EP190: Dr. Naomi Elton's Blueprint for Navigating Success in Medicine

Career Planning and Wellbeing for Doctors with Dr. Naomi Elton

In this episode of The Girl Doc Survival Guide, Dr. Naomi Elton, a systemic therapist and retired consultant psychiatrist, discusses her career journey and the importance of career planning and self-care for doctors. She talks about her new book with co-author Caroline Elton, PhD: 'Career Planning for Doctors: An Evidence-based Guide,' which provides practical exercises and methods inspired by Daniel Kahneman's cognitive decision-making strategies. Dr. Elton emphasizes the value of mentoring, coaching, and addressing emotional labor in career development. She also highlights the differences between therapy, coaching, and mentoring and provides tips for defining career success. The episode concludes with a recommendation for another career advice book, 'A Job to Love.'

00:00 Introduction and Guest Welcome

00:57 Personal Anecdote: Career Support in the 1980s

02:31 The Harsh Culture of Medical Training

03:54 Career Planning and Wellbeing

04:22 Tips for Effective Career Planning

11:33 The Importance of Mentoring and Coaching

14:48 Defining Career Success

16:30 Final Thoughts and Book Recommendations

Transcript

Christine Ko: [00:00:00] Welcome back to The Girl Doc Survival Guide. Today I'm very pleased to be with Dr. Naomi Elton. Naomi Elton MD is a Systemic Therapist at The Family Treatment Service in London, United Kingdom. She's also a retired Consultant Psychiatrist in Cambridge, United Kingdom. She currently works as a coach and systemic therapist with skills developed through her background and career in child psychiatry. With Caroline Elton PhD, and I've said before, they're actually not related, she is the author of a new book called Career Planning for Doctors: An Evidence-based Guide, which I think would actually be helpful for all doctors, whether early on in their career or even later on in their career to read and think about because this is an important topic.

Welcome to Naomi. 

Naomi Elton: Thank you. Thank you so much for having me and for such a lovely, kind introduction.

Christine Ko: Can we start off by your [00:01:00] sharing a personal anecdote? 

Naomi Elton: Yes. Surprisingly, perhaps, I never received any career support myself. Back in the 1980s when I trained, it just wasn't a thing. Woe betide you if you had an issue and you had the courage to try and raise that issue with somebody. My very first clinical year, the first part of it was in general surgery, and I found that quite a leap. It was really hard to understand some of the surgeons who are my trainers. Some of them seemed quite arrogant. And so I looked down a list of tutors and I selected one who was in fact a child psychiatrist. And I thought, Oh, that would be a good one to go and talk to. So off I went, and I told the story, and this child psychiatrist became very fierce and looked at me [00:02:00] and said, Have you ever thought what it must be like to be a surgeon and to have to cut people open? And of course, I never had really thought what it must be like and felt utterly ashamed of myself and ended the the incident as quickly as I could and scurried off with my tail between my legs. That was really what career support was like in the old days, and I think that's very telling and partly why we wanted to write the book. 

Christine Ko: I love that story, actually. On two main levels. One is I relate to it because early on in my training, surgery was basically one of my first rotations, and I was also similarly very surprised by the culture that was in surgery at the time. People were exhausted; the residents were exhausted. There were no time limits on how long they could be in the hospital, and it was rough. And so I can also [00:03:00] see the perspective of the child psychiatrist who reprimanded you saying, What is it really like for them? The training was harsh in itself. And then I think that creates a harsh culture. How can it not? But what I also really like actually about your story is this child psychiatrist was harsh with you, but you ended up going into psychiatry and also child psychiatry, right?

Naomi Elton: Absolutely, yes.

Christine Ko: So in a way, even though we might encounter harshness sometimes, there was the ultimate path that's meant for us.

Naomi Elton: Yeah, and that's another reason why we wrote the book because we wanted to do something about that harshness. You can't really do that much about the entire world. You can only really do something about your own part of the world and the best place to start is with yourself. So as well as career support and career planning, there is [00:04:00] a thread running through the book, which is about self-care. And about wellbeing. We've got a whole chapter in there about supporting your own mental health, your own wellbeing, and that of the doctors who you are training, who you're educating. 

Christine Ko: Excellent. Yes. So that segues nicely into my next question. Do you have important tips for career planning and that thread of wellbeing?

