Career Crisis?

Hands up who has stuck their nose into pain science, or just science in general, adopted some new ways of approaching patient care and got better outcomes?  Hands up, who has then poked their nose back into their profession’s water cooler discussions, be it at a conference, internet discussion forums or the actual water cooler itself, and found themselves despairing, pulling their hair out and declaring I CAN’T DO THIS ANYMORE – I NEED A CAREER CHANGE!!! ??

Over this last week I have had discussions with three colleagues who have approached me about wanting to make a career change out of their respective manual therapy industry.  They have approached me seeking some guidance into what might be possible, affordable, fulfilling career options to take sidesteps from their current careers. The recurrent undertones of discontent seem to follow these broad themes:

  • People in my profession aren’t keeping up with what is going on, in fact there seems to be pushback against any movement forward – It’ s like they WANT to keep us in the dark ages/on the fringe
  • The way that the practice that I work in is structured is designed to keep people sick/broken/in pain/fearful/coming back and I can’t seem to fight against these commercially driven factors to change things
  • My colleagues talk about change or keeping up to date but the other day I overheard him/her telling a patient that “once we get the MRI (for their non specific low back pain) then we can make a plan”.
  • I practice using a current understanding of pain, yet these “gurus” spouting reductionist nonsense often represent our profession to the public and the medical profession. They end up representing me and its not fair!
  • I am stuck in a rut and can’t seem to get my longer term patients to move to a more active management approach – it drives me crazy

I feel like I have been having these conversations almost weekly for a year – and I am no closer to coming up with answers for people regarding a tidy solution.  So, despite admitting to not having the answers, these are some of the suggestions that I have made to various people along the way.

  • Remember that the grass is always greener on the other side. Many people in the other careers that you might aspire to switch over to, have very similar issues and frustrations, sometimes they are exactly the same, sometimes slightly different.


  • Is switching to a different profession (within allied health/manual therapy) going to allow you to practice in such a different way as to dramatically improve your personal job satisfaction? Is the loss of income, costs of retraining and setting up going to be worth it?  If it is, then go for it…. But make sure you have thought it through really carefully. Remember that education is a massive industry these days, and it is buyer beware in terms of whether you will get a job at the end of a masters degree or other course.  Universities are more than happy to take your money and enroll you in a program with little or no reference to whether the industry can support all the extra grads.


  • Instead of focusing on what other people in your industry are doing or saying – just do your job really, really well. Focus on each patient as an individual and try to apply the best approach that you think will help that person, with reference to what the science tells you, but also with reference to your experience. Remember that the changes you can help a person to make in their life can be phenomenal.  The reality of improvements on functional testing or a pain catastrophising scale that we might judge our clinical success by, play out for the patient as things like getting back to work, playing with kids, getting back to the sport or gardening that they love.  That is a massive impact!  It is easy to get wrapped up in prestige, hierarchies and reputations of a profession, (especially in the presence of gurus) and forget that within each of those industries, there are great practitioners and crap practitioners.  Is the label that important? Does it change how you can deliver your service?  Can you slightly change your model of delivery and still stay well within your scope of practice?


  • Take stock of where you are at personally – have you had a holiday recently? Are you regularly engaging in conferences, seminars  or professional meeting to keep you motivated and in the zone? Are you working too many hours? Dealing with patients, especially ones in pain is draining in full time mode. Can you switch to part time or diversify your practice to break things up?  At a low ebb you will find yourself wanting to bail out much more readily. photo-Vietnam-beach-holidays-pics-hh_dp4270659


  • Can you refer those long term, dependent patients who are still stuck in passive mode, and haven’t made the progression to an active approach in line with your own changes, to someone else? It’s really hard to change the nature of that relationship once it has been established.  The effect they have on your mood, and that fact that you are probably not helping them much might mean that the kindest thing you can do for them is suggest that they “start fresh”  with a colleague who can show them a new way forward.  (Make sure you know that whoever you are referring to has a good grasp of a biopsychosocial approach!)


  • Pursue the stuff that you love outside of work. Remember that work is only part of your life and no career is going to give you complete and utter life satisfaction.


  • Stay off the idiot forums!! If that is your exposure to the nonsense that upsets you, just don’t go there, at least for a while.  Stick to discussions with like minded people  and hang out with people who you think can balance things well.