I’m 40, and it’s all stacked against me

I’ve recently had A LOT of conversations with people where the other person says, with some considerable exasperation, ”I’m 40+ and….” describing a situation where they are about to complete a substantial period of growth and achievement only to find themselves on a cliff edge that seems to miss the bridge.

One such example are several medical clinical academic colleagues, who – all of a sudden – I hear saying everywhere, ”I’m 40+, about to CCT in [month X], done [list series of clinical academic fellowships and leadership training], and I don’t even know what job I’ll get – if any!!”

The narratives shared by my NMAHP clinical academic colleagues are similar, if framed a bit differently. ”I’m 40+, I’ve been Band 6 for [X years], done all the rotations, and when I complete this current fellowship [year X], what’s there for me – if anything?”

Congratulations! You have arrived: to midcareer! Welcome! 😬😅

Yes, this is literally it. The absolute hallmarks of midcareer. Tick all that apply:

  • Have you worked your socks off for 10yrs or longer?
  • Have you passed several key gateways, preferably with some testing (e.g. degrees) and rites of passage (e.g. dramatic interview panels) involved along the way?
  • Is your CV more than five pages long, with several qualifications and an increasing range of subheadings (such as ”professional service” and ”leadership”?)
  • Do you worry, at times acutely, but always silently, about the CV sections that describe your grants and papers – about these not being long enough?
  • When looking back, do you feel you’ve done reasonably ok; while looking forward, do you feel acute worry that your chances of succeeding feel somewhat less than at the hight of your confidence a few years back?

If you can confidently say ”yes” to all of the above, then you are almost certainly at midcareer. The stronger your yes’es the deeper in it you are.

Now, the good news: it will pass, and much of it can actually be very enjoyable.

The bad news: it might not pass quite as fast as you’d like it to…

So what survival tips might I have, based on what I found helpful and based on that annoying thing known as hindsight?

I’d say, be really regimented to work with good egg people only. This is my #1 go-to advise anyway, but considering the hurdles of midcareer, you can’t afford to spend your mental energy and wellbeing on anything but the good eggs.

I’d also say, try not look down (or ahead) too much. You do need to keep the course in mind, but you’ve essentially arrived to the Bermuda’s Triangle of clinical academic career. There are a lot of reported dissapearances, of which no one really knows what is myth and what is truth; participant and eye witness accounts of this part of the journey differ vastly; and it can be really hard to make sense of what in the earth is actually going on, who to trust, and what to do. Given all this uncertainty, worrying too much about whether you are on the exact course is just a source of stress and waste of your very precious time. Check in with your few, most trusted sources, and use your few internal key measures of success, once a year to check the rough direction. And try to do your best the rest of the time. Remember that sometimes keeping the course means just keeping a float.

And, I’d say, look after yourself. This stage of your career may feel like make or break, but it’s not. It really is just midcareer. You’ve done the first third. There’s the present third. And after that another whole third to come. Pace yourself, look after your mental and physical wellbeing. This is a good time to be the steady donky, rather than the sprinting horse. It may seem like everyone else is powering past you just now, but it’s an illusion. Give it a few years and the work you put in now will pay off.

I added this one later: don’t allow the system to take advantage of you. The game gets more complicated as you progress, and the system likes to chew up midcareer’ers. Watch out for tasks that don’t really matter – to you, to the world, or to patient or population health. New tasks are invented all the time, too often without clear reasons, and giving these tasks to effective midcareer’ers (often under a guise of leadership opportunity) is definitely a thing…

So when will it end, and how do you know you are out of it?

In all honesty, I am not sure. My guess is, it takes somewhere around 7-15yrs. But I may well be very wrong about that.

You do know when it ends, because the world stops spinning. You feel your feet and balance again. You can look forward again, and know that you’ll be ok. You can look at the final third of your career, and look at the odds without the feeling that they are all against you. You know, again, that you’ll win some, lose some.

Disclaimer: So many people have spoken to me about this, in different ways, over the past 12 months. If you think you recognise yourself, rest assured, this post is not based on any one person other than me – specifically on me realising my own experience of midcareer through listening the stories of others.

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