Naomi Elton: The first tip is to do it, to do the career planning. Whether you read the book or whether you learn your career planning from a different source. The classic error is to not do it at all, to really literally make your career decision in a kind of bish bash kind of way. So one of the inspirations for our method is Daniel Kahneman, the late Nobel laureate psychologist who [00:05:00] wrote the book, Thinking Fast and Slow. I would highly commend this book, which you can easily buy in an airport. Basically he's trying to encourage people making decisions to lean away from the very fast, what he calls System 1, type method for thinking that's absolutely riven with cognitive biases and to encourage decision makers to veer much more into what he calls System 2 thinking, which is much more slow, deliberate. He wrote another book since, Noise. And in Noise, he's teaching you how to bring some decision hygiene to bear on your decision making. So we take these methods and we apply them to career decision making. And it basically means being very systematic, slowing down your thinking. Doing some exercises. We offer a series of six [00:06:00] exercises, and they're all really super easy to do. None of them will take, necessarily, more than one hour, but you're gonna do it over several months and then you're gonna carry on with your System 2 type of thinking.

Christine Ko: I had the opportunity to read through your book, and it's wonderful. I am going to do those six exercises even myself, even though I would say I'm in the latter part of my career. Also one thing that's not really emphasized is career transitions too, that maybe we don't always have to be the same type of doctor that we've always been, whether it's even just from say, like an academic or research setting to more clinical or the other way, more clinical to doing more clinical trials or administrative work, or going part-time versus full-time or coming from part-time to full-time, or using your medical degree in a totally different way, like life coaching, [00:07:00] or consulting, or working for the FDA or industry in some way. So I do recommend your book to anyone listening, and I will put a link to it in the show notes as well. It's through Oxford University Press.

Naomi Elton: I agree our careers shouldn't necessarily be thought of as going from A to Z in as short time as possible and then stagnating it. Every career may have a very different shape to another person's career. Women's careers are more variable in shape than men's careers. Not always. 

Christine Ko: I appreciate that you said that. That makes sense. For a lot of parents, but especially women who are still the child bearers, having children does come right when your career would be moving at an upward trajectory in terms of responsibility. I remember it being hugely stressful because at the same time babies and [00:08:00] toddlers require a huge amount of effort as well. Not just physical effort, but mental effort. Then also there's the career obligations. 

Naomi Elton: I think that's right and if you think about it, if you are a parent and if you are a doctor or a physician, both of them entail emotional labor. It's very easy to neglect to think about your own emotional needs and who's actually gonna look after them. 

Christine Ko: Oh, that's so insightful. I would say yes to that a hundred percent. To be aware of your emotions and to be aware of emotional labor, somewhat more objectively and as data like, Okay, I'm angry right now. No judgment. Or, They're angry right now. No judgment. And try to figure out how to use that data in a productive way rather than feel drowned and overwhelmed. 

Naomi Elton: Yeah. And it's a no judgment bit. That's so [00:09:00] important and so hard to do.

Christine Ko: Yes. And I really think your comment about the emotional labor piece is so important. Emotional labor, I do think at the time, I couldn't carry well. Ultimately. I tried just to number one, not think about it because I felt overwhelmed. And then number two, also in some ways, cover over my emotional labor worries at home with more work actually. 

Naomi Elton: Yes. That's just so classic because I think doctors are by nature very conscientious individuals. It becomes almost instinctual to respond to stress by throwing yourself into another piece of work. 

Christine Ko: Yes. I think also for me, it's something that I can control a little bit. Work feels familiar, and I enjoy it. It feels [00:10:00] safer than navigating emotions that can feel very rough and unpredictable. 

Naomi Elton: That seems like a very common experience among doctors, I would say.

Christine Ko: Okay. I like your tip for career planning to do the exercises, so that's good. And then I also like your tip, if I phrase it this way, to think about the labor you're doing emotionally at home and at work. That might affect your career planning just in terms of sort of emotional resources.

Naomi Elton: Perhaps connected is the idea that you don't have to do all of it on your own. I suppose that's another golden thread that we've tried to weave through the book, is that, not only for the career planning, but also if you run into issues, whether they're clinical issues, whether you have a very complex case, it can be very hard to ask for help, [00:11:00] whether it's advice on the drug that you are about to prescribe or whether it's somebody to bounce ideas off about your career. It can be invaluable to ask for help. So we want medical educators to be able to access the method too, so that they can share it with their juniors. 

Christine Ko: Yes. I like that. That's a really good point. Is there anything that your research and writing the book made you feel like it would've been nicer had you known it and done differently in your career?

