Getting Beyond the Why


There’s no shortage of advice suggesting that the key to long-term career satisfaction is to start with our why. Popularized by Simon Sinek’s Start with Why and his accompanying TED talk, the concept has become a touchstone for people embarking on a career search or looking to make a career change. Indeed, there’s research to support the importance of discovering one’s purpose in life – examples include Ryan and Deci’s self-determination theory (where relatedness is considered an essential human need, alongside autonomy and competence) and job crafting (where seeing one’s career as a calling is associated with long-term job satisfaction).

Although these findings suggest that there’s value in starting with one’s why, the vague answers that it often produces fails to force people to reckon with the realities of their future career. When I ask students why they’ve selected a career in health care, one of their most common responses is a desire to help people. I think it’s wonderful that students want to devote their lives to serving others, but I’ve found that few have considered my follow-up question: how do you want to help people? Few have explored how they want to spend the next 30-40 years helping people, whether it’s diagnosing disease based on the results of images, labs, and other findings (physicians), or evaluating medication treatment plans for safety and efficacy (pharmacists). Why not help people by supporting them when they’ve been affected by crime (police officer), or have a crisis of faith (minister or priest)? All of these careers help people, but they do so in very different ways.

Even fewer students have thought about some of the less glamorous roles that their job will entail. Student physicians are surprised to learn that much of their time will be spent documenting their activities in the medical record. Student pharmacists don’t often realize that they’ll be spending more of their time dealing with prescription drug insurance than they will actual patients. Those who have previously worked in health care (e.g., scribes or pharmacy technicians) may get a preview of these experiences, but likely not the detachment from patient care that results from facing a screen most of the day, or the feeling of helplessness that results from facing the frustrations of patients and prescribers alike. Every job has its moments of stress but feeling emotionally drained by the day-to-day functions of the job is no way to spend a career.

An important role for us as educators is to help trainees identify their work-related motivations and make career decisions that align with them. This is often referred to as person-job fit, and there are a variety of frameworks to describe it. Maslach and Leiter’s areas of worklife provides a helpful framework for organizing person-job fit into six domains: workload, autonomy, reward, community, fairness, and values (see Figure). Only two areas from their model address why (reward and to a lesser extent, values) whereas the rest refer to the who and how of the job. If we advise trainees to focus primarily on the why, we’re only helping them navigate a fraction of those factors that can make or break their career in the long run.


I don’t mean to suggest that why is unimportant, but I do think we need to do a better job of encouraging students to get beyond their why and consider the who and how of their future careers. Even better, we should encourage them to get a preview of those careers through firsthand experiences like job shadowing or internships. For those of us who can provide these opportunities, we should make them as realistic as possible by letting students experience both the desirable and undesirable aspects of the job. That way, our trainees don’t wake up in 8 to 10 years (and to hundreds of thousands of dollars in debt), realizing they’re in a career where the moments of frustration outnumber the moments of fulfillment.

Image credits: Ryan McGuire from Pixabay.

Brent ReedComment