Career focus: Generic careers for graduates

Generic careers for graduates Half of all careers for graduates are for graduates from any discipline, which includes medicine. Wai-Ching Leung considers the place of medical graduates in the wider world of work The nature of work has changed considerably and will continue to do so, but not all of these changes are reflect- ed in conventional medical careers. Employers outside the NHS now perceive the value of a medical degree and doctors' experience differently than they did previously. Doctors contemplating careers outside medicine need to take into account these factors that shape the future of work as they decide whether to embark on alternative careers and as they market themselves to prospective employers.

The future of work

The main driving force is "economic globalisation." Globalisation is defined as the accelerated flow of labour, capital, goods, and services between countries because of improvements in transport and communication and deregulation policies adopted in many countries.¹ Countries compete for capital investment from the major world corporations.² In order to attract that investment, it is necessary to have a flexible work- force with high levels of skill and a commitment to "lifelong learning" and training.³

To create a highly skilled workforce, higher education has expanded considerably in the past few decades and further expansion has been planned.⁴ The proportion of school leavers entering higher education has increased from a 10th in 1962 to a third currently. Since 1997, there have been over 250 000 graduates of first degrees and over 110 000 students completing postgraduate courses each year⁵ Of all first degrees conferred, 8% were first class honours and 42% were upper seconds, and 54% of first degree graduates were women. To create a flexible workforce to enable business to compete internationally, the government has gradually deregulated the employer-employee relationship in the private sector over the past two decades. The power of the trade unions and employees has been considerably weakened to provide a flexible workforce for employers. On the other hand, the government closely regulates the "supply side" services (such as health and education), which are often considered essential for Britain's competitiveness. Of course, they are also headline political issues.

The validity of the "economic globalisation" argument has been seriously questioned, and real doubts have been expressed that successive governments' policies will generate more highly skilled jobs.⁶ Nevertheless, these policies will considerably affect the nature of work.

Effects of globalisation

There are common themes in the effects of these changes on the future of work.⁷ These changes apply to conventional medical careers to a different extent.

Competition for high level skilled jobs - Given the vast increase in the output of graduates, the planned expansion of higher education, and the real doubt that more highly skilled jobs will be created, a long term trend of increased competition for vacancies for high level skilled jobs seems inevitable. Most reasonably attractive training positions now require an upper second class degree as a basic requirement. However, although medical workforce planning is by no means perfect, doctors pursuing conventional medical careers are substantially protected by such planning and restrictions of posts to doctors.

Specific knowledge becoming less important than generic skills - Currently, over half of all graduate jobs advertised are for graduates of "any discipline."⁸ On the one hand, this highlights the vast range of alternative careers available to doctors. On the other hand, outside conventional medical careers, a medical degree may not be considered more favourably than degrees in other disciplines, despite the length of the medical course. Most employers ask for evidence of demonstrable transferable generic skills.

Job insecurity - To nurture a "flexible" workforce, employers increasingly require all employees to work under short term contracts so that the organisation could "out-source" or subcontract their services when it is financially advantageous to do so. Whereas employees might once have expected to stay in an organisation throughout their working lives, it is becoming normal for employees to move between organisations frequently. This causes increased job insecurity in employees, especially when economic depression is looming. In conventional medical careers there have been no threats to permanent con- tracts for senior doctors.

Expectation of employees' "flexibility" - Employers increasingly expect their employees to work unsociable hours and beyond their intended roles. Doctors have always worked long unsociable hours, but, at least for junior doctors, there has been a reduction of such commitments over the past decade. In this respect, the gap between doctors and other careers is rapidly narrowing.

Work intensification - Work intensity has certainly increased in all careers, and this trend is likely to continue. It applies to both conventional and alternative careers.

Responsibility for lifelong learning As it is the norm for employees not to stay in a job forever, it has become the responsibility of employees to keep their skills sufficiently broad and up to date to be attractive to a range of employers. Doctors pursuing conventional careers also have this responsibility, especially with the introduction of clinical governance and revalidation, but they could expect support in the form of funding, protected time, and guidance on how to achieve their lifelong learning. Such support may not be available in alternative careers.

