Welcome to the Clinician Researcher podcast, where academic clinicians learn the skills
to build their own research program, whether or not they have a mentor.
As clinicians, we spend a decade or more as trainees learning to take care of patients.
When we finally start our careers, we want to build research programs, but then we find
that our years of clinical training did not adequately prepare us to lead our research
program.
Through no fault of our own, we struggle to find mentors, and when we can't, we quit.
However, clinicians hold the keys to the greatest research breakthroughs.
For this reason, the Clinician Researcher podcast exists to give academic clinicians
the tools to build their own research program, whether or not they have a mentor.
Now introducing your host, Toyosi Onwuemene.
Welcome to the Clinician Researcher podcast.
I'm your host, Toyosi Onwuemene, and it is an absolute pleasure to be talking with you.
Thank you for listening.
I'm talking today about whether it is time to stop being a team player, and I recognize
that the title of this podcast episode seems a little controversial.
What do you mean?
I should stop being a team player.
I'd like to point out that the title of the podcast episode is, is it time to stop being
a team player?
That's a question.
It's a question you got to answer.
I did toy with calling it, you should stop being a team player, but you know, that is
more controversial than the question.
So I like the question because it's, you know, it's tentative.
You get to decide.
Perhaps the answer at the end of the podcast episode is, oh, definitely no, or maybe it's
yes.
Let's see.
Anyway, but the reason I want to bring this up is because it came up yesterday and it
came up in the context of a conversation I was having with an external invited speaker
who I was taking to the airport because it made sense for me to take her to the airport.
I was going to be able to connect with her and I didn't live too far from the airport.
So anyway, so we're conversing and the conversation turns to call.
So she has a specific, you know, makeup of her clinical work and she doesn't participate
in a certain call and so I asked, oh, you have this number of providers in this area.
How do you manage call?
It's always a question that's interesting to me because what I find is as a hematologist,
they're not many hematologists.
And so let's say there are three or four at one institution.
It's like, wow, do you guys split, you know, the call three ways for the entire year?
I'm always curious to know how people do it.
So what she said, she was like, well, I don't participate in that call because I have my
own call schedule that nobody else covers for me.
And she's like, but of course I'm a team player.
And that is the exact phrase that leads me to this podcast episode because I only hear
that team player term in the context of taking on more work.
And so here I am ready to talk about this episode and why I think it applies to clinicians
who are working to lead research programs.
What does it mean to be a team player?
Well, I will tell you that I was a kid who did sports in elementary school.
So I understand playing on a team.
I also now as a parent take my kids to play games.
I get being on the team.
And so I'd like to just lay out for you what I see as being on a team and being a team
player in the context of sports.
And then I want to bring it back to academic medicine and try to correlate it because I
think there's a challenge in the way we're defining the game in academic medicine and
a way in which we're defining the team.
And I'd like to just offer some suggestions as to whether it truly is a team sport and
to clarify your role as a player on this team and whether playing on the team is right for
you in the context of your academic career or not.
OK.
So let's take the game of basketball because now I am learning a lot about basketball because
my son plays basketball.
OK.
There are, to my understanding, five players on each team.
And the five players on one team know that the goal is to get the ball in the hoop as
many times as possible over the course of the game so that at the end of the game there
are more hoops or more points to your team compared to the other team.
And that is how a win is defined.
And in the context of playing the game, there are things called fouls.
There are things you're not allowed to do.
And clearly the real goal ultimately is to score the basket.
And when you score a basket, you score as many as possible.
You prevent the other team from scoring a basket and you win.
And if you win enough games over the course of a season, you end up with a championship
ring and a trophy.
OK.
That's the game of basketball.
If I've gotten it wrong, feel free to send me a DM and school me.
I would appreciate it.
OK.
Let's now come to academia.
Hmm.
Well, in academia, what is the game?
What is the game?
To my understanding, the game of academia is about excelling in scholarship.
The reason you excel in scholarship is because when you excel in scholarship, it brings you
reputation.
You are known as a scholar in X field.
Your growing reputation grows the reputation of your institution.
