Sometimes all it takes is one conversation to spark an idea.
I had such a moment during a retreat last spring. I was with a group of faculty and staff who were brainstorming ideas for supporting wellness and thriving in the Department of Medicine. One of the senior faculty in the group reflected on his career needs and goals, and how those had changed over the course of his career — a lifespan approach to understanding wellness and the entire trajectory of a career.
This idea had instant appeal to me. In graduate school, we learned theories of lifespan development that describe sequential stages of physical, emotional and social growth. Erik Erikson’s work appeals to me most. He categorized each stage in human development as a set dialectical challenges, with each stage creating the foundation for the next, spanning infancy to end of life:
- Trust vs. Mistrust, Infancy (0-18 months)
- Autonomy vs. Shame and Doubt, Toddlerhood (18 months-3 years)
- Initiative vs. Guilt, Preschool (3-5 years)
- Industry vs. Inferiority, School Age (6-11 years)
- Identity vs. Role Confusion, Adolescence (12-18 years)
- Intimacy vs. Isolation, Young Adulthood (18-40 years)
- Generativity vs. Stagnation, Middle Adulthood (40-65 years)
- Integrity vs. Despair, Maturity (65 years and older)
Our lived experience is typically somewhat different. We move through a continuum of development over the course of our lives, sometimes without noticing movement from one milestone to the next.
The field of medicine is no stranger to the use of a developmental lens. The needs of medical students who are new to the field have distinct needs compared to interns, residents and fellows. Each developmental stage requires the adoption of new skills and capacities that build on achieving mastery of the previous level.
However, when it comes to becoming an attending physician, the developmental language tends to stop (albeit the academic labels continue). With the absence of unique terms that reflect developmental stages, there is a tendency to assume that the needs of a first-year attending physician are comparable to those of the late-career physician. When we pause to think about this, however, we know this is not true. Early-career physicians — and especially first-year attendings — have much to learn about the medical systems that surround them, management of their clinical practices, and implementing empirically based interventions to an ever-growing panel of patients.
At the same time, the majority of new- or early-career physicians are establishing long-term partner or romantic relationships, parenting young children, learning the joys of geographic stability and potentially homeownership, and establishing social connections outside of work and possibly medicine. They may feel the need for guidance, mentoring, networking, connection and establishing routines that mid- or late-career colleagues have firmly in place.
Managing the imposter syndrome may seem like tough work in the early years of being an attending physician. The same may be true for early-career staff who are mastering our complex work environments, identifying their own career paths (with or without mentoring) and establishing themselves in their home and social lives.
At the other end of the developmental continuum, late-career physicians and staff may be navigating different challenges. Changes in clinical, administrative and research environments may seem orthogonal to their professional roots, preferences or goals. Feelings of mastery, accomplishment, relevance and a sense of legacy for decades of dedication and work may feel challenged or threatened. Physical health may change along with the people who surround you. Friends and spouses may be moving faster or slower through this end of the developmental continuum than you. Mentors more senior than you may be gone.
At the same time, there may be many personal, professional and scholarly accomplishments to reflect on and celebrate — students or mentees who are at the top of their careers and advancing important work; papers that continue to be cited as landmarks in one’s field; the deep gratification that comes with seeing one’s family members grow and reach their own developmental milestones.
In this next year of wellness initiatives in the Department of Medicine, we will be employing a lifespan perspective as we consider activities and initiatives across our three missions: research, education and service. As part of this perspective, we will take a nuanced approach to understanding faculty and staff needs across the lifespan continuum.
As you consider your own career path and those of the people who surround you, I invite you to try on a lifespan developmental lens:
- What are your career needs now at this stage of your career?
- How have they changed over time?
- How are the needs of your early career colleagues different from your own?
- How do the needs of your more senior colleagues inform your choices as an early- or mid-career physician?
- What practices do you want to emulate?
- Which ones will you choose to do differently?
