My original intention in studying medicine was to become a missionary doctor because I had an implicit belief, shared by many people, that 'full-time Christian work' was somehow more spiritual than working as a Christian in a secular job. This, I have since realised, is an idea that has no scriptural basis.
The apostle Paul makes it very clear that we should approach our secular jobs as if we were working directly for Christ, not for our line managers.[1,2] All Christians are full time Christian workers called to be salt and light to the world around us. I never became a missionary, but looking back I can see how God planned my career and prepared me for it.
During my undergraduate training I rotated through a number of different specialties. While I was on each attachment I was convinced that 'this was the career for me', whether it was psychiatry, obstetrics or general practice. I became a surgeon because the last attachment I did before finals was an elective in surgery (I reckoned surgery was going to be my weakest subject in finals so I thought the elective would be a good opportunity for revision).
The consultant, who clearly saw things in me that I didn't, suggested that I should consider surgery as a career because I had the right attributes for it. What those were he didn't specify but no other specialist had ever suggested that I was suited for their specialty so I applied for surgical training. I became interested in education because someone was needed to give lectures to the nurses and paramedics in the hospital where I worked and my boss volunteered me.
At no time did I ever imagine that I would one day become dean of a medical school and yet I am firmly convinced that this is where the Lord wants me to be. This leads me to ask, how are you supposed to make career choices? What criteria should be applied in making those choices? At first sight my haphazard approach to career planning should preclude me from giving advice to anyone else. But it does show that when God is doing the planning the outcome is better than we could manage for ourselves.
These are difficult times
The external challenges facing anyone attempting to plan a career today are immense. As I write this the House of Commons Health Committee has just published its findings on Modernising Medical Careers (MMC). The report is highly critical of the way change was introduced, particularly the Medical Training Applications Service. Everyone is aware that selection into specialist training was a disaster last year and is still problematic this year. In fairness, it must be said that the application process for the Foundation Programme is now working smoothly.
The report also highlights the increasing rigidity of MMC. The original aim was to increase the flexibility of training but the opposite has happened and training programmes are more tightly defined than they have ever been in the past. At the same time, the choice of career path has to be made at an earlier stage (mid-way through Foundation Year 2) than was previously the case. For those fortunate individuals who have known since they entered medical school what specialty they wanted to enter, there is no problem but for the majority there is little opportunity to try a variety of careers before finally settling for definitive specialist training. Even though by finals I knew I wanted to do surgery I did not settle on my final subspecialty (surgical oncology) until I was a lecturer.
The situation is even more uncertain for those who will qualify in 2010 and after. The Tooke Report  suggests further changes to postgraduate training. Some of the changes have been accepted by the government but others are still open for discussion. There is even debate going on about the need to introduce a national examination, either at the end of medical school or some time during the Foundation Years, that could be used to inform decisions about selection for training. How this would work is entirely unclear.
There are valid arguments for having aptitude testing as part of the selection process (eg are prospective surgeons good at making decisions on incomplete evidence?), but little evidence that academic ability predicts ability in a particular specialty. Should the people with the lowest marks get the best jobs on the grounds that they need more attention paid to their training?
Given these difficulties, how do you decide what career you are going to follow? We will look at this from two perspectives – firstly, the Christian principles that govern our choices and secondly, how we apply those principles in practice.
1. We are not free to make our own choices
As Christians we acknowledge the lordship of Christ, which means that we must follow his instructions. Paul reminds us that 'You are not your own; you were bought at a price', the corollary of which is 'Therefore honour God with your body'. In other words, all of our actions must be focussed on what God wants of us.
2. God has a plan for us
God clearly told the Israelites who were in exile 'I know the plans I have for you'. The New Testament confirms that God has a plan for us as Christians.
3. God directs us if we are willing
Wondering if we are doing God's will can give rise to severe anxiety. There are reams of books written on the subject of seeking guidance and following God's will. We can be left with the impression that discerning God's will is difficult and that it requires special spiritual exercises. God has promised that he will guide us. In fact, God tells us that while we plan, it is in the end he who decides what happens.[11,12]
4. Our central objective is to glorify God
It is important to remember that what we do in our professional life is secondary to our primary purpose of glorifying God, but it is still an important part of that purpose.
5. The church is the body of Christ
God has entrusted us with the task of doing his work on earth. It is through us that he brings help to those in need and extends his kingdom. He has given each of us specific gifts that are to be applied for the benefit of the body.15 As Christians our plans must be focussed on what we can contribute to the overall mission of the Church. This includes 'caring for the sick' but obviously extends much wider.
applying the principles
1. Pray about it
If we are honest, what we often do is ask God to make our plans happen. This is not prayer. Praying about your career is asking God to make his plans happen. It would be very comforting if he would show us the whole game plan (eg 'you will become president of the Royal College of Physicians and receive a knighthood for services to medicine' or 'you will work as a missionary in Brazil and see a great revival sweeping through your district'). But God guides us one step at a time: 'The Lord directs the steps of the godly. He delights in every detail of their lives.' This means that prayer about your career path has to be a continual exercise, not just something you do when you are applying for a job. On a practical note, it is very helpful to get a friend or friends to pray with you.
2. Examine your gifts
If you find psychiatry particularly enjoyable but struggle with dermatology, it is unlikely that the Lord is calling you to be a dermatologist. It is worthwhile talking to other people about what they see as your strengths. Sometimes colleagues or tutors will have a clearer idea of what you are suited to than you do yourself.
3. Learn about the options
Talk to people who are already following the career that you are interested in. Take time to go to careers fairs and exhibitions. Search the web for information. The National Health Service has a web page, as does the British Medical Association  and each of the medical royal colleges.[21-23] There are books about medical careers but they rapidly go out of date as the career paths change. They can, however, give you an overview of what careers are available and what they entail. BMJ Careers provides more up to date information on particular topics. If you are contemplating working overseas for a period, contact the CMF international team (firstname.lastname@example.org). They have an enormous amount of information and experience that they can share.
4. Make your choices
At some point you have to complete the application form and send it off. You cannot procrastinate forever. At this point you may be overcome by another attack of anxiety, wondering if you have made the right decision. Relax. If you believe God is guiding then you can accept that if it is his will for you to get the job you will, and if it isn't you won't.
5. No substitute for hard work
As medical students, you have a responsibility to God and your future patients to be diligent in your studies. If you believe God is calling you to a particular field, act in faith and take the necessary steps. For example, take opportunities to acquire relevant research experience (eg helping out with a project) and qualifications (eg PhD or MD) if you are pursuing an academic career.
No job offers?
It is difficult enough trying to decide what career path to follow. It is worse when every job application results in a rejection. This is the time to reassess your plans. When I was leaving the Royal Air Force (RAF), I applied for eight senior registrar posts and did not get short listed for any. With only two months to go before my RAF job finished I reassessed the situation and applied for a registrar post instead. I was invited for interview but did not get the job. Instead I was offered a one year post as locum lecturer which set me off on an academic career. What looked at the time like a difficult situation turned out to be an important part of God's plan. The apostle Paul reminds us that 'in everything God is working for the good of those who love him'. He goes on in the same chapter to remind us that nothing '…will be able to separate us from the love of God that is in Christ Jesus our Lord.'
Remember God has a purpose for your life and true success is fulfilling that purpose whatever it turns out to be. You may become famous in medical circles; you may become well-known in Christian circles; you may live in total obscurity. What matters in God's eyes is that you are faithful in the tasks he gives you and make full use of the opportunities he sends you to extend his kingdom.