So... one of the reasons I'm regularly awake in the wee sma' hours this week is a bit of a work-related dilemma. It's quite a nice dilemma, as dilemmas go, but I'm thinking posting about it here might usefully a) give me an opportunity to formally set out the pros and cons for my own benefit, b) prompt discussion of the whole concept of 'overspecialisation', and c) bore myself to sleep.
Regular readers will be aware that, in the almost-decade or so I've been posting on Barbelith, I've climbed the greasy pole of psychiatry and am now, if not exactly perched upon its tip, decorously straddling its upper reaches. Continuous professional development (CPD) aside, I've sat my last exam and have no more hoops to jump through unless I feel a particular desire for further hoop-jumping. Being something of a lazy person, I'm quite happy to sit back and take a breather - for a while, anyway.
My original plan was to manoevre myself into the position of doing a general adult psychiatric job most of the week with a day or two of more esoteric stuff ie. technically two separate part-time posts running in parallel. Over the last couple of years I've managed to put this in place, at least on a locum basis, and now I'm being invited to apply for the same posts, but in a permanent capacity.
Job A: General adult psychiatric work in a London-based community mental health team but including an in-patient ward and home visits. On-call rota. Mixed, bread-and-butter stuff: high-stress, lots of responsibility, lots of paperwork. Main plus is the excellent out-patient team (I've always preferred working alongside non-medical colleagues), good social life, and lots of contact with medical peers (academic meetings, journal clubs, etc.).
Job B: More esoteric niche psychiatry, originally intended as both relief from and 'spice' to Job A. Entirely out-patient based, in a tertiary service (ie. if patients voice more general psychiatric issues, they can be directed back to a general psychiatrist). No in-patient responsibility, no home visits, no on-call. No multidisciplinary team: I'm basically working alongside medical colleagues rather than nurses, social workers, etc. Little work-related social life and fairly minimal contact with peers - although future potential for meeting fellows via conferences, etc. Lots of paperwork, but more standardised (ie. out-patient assessments).
A quirk of timing has meant that I've had to temporarily give up Job A for a couple of months, while it's advertised as a permanent position; I've been strongly encouraged to apply, with the whole team backing me. This was indeed my plan. In the meantime, the more specialist Job B has taken me on full time. This was understood to be a short-term situation until I applied for Job A, then returned to a more balanced splicing of the two.
Aaanyway, I was a little anxious about doing Job B all the time, even for a short period. I'd always considered it a little piece of psychiatric exotica adding flavour to the more general stuff - and reckoned I'd quickly get sick of it if it were all I did. Now I'm in that position, however, I find I'm thriving in calmer, lower-stress Job B - to the extent that I'm thinking, "why don't I make this my permanent career?" Reasons against included worries about being overwhelmed by the volume of paperwork (which is plentiful but which I'm managing to stay on top of, possibly because I'm enthused about the work itself), the work becoming a bit samey (not the case as yet), and anxiety that I might, in the long-term, be boxing myself into an overly narrow field relatively early in my career ie. overspecialising.
Which is where I'm at at the moment, and part of the reason I've posting at 4am. Job A's not yet been advertised as a permanent placement so there's no pressure to jump either way for a couple of weeks anyway. I suppose my heart's telling me, "you're loving Job B, stay here" and my head's telling me, "it's more sensible to do some of A and some of B". I'm still broadly undecided, and it's getting to the point where, when people from either post ask about my plans, I feel (and probably sound) like I'm dithering. Oscillating wildly.
Bleh. So. My own not-terribly-unpleasant work dilemma aside, have other people worried about the spectre of 'overspecialisation'? In medicine, the passing of the generalist is a frequent source of teeth-gnashing and rosy-spectacle-wearing, and there does seem to be a trend toward having a narrower focus of interest. Whether this is a Good Thing is moot.
What do y'all think? |
