When is Mid-Career?

I am not a huge Harry Potter fan or even fantasy as a genre, but his invisibility cloak has been draped over the concept of mid-career competence now for some time. Unveiling the now-visible is like opening a veritable can of worms – how can we build ‘competence’ when we know that competence is abstract – and what constitutes ‘mid-career’ now that many of us are not retiring until our early seventies? To add to the complexity of this, healthcare offers so many career twists and turns and thinking of a career in a singular way now seems to be taking a reductionist approach to the journey. Even if we could define tangibly when mid-career begins, how long does it typically last? When does early become mid, and when does mid become late? Considering that ‘middle-aged’ has blown out, does this mean mid-career has too? Is it possible to know you have reached a mid-career point when the career terminus is unknown?

The Complexity of Competence

Competence is a melting pot of knowledge, experiences, and behaviours. It is not necessarily linear or chronological—it is neither gained nor lost easily and does not merely exist as a physical or emotional concept but probably a hybrid of both. An excellent example is when someone has physically demonstrated competence in a skill but chooses to perform it incorrectly due to an extrinsic or intrinsic motivation or lack thereof.

What are the Healthcare Blues?

So how can we build something abstract, and why specifically target mid-careers? Healthcare is a stressful working environment where a combination of stressors can manifest in many different ways, including fatigue and burnout symptoms. Symptoms may include work dissatisfaction and lethargy due to navigating the workplace experience-complexity gap over time, especially during the omnipresent pandemic. Symptoms may appear insidiously and remain unnoticed for years until they make more obvious physiological differences. An insightful editorial by Pakkala (2010) highlights some of the signs of stress and the genuine role that hormones can play in mid-career ‘blues’ about menopause and andropause. In addition, physiological strategies to keep the ‘blues at bay’ are highlighted, including the importance of continuing education to refresh the outlook on professional life. Other potential strategies include changes in work schedules, rostering patterns, job redesign and involvement of the mid-career healthcare worker as a ‘consumer’ in the planning of activities. Health professionals experience many stressors, including excessive workload and poor work-life balance. Indeed, even the fact that there is a journal called the Journal of Mid-Life Health means that mid-careers must also be necessary.

Investing in our Mid-Career Workforce

We need to refocus the lens on retaining essential resources within our healthcare system rather than letting the mid-career blues tempt them away from the diverse career structures that healthcare can offer. We must recognise that early specialisation may require a more generalist pathway in mid-career. However, even a generalist role is a speciality in itself. It will require scaffolding new skills and expertise for someone who has chosen to specialise in their early career. To achieve this, we will need to use different policy levers – currently, we have an approximate 80:20 rule of thumb in healthcare, particularly acute – we spend 80% of our time and taxpayer’s money on 20% of the workforce which is the entry to practice, transition to practice and postgraduate domains. We also need to spend time and money on our mid-career workforce, which provides supervision and mentoring for our more junior workforce. We want to retain, entertain, and provide reasons for an intention to return to the workforce if they do leave. Policy levers should be pulled to enable the vast majority of our workforce to remain competent and take on new challenges like we currently do with our early-career cohorts.

A Case for a Sabbatical

Another potential way of building competence and self-esteem in the mid-career stage is to provide the same type of opportunities across professional disciplines, such as sabbatical opportunities following a set number of years of service. If geared towards mid-career, this is an excellent opportunity to build new skills or build upon existing skills. It may also be an opportunity to recharge and replenish drained batteries whilst supporting and building new skills. Notably, a sabbatical is not a ‘break from work’ – it is paid leave to pursue new learnings and experiences. There will be many whose purview may not include further government debt to pay for an array of sabbatical opportunities, but this may be a sound investment compared to those associated with recruitment/replacement.

Building Leadership Capacity

The mid-career may also be an opportunity to support the development of competent healthcare leadership and management skills for those who aspire to these roles through theoretical and experiential learning. All too often, great clinicians are thrust into the roles of Managers or Leaders based on their longevity rather than their appetite or motivation. Learning the critical skillsets and competencies before taking up these roles will set people up for success. Effective leadership is most likely achieved through genetics, conditioning and learned skills, so enabling the opportunities to learn may join the triangulation dots. We also know that good leadership and governance, clinical and corporate, are the hallmarks of a safe and quality healthcare environment. So, by building mid-career competence, we are also building capacity within the system to excel.

Reaping the Rewards

In summary, regardless of when the ‘mid’ career starts and finishes, we must retain a seamless connection from early career to an eventual transition to retirement. We need to connect these dots and appreciate what experience and maturity bring. By building the infrastructure to support the ongoing competence of our mid-career health professionals, we can inject the necessary motivators to beat the ‘blues’ and retain those who can mentor our early-career workforce.

References

Pakkala, A. (2010).Mid-career blues in healthcare workers: A physiological approach in ethical management. Journal of Mid-Life Health. Vol 1, Issue 1. Accessed May, 2024

Author

Tony McGillion 

Tony McGillion is the Divisional Director of Education & Training at Northern Health and a Registered Nurse with over three decades of experience across various roles. He began his career in the UK, also working in Saudi Arabia, before transitioning to leadership and educational roles in Australia, including positions at Epworth Hospital, Cabrini Health, Austin Health, and as a policy advisor to the Victorian government.

He later joined La Trobe University as an Associate Professor and held multiple directorships. Tony holds a Bachelor of Education, a Master of Health Administration, and adjunct positions at the University of Melbourne and La Trobe University. He currently focuses on leadership development in nursing, serves as Chair for the Australian College of Nursing in Victoria and Melbourne, and mentors mid-career nurse leaders.