Turns out the question of ‘What do I want to be when I grow up?’ is seldom really resolved.

Some memories of elementary school remain crystal clear. For years, the proverbial question was to write essays about something interesting that happened during summer vacation, but later it became — Ugh! — “What do you want to be when you grow up?” I recall staring at the blank page with my Eraser Mate pen in hand, knowing that for now I could just fake it, put anything down to complete the assignment. However, with each year that passed, this question resonated more loudly; I knew that at some point I would have to answer it for real. It seemed like Regis Philbin would ask me, “Is this your final answer?”

Well, for me that moment came and passed ... kind of. It turns out this question doesn’t really go away. Even 20 years later, as an established ophthalmologist, I am still asking myself this same question.

Now it’s no longer an academic assignment, but more of a personal challenge. What’s next? What would be interesting, impactful or long lasting? Perhaps you still ask yourself these questions too?

WHAT DO I WANT TO BE WHEN I GROW UP?

After 12 years of school and residency, a doctor needs to pick a fellowship. This career decision has a massive impact. A year or two later, this same doctor needs to pick a first job. It is amazing that someone in their late 20s or early 30s is still making decisions that will impact the trajectory of their career.

While my early essays about what I wanted to be likely gave answers that I thought would sound good for the teacher or my parents, after residency my answer was driven by personal interests and a growing family. Once established in practice, a career change may involve taking on a management role or a pivot to a whole new field.

Applying design principles can help guide your career decisions at any age, stage or simply because you sense it is time. This is the final column in my series on how physicians can utilize design principles in practice. Let’s roll up our sleeves and apply this to our career.

PRINCIPLE NO. 1: WHAT DO YOU WANT?

The first principle of design — to create specific ways to optimize a function that brings value to both user and producer — forces the producer to look at the question rather than generating a response. The “you” in the question “What do you want?” is very personal and invites you to challenge yourself when considering options. Focusing on your values in making your choice frees you from decisions that are tainted with obligations or guilt.

Spend time on diligence. Once you think you spoke to enough mentors or colleagues about your prospective career change, find even more and continue to research and engage in conversation. It is worth several hours of your time to investigate a position before you commit. After all, you sacrificed many meaningful years of education (and likely accumulated student debt), sleepless nights studying for and worrying about tests, training with many days post-call, etc.

Track down and place that extra call to the person who left the position you are about to take. Find a colleague working in a parallel position who can give you honest feedback. Do the impossible: Take off a few days of work to shadow in potential clinics or the academic environment. You’ll be surprised what you learn by the water cooler.

Defining success is personal and changes over time. Don’t shy away from reevaluating your own definition as the years pass.

PRINCIPLE NO. 2: FOCUS ON QUALITY AND TOTAL EXPERIENCE

Do not just zoom in on the next job. Find the peripheral pieces of a career that can contribute to real satisfaction at work. Of course, the job description is front and center, but what about the corporate culture, work-life balance, opportunities for promotion or even possibilities to teach or join in collaborative projects? These will have great impact on your career, so spend time on diligence.

PRINCIPLES NO. 3 & 4: FOCUS ON OUTCOMES & CREATE MEANINGFUL CHANGE

The third principle is to create a process focusing on outcomes. Recognize that the question regarding career never really goes away until you stop working, so, buckle up and enjoy the ride — but find a comfortable process to explore and prepare each time you think about career moves. Consider putting your toe in the water to test possibilities, but remember, as Ben Franklin said: “When you’re testing to see how deep water is, never use two feet.”

Examples of creating an effective, satisfying process in this case may include finding opportunities to teach outside your clinic or even outside your field of work or taking field trips to other offices; you could try classes in areas of interest or even a one-day-a-week job in another sector. Don’t be afraid to try several things to find what works best for you.

Sometimes it is a matter of refining your current career to focus on areas you enjoy. For starters, try to gradually stop doing the parts you do not enjoy. In my career, every two years I have stopped doing a piece of my job. It started with elimination of refractions, then I decided to no longer see routine exams. Two years later, I stopped seeing glaucoma consult,s and now I only do cataract surgery. Maybe in two more years I will only treat left eyes.

Making a choice to stop seeing about 20% of my patients every couple of years was scary at first, but this process allowed me to fill my clinic with work I find more interesting. Creating a habit of exploring without making a complete career shift facilitates incremental career changes. Ultimately these career changes lead to work with a sense of meaning and purpose.

The fourth principle is to use your own positive experiences to create meaningful change — seeing the impact of your new career choices will fuel you to continue the journey.

CHANGE IS GROWTH

I used to get anxious about the yearly essay on what I wanted to be when I grew up. As it turns out, now that I am grown up (debatable in my house), my worry is that I stop questioning myself about my career. Once this happens, I’ve stopped growing. I’ll leave you with another Ben Franklin quote: “When you’re finished changing, you’re finished.” OM

Scott LaBorwit, MD, is a principal at Select Eye Care, with locations in Towson and Elkridge, Md., and is an assistant professor, part-time faculty, at Wilmer Eye Clinic of Johns Hopkins Hospital, Baltimore. His e-mail is Sel104@me.com.
Disclosures: Dr. LaBorwit is a consultant to and speaker for Alcon.