Individualisation - In alternative careers most employees now cannot expect to follow the career path of others. They need to manage their futures, develop in new directions, collect their individual portfolio of achievements, and use new knowledge and skills flexibly. By contrast, the extent of individualisation has actually been reduced in conventional medical careers, especially with the "Calmanisation" of specialist registrar training.

Effects on private life - There is evidence that the above effects cause stress to individuals and cause families to become dysfunctional.⁹ These effects have always been well known to doctors, and the gap between doctors and other careers seems to be narrowing. These factors might inform doctors' decision whether to enter an alternative career path or to stick within the conventional medical career structure. As might be expected, there are things to be said for and against both courses of action.

Increased choice of careers - As over half of all graduate jobs now are for graduates of any discipline, there is a wide range of employment opportunities. Some of these are training positions for more substantial posts. A survey of over 11 000 graduates revealed that the leading career destinations for graduates in 1999 were management consultancy, marketing, media, research and development, accountancy, information technology, and general management.¹⁰ For all these careers (apart from accountancy), it is possible to exploit your medical knowledge and experience by pursuing a niche with a medical slant.

Acceptability of making career changes - Experience in other fields is often viewed positively as it brings transferable skills.

Demystification of doctors - A medical degree is no longer accepted as a sign of intelligence or ability in itself. Transferable skills and competencies must be demonstrated.

Age - Medical graduates are usually older than other graduates. All things being equal, employers are more likely to employ younger graduates, as they are perceived to be more adaptable and to have a great ability to learn.

Degree classification - The classification of degrees often forms the basis of initial selection. Medical degrees are unclassified. Most employers would regard a medical degree as equivalent to at least a second class degree, but it is not clear how they would compare a medical degree with a first or upper second class degree in other disciplines.

Loss of traditional advantages - Escape from unsociable hours and intensive work, family life, and financial incentives were often cited in the past as reasons for considering alternative careers. These advantages are rapidly diminishing.

Uncertainty-Alternative careers are uncertain in comparison to conventional medical careers.

Other factors

Age and knowledge specific nature of the career - It would be realistic for younger doctors to compete for generalised graduate vacancies. It might be more appropriate for older doctors to choose alternative careers in which knowledge and experience in medicine and the health service would be substantial advantages.

Mismatch between existing employment and potential ability - Doctors whose existing employment fails to match their potential ability would be more inclined to seek alternative careers.

Balancing challenge and variety with security - Alternative careers are often more risky, but they can bring challenges and variety of experience.

Awareness of these issues would allow doctors to market themselves more effectively to prospective employers if they decide to embark on alternative careers. Besides focusing on knowledge specific attributes, doctors should also highlight how their medical degree and experience could contribute to generic transferable skills and attributes sought by employers.

Wai-Ching Leung, senior registrar in public health medicine, Department of epidemiology and public health, Newcastle General Hospital, Newcastle upon Tyne NE4 6BE
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studentBMJ 2000;08:217-258 July ISSN 0966-6494

2. Green A. Education and globalization in Europe and East Asia, convergent and divergent trends. J Educ Policy 1999;14:55-71.
3. McEwan A. What's "new" about the "new international economy"? Socialist Rev 1991;21:111-31.
4. Brown P, Lauder H. Education, globalization and economic development. J Educ Policy 1996;ii:1-25.
5. Higher education in the learning society. Report of the National Committee of Inquiry into Higher Education. London: Stationery Office, 1997.
6. Higher Education Statistics Agency. Qualifications obtained by and examination results of higher education students at higher education institutions in the United Kingdom for the year 1998/9. Statistical first release 37. Cheltenham: HESA, 2000.
7. Ashton D, Green F. Education, training and the global economy. Cheltenham: Edward Elgar, 1996.
8. Esland G, Ashier J. Introduction. In: Ashier J, Esland G, eds. Education, training and the future of work. London: Routledge, 1999.
9. GET2000. Graduate employment and training for Newcastle. London: Hobsons, CRAC, 2000.
10. Carnoy M. The great work dilemma: education, employment and wages in the new global economy. Econ Educ Rev 1997;16:247-54.
11. Birchall M, Allen L, eds. Times top 100 graduate employers. London: High Fliers Publications, 1999.