Do you work for fame, fortune, social justice, stimulation, or toys and leisure? Your answers will help determine what may be missing from your career.

"If the answer is toys and leisure, consider being a consultant who has control over his or her contracted hours. If the answer is social justice, consider working to improve the public welfare on a part-time or full-time basis," said Joel Yager, M.D., a professor and vice chair for education in the department of psychiatry at the University of New Mexico School of Medicine in Albuquerque.

If stimulation is missing, fund part-time sabbaticals or fellowships to pursue specific professional interests, Yager suggested.

If routine administrative, educational, and clinical activities need to be revitalized, try tackling intriguing questions or problems from a scholarly angle, he recommended. Diversify clinical activities by team teaching, teaching in other university departments, forming local study groups, or joining local and national professional organizations and attending their meetings, said Yager.

Carolyn Robinowitz, M.D., then dean of the Georgetown University School of Medicine, said she volunteers to teach different topics to second- and third-year medical students every year. "This probably complicates things for the psychiatry department, but it expands my armamentarium of knowledge."

Robinowitz, who is a former APA senior deputy medical director, also finds mentoring a student or resident gratifying. "I enjoy sharing my knowledge with young people and being able to offer advice and direction. Their energy and eye to the future also make me feel young," she said.

Making time for work they enjoy and for outside interests are important principles to 35 psychiatrists in private practice in the Dayton-Cinncinnati, Ohio, area. Jerald Kay, M.D., a professor and chair of the psychiatry department at Wright State University School of Medicine in Dayton, surveyed those psychiatrists earlier this year.

"Many respondents said that they carve out time to conduct short- and long-term psychotherapy because they feel this is critical to their growth as clinicians."

Another strategy respondents use to maintain clinical interest is seeing patients with a variety of diagnoses that require different therapies and techniques, said Kay. In addition, some of the respondents also limit the number of severe cases they see at any given time because the demands of treating those patients are great.

To keep abreast of trends in psychiatry and mental health, some private practitioners sought training in such therapeutic techniques as eye movement desensitization and reprocessing (EMDR) and hypnosis, while others sat for additional qualifications in forensic psychiatry or substance abuse. Some respondents look for opportunities to discuss difficult cases, medical politics, and management strategies, Kay said.

Yager noted that many people want to make changes but are uncertain about how to do it. He recommends the following steps to plan short-term changes:

• Pick the most important or desired outcome you want to accomplish by next year.

• Question your motivations and passions regarding the desired goal.

• If the goal meets this scrutiny, write a four-page concept paper on the goal’s aims, significance, and general methods and timeline.

• On New Year’s Eve, list specific tasks, events, and processes you will undertake to accomplish the goal by next New Year’s Eve.

To plan long-term changes, Yager recommends listing 25 things you want to do before you die. "Imagine your 100th birthday party. What would you like people to say about you?"