Probably even more complex than the motivations to leave medicine are the motivations and pressures for doctors to stay in the profession. Doctor’s are regarded as having a special role in society as defender’s of health – changing careers is seen by some as turning your back on and abandoning the health needs of the community. Feedback from lay people is often one of great puzzlement and an unspoken question about whether you are being forcibly de-registered. Pride, fear of loss, fear of failure, family welfare, poor self-confidence and personal circumstances all affect our decision to commit to change.
This may be family pride or personal pride. In many cultures, a person’s profession impacts the prestige of the entire family – losing this status can affect family relations, power holdings and acceptance within and outside of a family. Their can be much pressure from family members to remain a medical practitioner for family pride. Personal pride in being doctor, running a successful practice, having esteemed colleagues, achieving well in one’s specialty and/or earning a good salary form a solid foundation for some people’s lives.
2. Fear of loss
On the other hand, fear of losing these same things form a strong barrier to moving towards change. Giving up one’s medical practice and losing status are an obvious downside to a career change. In non-medical fields, you will no longer be instantly recognised as a ‘pillar of society’ and people may treat you very differently. Certainly, losing one’s regular high income is a difficult loss to tolerate. Fear of losing friends maybe a more subtle worry, whether this be from decreased social contact time or loss of friends maintained through your work role or status.
3. Fear of failure
Sometimes, there maybe a thought at the back of your mind that you’ve failed as a doctor because you didn’t achieve such and such a level of registration / specialisation. You think that your satisfaction with medicine may improve once you reach a higher status and ‘giving up’ now is a sign of failure – to your colleagues and yourself.
4. Family welfare
Sometimes it is just not reasonable to give up your current stable job because you have mouths to feed and children’s educations to pay for. This was particularly relevant for male doctors in the past millennia, but less so now with blurring of family roles.
5. Poor self-confidence
Insecurity is a powerful barrier to a career change. More often than not it is the fear of the unknown consequences that are associated with change that people with poor self-confidence find difficult to overcome.
•”I don’t know how to do anything else but medicine”
•”I’m better off with the devil I know than the devil I don’t”
•”If it wasn’t for my medical degree no-one would even know I exist”
If your poor self-confidence is pervasive and associated with other affective / cognitive symptoms seriously consider whether you’re experiencing a depressive episode.
6. Personal circumstances
There are many other circumstances in a doctor’s personal life that may serve as barriers to a career change in varying degrees. e.g. ill health of a family member, high cost of living, age, convenience. For different people these circumstances may be either barriers or motivators to change.
7. Social conscience and responsibility
Commitment and a sense of responsibilty to patients will keep many doctors practicing year after year despite becoming burnt-out or chronically stressed. Many doctors have an elevated sense of social conscience that motivated them to take up medicine in the first place. As mentioned in the opening paragraph of this page, it can be difficult dealing with the feeling that you are being selfish for not offering your medical skills to patients.
8.Locus of control
A further psychological factor affecting our motivation to change careers is that of locus of control. Individuals attribute control of their circumstances and their ability to control the direction of their lives along a continuity of external-internal control. At one extreme, some people consider themselves to have very little control over their circumstances (discounting their own abilities to alter their themselves to have very little control over their circumstances (discounting their own abilities to alter their environment) and find it difficult to deviate from well-beaten career paths [external locus], they feel that big decisions are not really theirs to make; at the opposite extreme other people attribute control over their lives entirely to their own ability and decisions [internal locus] and readily see a means for change.
Again, for many of us there is some degree of all of these factors influencing our drive to stay in the profession. Having discussed some factors that motivate doctors to change careers and to stay within medicine, it is important to recognise some factors that can support a decision to change careers. These may include (i) positive family support in the form of financial support and/or moral support, (ii) financial independence – being free of debt and having a good financial backup certainly helps, and (iii) clear goal focus and passion.
In the next article, we look at various ways in which people may make the decision to change careers. Read next article in this series…