Planning for change.

CAREER MANAGEMENT

In this article the author discuss issues to think about if you are planning a career change, ways to continue what you are doing but change your environment so you will be more satisfied, and a technique for changing something about yourself if you want to.

"The only people who welcome change are wet babies." "Every change is perceived as loss by someone." "You can't change others; you can only change yourself." These words of wisdom remind us that change is not easy. What we may dislike most about change is the sense of being out of control.

Some changes can be planned for. You can plan to change your career, move to another city, send your children to college, or buy a house. Other changes just come up and grab us, and then we learn to cope. You figure out how to survive the change of losing a loved one or being fired from a job. One of the great challenges of life is not to let the vulnerability we feel when change surprises us keep us from seizing the power we have and planning for the future.

We need to regain a sense of power and control in turbulent times and plan for the future. I'm not talking about people who want to control others, boss them around, arrogantly laud their position over others to make them feel small. I'm talking about controlling our own destinies as much as we can. We need to use our personal power, not overuse or abuse our positional power, and not fret about power we do not have.

You can gain some sense of control over change by planning ahead and visualizing how the change will affect you. The more you can picture what you'd like to do, the more your subconscious can make the forces come into your life that make it possible. "As you begin to negotiate change in your life, keep in mind that you're entitled to disorganization and confusion. They are signs of health. Sometimes, they are the side effects that make you resistant to a change, even though you earnestly want the final outcome. Be patient with yourself and know they will go away in time.... Changing can be a way of taking charge, of getting in the driver's seat, and of predicting your life's path while everything around you is unpredictable."*

Change Your Career

Before you make a career change, do some planning to make the transition smoother. Think about the following issues:

Geography/location

Where do you want to live? Is sunshine important to you or snow for cross country skiing? Do you like the wide open spaces of country living, or do you like to get to the grocery or hardware store in 5 minutes? If the sight of miles and miles of cornfields gives you a feeling that all is right with the world, New York City will not be the place for you.

I like the tall trees, the rolling hills, and the brick houses where I grew up. I think we may be like baby ducks who choose as their mama the first animal they see. Our psyches tend to want to live in or get back to the kind of land we grew up in if we had pleasant experiences there. Consider not fighting this urge--work on getting a job in the location you like best.

A couple from Arizona was interviewing for a job in the Northeast. The job, the schools, the house, the community all seemed right, but after two visits, something wasn't right and they just couldn't put their finger on it. When they got back home, they realized the sun had not shone any time during their visits. They were used to seeing the sun everyday, and they decided not to take the job. Sunshine was that important to them.

Don't start with the notion that you will go anywhere in the country. You probably wouldn't be happy everywhere, and the thought is too broad to work with. Just as a history teacher told you to narrow your topic when you chose Russia as the subject for a term paper, pick a part of the country you like and then work to find a job there. If later, after a visit somewhere else, you decide the new place is all right, that's fine, but it's mind boggling to start with the entire United States or world in mind.

Health issues

People have various health concerns. One person's arthritis improved in Arizona, but the dry weather there also caused another to suffer nosebleeds. One had circulation problems that worsened in extreme cold. Another's allergy reactions were continuous in the tropical warmth of Florida, where something is always blooming. Think about you and your family members. Will you be comfortable enough in the new location?

Life-style

* Pace of life--Do you want to work from 8 a.m. to 6 p.m.,

or do you want to work from 6 a.m. to 9 p.m.? Many

will say they do not have a choice. You always have

choices. If two people drive delivery trucks and one

works the night shift and the other the day shift, their

life-styles are very different. Emergency department

doctors and pediatricians have very different life-styles.

* Recreational opportunities--Do you want to play golf,

sky dive, scuba dive, water ski, or snow ski?

* Cultural events--Do you like opera, theater, ballet, or

foreign films?

* Social events--Do you want to belong to a country club,

or do you prefer simple evenings at home with pizza

and beer?

* Friends--In some areas, neighbors bring ice tea when

you are unloading the moving van. You can live in

other areas for years and never know your neighbor's

name.

Financial needs

I talked to a physician recently who makes $6-10 thousand a year. In addition, he gets room and board where he works. He said, "If I make much more than that, I give it away." He travels between Alaska, the Pacific Northwest, and Brazil throughout the year, giving his services away some of the time, making a modest salary other times. Variety, travel, and service to humanity are his most important values.

I talked to another who makes more than $200,000 and cannot get by on less. I am not asking you to pass judgment on yourself, but I am asking you to think hard about what amount you want and need and then make plans for how to get it. Here are some questions to ask yourself?

* What does it cost to live each month? Make a list of the

items: house payment, car, food, utilities, insurance,

recreation, savings for college, clothing, vacation, care

of a parent.

* What could you change? You probably can't change

your house payment, but you could change clothes buying

or recreation. It is often painful to do this, because

it kicks up a power struggle between couples. Who

decides how the money is spent? Is the decision shared?

Is it equal? Should it be? Even though it is tough, make

yourself talk about it. A financial planner can be a big

help, because he or she can help keep the conversation

objective.

* What amount of money do you have in a retirement

fund? What will it be worth when you retire? I've

talked to a number of physicians in their 60s who are

having difficulty getting the jobs they want.

* What do you make now?

* What will you make if you change jobs? If you are going

to step down in salary, can you try living on less for a

couple a years to experience what it feels like and to

build a financial cushion?

