Now what?

Analyzing the results

To make use of the information in structuring and shaping your job for the future, ask probing questions to reveal motivations that may be subtly hidden.

For example, how is your time allocated? Do you spend most of your time on the tasks you truly enjoy or are you focused on carrying out dreaded assignments?

Examine your past for motivators. Why do you like certain parts of the job and not others? And look at your own development. What are the key skills you need to improve?

You'll think of many more questions to ask as you review the information in this way. For example, ask yourself if you're a goal-oriented person or one who enjoys process.

Personally, I'm goal-oriented, which makes me impatient with endless ambiguity and vagueness. I find tasks without specific goals unsatisfactory and avoid them whenever I can.

If I found myself in a job that demanded working constantly without attainable goals, I wouldn't last long.

Making changes

Once you learn what lights you up and what makes you tear out your hair, then you can begin to revise and restructure your job to make it more like your ideal.

At best, it's reasonable to shoot for 80 percent of all the tasks in your job to be enjoyable.

A good place to begin is by talking with your boss about your intentions. Make the point that adjusting some of your job activities can enhance your value to the organization. Get buy-in from your supervisor and you're well on your way.

Here are a few important items to consider in restructuring your job to maximize the positives:

* Off-load some tasks; take on others. This is less difficult than it might appear since everyone has a different standard for these tasks. For example, some people loathe public speaking, while others relish every opportunity to make presentations. Similarly, some crave the quiet of paperwork; others detest it. Once you have a list of less-desirable tasks, use the Tom Sawyer approach to get rid of some of them (get the other guy to whitewash your fence). But remember, it works both ways. Other professionals within your organization have tasks they'll be pleased to off-load on you, as well.

* Focus your energy on the best use of your time; build systems for the rest. No one has time to waste. Executives who are demoralized and exhausted by doing tasks they dislike are making poor use of their time and talents. Make the most of your abilities by gaining a better focus. Aggressive planning can create structures and systems to fill in the gaps when needed.

* Plan your future career. Use this information to plan future career decisions and moves. For example, if you don't like management and operations issues but you are an effective leader, don't set your sights on being a COO or EVP because you won't like it and you probably won't be successful. But you might chart a career path to advance to CEO, if you can develop strong support from your team in the operations area.

* Keep an open mind. You're probably not going to make huge changes over the arc of your career--people don't change that much. At the same time, recognize that you are capable of growth and your current likes and dislikes can develop into new situations and circumstances. You're most likely to improve at tasks you like. We evolve by moving forward and you'll find it pays to keep an open mind. For example, although you may not like working with task forces or committees on short-term projects right now, a few years in the right environment--one that encourages experimentation--could make that prospect more attractive. Revisit this assessment every five years or so, adjusting your chart as you go.

* Have fun. Take yourself and your work seriously, of course. But remember that you're human and your colleagues are, too. Find fun in victories that can occur every day and celebrate them.

The smart course is to look at where you are now and find ways to improve the situation by maximizing your strengths and interests. Ideally, it's helpful to make this sort of self-assessment at the outset of your career making course corrections at regular intervals-probably every five years.

And please, let there be no confusion about what I'm advocating here. I'm not talking about slacking off or only picking the best assignments. This assessment is an enlightened way to get the maximum out of yourself on behalf of your employer and, of course, yourself. You'll be working hard, but you'll also be having fun.

Mary Frances Lyons, MD, is a senior consultant at Witt/Kieffer in St. Louis Mo. She can be reached by calling 314/862-1370, by fax at 314/727-5662, or by e-mail at [e-mail].