COMMENTARY

No Career Goals? That's Just Fine

Vinay Prasad, MD, MPH

Disclosures

December 28, 2020

A reporter asked me recently, "Where do you see yourself in 10 years?"

I had been asked the question before, but this was the first time that someone was asking me outside of a formal interview setting. Through medical school applications, residency, fellowship, and faculty job visits, a number of superiors had asked me to provide a roadmap of my future self. I dutifully complied and possibly even believed what I was saying. In retrospect, of course, my predictions were completely off the mark.

Now, however, I was being asked the question outside of a "hiring" situation. I could be completely honest. But what was my answer?

I wanted to draw a distinction between my wishes and my goals.

My wishes are external. They don't have to do with me. They are detailed in my book Malignant, but here is a summary. I am frustrated by cancer drug policy. I think cancer drugs cost too much and deliver too little. Worst of all, the current system incentivizes the pursuit of marginal and even ineffective therapies. I hope for increased recognition of these problems over the next decade. I wish we could even test solutions, some of which are suggested in my book. These are external desires, though. They have to do with what bothers me in the world at large.

What about my personal career goals? Do I want to be promoted to professor? Do I hope to earn tenure? Do I wish to be a section chief or a department chair? Do I aspire to be a dean? Program director of the oncology fellowship? The head of a health policy center?

What about outside my workplace? Would I sit on a national committee? Become the editor-in-chief of a journal? Take a job in government?

While I can't say for sure that these things won't happen, I can honestly say that I have no desire for any of them to happen. They aren't on my wish list.

Promotions and tenure won't change my life. A change in title and a modest pay increase won't alter my day-to-day. As for tenure — who needs it. There is no job protection in 2020. We are all just one tweet away from unemployment. Being promoted to a leadership role is a form of anti-tenure; it would severely curtail my freedom to say what I think. Moreover, leadership positions are often thankless. Were it not for a love of titles, far fewer would pursue them.

In an essay that I wrote for Medscape in 2019, which feels like a lifetime ago, I argued that senior faculty should make room for junior faculty by relinquishing roles and creating opportunities.

A year later, my thinking has evolved. Maybe I was wrong. Perhaps the right answer is that junior faculty should let personal career goals go. None of them will make you happy. They are all brass rings. And yet, those of us in medicine have become accustomed to grasping for the next ring. We had to jump through hoops to get into medical school, residency, and fellowship. We had to jockey to join the right practice. It takes a while to realize that there are no longer any personal achievements that would change your day-to-day.

Is My Heretic Idea Right?

Worried that I was missing something, I called a couple of classmates from medical school in different positions and specialties to ask the same question.

One colleague began by saying, "I am hoping we can finish..." but I stopped him because his reply was related to a long-term work project.

"No, I am asking you about your personal career goals. What do you want for yourself?"

To which he replied, "For me? Nothing. I gave that up. I aspire for nothing."

A second colleague confirmed the message.

"There are lots of things I want to fix at the practice to make my life better. But for me personally, I don't want any more obligations," she noted.

So perhaps my heretic idea is right.

We all reach a point in our medical careers when there are no titles or accomplishments that we desire. Sure, we may want to see our practice achieve a milestone, or we hope to spend more time teaching or mentoring. But there is nothing more we want for ourselves.

This may come to different people at different points, but the feeling comes eventually. And that is a good day. It means you are satisfied with what you do, and your happiness and gratification will come from life outside work, which hopefully still exists.

Vinay Prasad, MD, MPH, is a practicing hematologist-oncologist and associate professor of medicine at the University of California San Francisco. He studies cancer drugs, health policy, and evidence-based medicine. He is author of Malignant: How Bad Policy and Bad Evidence Harm People with Cancer and co-author (with Adam Cifu, MD) of   Ending Medical Reversal: Improving Outcomes, Saving Lives. When not working, he enjoys cycling, reading, and binge-watching television.

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