Experience

Organizations want medical directors who have experience. It's the age-old question of how do you get experience when everyone wants someone who already has experience. Volunteer for committees on utilization review, quality assurance, or long-range planning. Sometimes HMOs and insurance companies will hire physicians part time to do utilization review and quality assurance. See if that opportunity is available in your area.

Find someone who is doing what you want to do and talk to them about it. What experience led them to where they are? To get the job you want, you may have to take a less than ideal job to get some marketable experience.

Educational needs

Think about what education and training you will need to do the job you want. You can learn management skills through courses from ACPE, other organizations, or master's degree programs. Which ones suit your time schedules, finances, and study habits? If you decide to get a master's degree, keep in mind that it will definitely help you do a management job, but it will not be an automatic guarantee that you will get a management job. When you finished your MD, you could go somewhere and immediately be a doctor. The same is not true for the master's degree programs. You will still need experience and contacts.

Family concerns

My husband is a pediatrician who became more and more interested in medical management. He actively interviewed for positions for two years. Each time he went off to interview, I felt sick, because I did not want to leave Charlotte, N.C. I loved the town, my friends, the church, the schools. But finally I agreed to move, and then I was miserable and resentful for a year. My husband was excited about the new job and the new set of friends at work. My children were adjusting well in school. I had given up a good job in Charlotte and was trying to find out how to fill the days with shopping. I've never been good at that. After a year, we went to a counselor. If this happens to your family, go sooner. We finally got there, but my suffering might have been shortened had we gone sooner. You need a third party to help you tell each other what you want and how you hurt. The counselor can help make suggestions for what might make you feel better. It's hard to think of these things on your own when you are in the middle of pain and frustration.

Change Your Environment

You may decide you do not want to make a dramatic career change, but you want to make changes in your life so you are more satisfied. Even if you continue to do exactly what you are doing professionally, you have the choice of changing your attitude about it, of adding pleasurable experiences to you life, of reducing your work load so you have time for recreation. If it means less money, what expenses could you cut back on to make that possible?

Pick one or two of the following activities to try. Schedule more free time or take up a new hobby. Take art, dance, or music classes. Help the homeless. Watch the comedy channel. Join a group that believes in a cause. Get a pet who will be affectionate and accept you as you are all the time.

Make time for exercise. You've heard that over and over again. If you are still not doing it, keep trying to make it happen. You simply cannot have a sense of well-being without it. The body was made to move, and if it doesn't, your mind, body, and spirit will suffer. Exercise can make you have or regain a sense of power. Hitting a golf ball far down the fairway can restore your feeling of control. Running or walking fast gives you energy, releases frustration, and makes your body feel strong and slim.

Find a support group--like-minded people who want to do an activity that you want to do or who want to complain about and solve problems on issues that matter to you. Do you have people you can talk to about your life? For some, one-on-one is desirable. Others need a group. Carl Jung, a late 19th and early 20th Century psychologist and philosopher, said for the well-balanced life we need to tend to the inner and the outer lives but neither to the exclusion of the other. We can examine our inner selves when we are working or thinking alone, but we need a group or a community as a context for tending to the outer life. We need to interact with others, come up against their needs and goals, and use the energy of many ideas to get things done. Working with others in some way helps our own lives to be centered, productive, and healthy.

You can tend to the inner life by writing in a journal for 10 minutes a day. A physician recently called to tell me he does it at the end of the day, and he has started sleeping better at night.

Change Yourself

A computer may have 5 sizes of print to choose from, but when you turn it on, it automatically goes to one particular size all the time. This is called the automatic default setting. People seem similar. Some default to worry, others to criticism, and still others to optimism. If you worry excessively, you may want to change that behavior, because it is exhausting and bad for your health. You'll need to change your thinking program. You can do that by repeating silently to yourself, "I enjoy being free of worry, fear, and anxiety." You may need to do it 10 times a day or 200--however many times it takes to break the pattern. Every time a worry thought occurs, you replace it with the positive statement. After several weeks, you'll notice a change.

You will make faster progress if you combine this technique with a relaxation exercise. Every day for three weeks, listen to some kind of relaxation tape, relax your body, and then say the positive statement to yourself. The brain receives the new message better when you are in a relaxed state.

If you automatically criticize people and things in your environment, you may find that people are not as cooperative as you wish they would be. You could try saying, "I enjoy people and trust their judgment." The truth may be that you may have little trust or respect for the people you work with, but if that's the case, you may need to become a good actor to keep your job. Repeating some positive statement about people will help you act better, and you may even begin to believe the positive statement after you have said it for three to six weeks.

If your automatic default is optimism, I'd leave it alone and enjoy it unless not facing some practical details is causing you trouble. If you put too much on your credit cards, you may need to say, "I enjoy saving money."

You may make great strides and feel better for months and not have to continue the relaxation exercise or the repetition of positive statements as much, but if a sudden stress comes into your life, you will need to gear back up to full force. Some people find it helpful to include a positive statement about their religious beliefs, particularly during trying times.

The repetition of positive statements may strike you as contrived and facile. If you try it, you'll find it takes quite a bit of discipline to control the thoughts in your head. The mind tends to jump from one thought to another, much like channels change when you push the seek button on modern car radios. But you do have a choice. You don't have to allow the random thought patterns. When you control your thoughts for at least three weeks, you will notice a change in how you act and feel. You may think your positive statement is a lie. That doesn't matter--say it to yourself anyway. It will become the truth.

Many books tell you to change things about yourself but don't tell you how. This is a how-to step that works. It's something you can start right away. Whether you want to change your career, your environment, or yourself, think about it, plan ahead, picture in your mind how the change will be, and work toward making it happen.