Naomi Elton: What would've really helped is coaching and mentoring. Later on I did get myself coaches and mentors. But, yeah, if I had my time again, I would've sought them out for every time I got into a new role. I wouldn't have been wary as I was about coaches. Early on, I honestly thought that there were gonna be people that were gonna be judgy, and they would tell you that you are a bad person, and things like [00:12:00] this. But in fact, now what I know is that you are the customer, and you are going to meet a coach or a mentor, and you're gonna see whether they're the right person for you. And if they're not, then you are not going to work with them. So you are gonna be a bit picky. And I wish I had done that and sought out a coach that actually truly listened to what I was saying.

Christine Ko: Yes. You're a coach yourself.

Naomi Elton: Yes, I am. 

Christine Ko: Would you be able to explain what you think the differences are between a mentor and a coach? 

Naomi Elton: Yes. It's a bit of a sort of spectrum. They tend to merge into each other. But generally a mentor is somebody who's done what you are doing before you, and they know the ropes, they know the nuts and bolts of what you're doing, and they can tell you how to do things. Whereas a coach may not necessarily have done what you are doing at all. They've had a little bit more training than a mentor. Quite often, they [00:13:00] are possibly more skilled at listening. They'll usually ask many more open questions. They will generally have a slightly greater skill level, but not always. You can get some mentors that are amazing people and instinctively know how to be there for people, even if they've only had one or two days of training.

Christine Ko: And so a coach, when you said have generally has generally had more training than a mentor, I think you mean that there are coach training : ? 

Naomi Elton: There are.

Christine Ko: A little bit off topic, something that I've been working through in my head over the last one to two years: so since we're talking about mentors, coaches, and then you're also by training a therapist. Since you've done all three, what would you say is the difference between mentoring and coaching, which you just said, and therapy, like having a therapist?

Naomi Elton: Oh, wow. That's such a big question. Let me think. I think, therapy, and this maybe sounds a bit almost disrespectful to [00:14:00] therapists, but it's not intended to be. It's a bit more intrusive really. Maybe it's a bit like the difference between a surgeon and a dermatologist.

Christine Ko: Okay. I love it.

Naomi Elton: I suppose the therapy world is such a private world and people have to trust to bring the things which perhaps they feel most vulnerable about. Whereas I think with coaching, coaches are trained to do a very fine balancing act and should be careful not to take on the mantle of the therapist. Does that make sense? 

Christine Ko: It makes sense. I appreciate your answer. I really like this analogy between dermatology versus surgery and coaching versus therapy. 

I am gonna move on to a different question. What would you want everyone to know about defining career success after maybe you've done all this career planning and you're in your career? How do you know that you've [00:15:00] "made it"?

Naomi Elton: That's a wonderful question. And in a way that's the whole purpose of writing the book. Career success, it's not really, as we've said already, about getting from A to Z in the most efficient manner possible. It's not about how much you earn; it's not even necessarily about achieving a high status. A much more useful way to think about career success is a person's subjective experience of satisfaction with their career. Do they look at what they're doing and what they've done and what they might do with confidence and satisfaction? A lot of that has to do with the individual, but it also has to do with where they work and what they're doing. If you are an optimistic person and if you are a fairly proactive person, that you have a greater chance of career success and career satisfaction. But equally, [00:16:00] if you are doing something that is something that you particularly value, and if you feel supported; you are good at what you are doing, i.e. you have had a good level of training to do what you're doing; and then lastly, if you feel that you are being fairly treated, these are in the literature the ingredients for career success. 

Christine Ko: I like it. Thank you. This has been wonderful.

Do you have any final thoughts? 

Naomi Elton: I wonder if you were going to ask whether our book would be suitable for doctors or physicians in North America? Because in our book we have a lot of case studies. And they're mostly doctors who are either trained or training in the National Health Service in the UK. I just wanted to reassure potential readers that for the most part, we are drawing upon the psychology literature. And [00:17:00] of course most of the psychology literature is emanating from American universities. I hope that goes somewhere towards reassuring your listeners that our book could be right for them.

Christine Ko: Yes. I know what you mean because the training system in the UK in the National Health Service is different than the US. But I read through it and a lot of parts resonated with me, and especially, for example, the exercises. That doesn't matter what country you're in. There's universally applicable themes that run throughout the book. For sure. Absolutely. 

Naomi Elton: For general career advice, there's another lovely book called A Job to Love. A Job to Love by School of Life.

Christine Ko: Okay. Thank you.

Naomi Elton: I highly recommend, and it's so incredibly readable for younger people.

Christine Ko: Thank you. A Job to Love. I will look that up. Thanks for that recommendation, Naomi. And thank you so [00:18:00] much for all your insights. I really appreciate your thoughtful responses.

Naomi Elton: Oh, thank you. And thank you for having me. It's been an absolute delight.