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The difference between obtaining a job after residency or fellowship and obtaining a job after being an attending physician is that the path is less clear after one has been in practice for several years.  The process has an aura of amorality because nobody is telling you what to do.  It reminds me of the “find me a rock” game where each time someone brings a rock, the receiver specifies additional features until the donor gives up in frustration.

The key to obtaining a job after being in practice is the demonstration of expertise because expertise decreases risk.  The following are five steps to help you obtain and demonstrate that expertise:

• Start with your inner journey
• Commit a small amount of time each day/ week toward achieving your goal
• Become an active reader
• Demonstrate your expertise in writing
• Seek assistance from others

Start with your inner journey

Our limits lie within us.  Earle Nightingale said that what the mind can conceive and believe, it can achieve.  We become what we think about:

• Take a moment to visualize what you want to be doing 1, 3, or 5 years from now
• What does it look, feel, sound, smell, and taste like; use all your senses as you paint a vivid, colorful picture of where you are, what you have accomplished, and what you are wearing
• Act as though you have already achieved your goal; put a post-it note on your bathroom mirror, such as, “I am learning more about … every day;” substitute “when” for “if”
• Even if you do not believe in your power yet, fake it till you make it; Henry Ford said that whether you think you can or think you can’t, you are right; put your creative self-imagination to work for you

Commit a small amount of time each day/ week toward achieving your goal

• Find a time at least 3 days per week where you devote 15 minutes uninterrupted toward achieving your goal, even if it means getting up 15 minutes earlier
• Allow 2-3 weeks for the habit to become engrained
• You will be amazed at how much more you will know within a few months, to say nothing of a few years.

Become an active reader

We know that when we use what we read (for example, a patient whose diagnosis eludes us initially), we remember it much longer than if we read to whittle down our task list (for example, studying a textbook for board recertification)

• Get into the habit of writing down on paper or in your computer 2-3 points for everything that you read that is relevant to becoming a thought leader
• File, don’t pile; keep paper or electronic folders on topics for quick recall
• Keep lists of topics on which you plan to demonstrate expertise

Demonstrate your expertise in writing

• At first, read blogs and other sources of information
• Have someone build a website for you that includes a blog; I use Word Press based on the advice of my website designer, who feels that it is user-friendly and has applications for a wide variety of tasks and goals (like photos, video, and podcasts)
• Comment thoughtfully on others’ posts, mentioning your website, which will build traffic to your site and help develop the perception that you are on your way to becoming a thought leader
• Write blogs that link to others’ posts
• Convert data to information that can improve performance in the form of 2-5 page white papers, as I discussed in a previous post, White Paper Mastery: How to Get Interviewers to Want to Speak with You
• Remember what Voltaire wrote, “The perfect is the enemy of the good;” just get started, knowing that you will improve over time (as in residency)

Seek assistance from others

This step involves admitting that you do not have all the answers and need help from others inside and outside your area.  Outsiders can help by questioning assumptions that you otherwise might accept on blind faith because everyone you know feels the same way (for example, ”always leave in a drain after cholecystectomy”).

• Seek colleagues with similar self-improvement aspirations; form your own mastermind group to exchange ideas and hold one another accountable
• Consider becoming involved in a mentoring program; we all have blind spots; trusted mentors have a way of helping us become aware of these blind spots, so that we can be more proactive than reactive
• Turn your dissatisfaction with your present situation into creative action that improves your life and that of others with whom you associate; as one of my trusted mentors said, “It’s the sand in the oyster that creates a pearl.”

Kenneth H. Cohn, MD, MBA, FACS

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