And so the more you're growing your scholarship and all of you on the team, the more you're
all doing it, all the faculty are growing scholarship, it increases the reputation of
the faculty on the scholarship and the institution increases its reputation, thus also continuing
to increase the reputation of faculty.
That's my understanding.
And if I'm wrong, this is also an opportunity to school me.
Now here's the challenge in academic medicine, especially for us clinicians.
It sounds like scholarship is not the only thing that we do.
OK.
As clinicians, we take care of patients.
And if we define the game of taking care of patients, our goal is to take care of patients
safely and to help them be as healthy as possible.
If you work in the ICU, it feels as if your game is to not let patients die, maybe.
But anyway, our goal is patient care, right?
The overall health and well-being of the patient.
OK.
So that's the part that is patient care.
And then administration, the goal of an administrator is to make sure things run smoothly, is to
set the direction of the organization.
And OK, I forgot about another mission, the mission of education, which is different from
the mission of scholarship, because scholarship is about research and it's about moving forward
knowledge.
So then there's the part of education.
And the goal of education is to educate the mind, the mind of usually students in the
institution who bring in money to the institution through their tuition that they pay.
And that is the goal of education.
So for us, clinical faculty or academic clinical faculty, there's a little bit of confusion
because scholarship is part of our role.
Though for many of us, we really have more of a clinical role than we have a scholarship
role, yet we're still required.
We're still held to a scholarship standard.
However small that may be, there's still a scholarship standard.
And then there's also a need for teaching.
And so teaching, clinical care, and scholarship sometimes clash with each other.
We try to do our clinical care in the context of education, but sometimes educating limits
our ability to do the clinical work well.
But we recognize that the benefits of educating the next generation far outweigh the drag
that it brings to our clinical work.
Because if you were running by yourself, it would be so much faster.
But if you're running with a trainee, it will be much more fun, though slow.
So we're able to integrate the concept of education within clinical care.
Okay, when it comes to clinical care though, and scholarship, how we can overlap them,
they don't always overlap, but how we can overlap them is to make the scholarship relevant
to the clinical care.
But in executing the scholarship, they really don't go well together.
So for example, you're in clinic, it makes it hard to write the paper.
It makes it hard to write the grant.
You have to finish with the clinic, dispense with the activities of the clinic before you
can go do all the other scholarship work.
But advancing scholarship is the goal of any academic institution.
And any academic institution that abandons its scholarly work to focus solely on all
its other work is no longer really an academic institution.
It's an institution, it's a hospital probably, but not an academic institution.
Okay, so now that's part of the challenge.
As academic physicians, academic clinicians, we've got a lot of roles, and sometimes they
don't overlap.
Sometimes your ability to provide what people say is excellent patient care, which usually
is seeing as many patients as possible, and that may or may not be excellent.
We can talk about that another day.
Just being able to do that does not allow you to move the scholarship forward.
And so then the question is, which do you choose?
And that's a challenging question, but we're not really here to talk about how you prioritize
one over the other.
But I do think that our institutions do that for us, right?
When we are coming into a faculty position, we're agreeing, I mean, 50% clinical and 50%
research.
So agreeing at the split of our hours is between clinical and research.
Now obviously it's more complicated than that.
It's never exact, but you know, on paper, that's what it says.
And so, but whenever there is a need to kind of like overstep the boundary of your scholarship
and pull you in to do more clinical, let's say for example, there are five of you esteemed
hematologists at the institution, and two people quit, all of a sudden there are three.
My understanding is that being a team player means leaving everything else to make up for
the load of two more people.
And I think the question I would ask is, is that playing the right game?
Is it really being a team player to drop everything and pick up the load of two extra people?
Is that really playing as a team?
And that's the context in which I keep hearing the term team player.
It's like, hey, leave all your work so that you can help the team.
But I think it's important to define the goal of the team.
I think it's also important to define who is included on the team.
Now when a championship team wins a championship, everybody celebrates the trophy together because
the trophy belongs to the team.
Now if you leave the team, you don't get to take the trophy because the trophy belongs
to the team.
But in a championship game, everybody gets a championship ring.
And no matter where you go, the championship ring stays with you.
So in the context of playing on a team, it's important to recognize that only the members
of the team get to claim the reward of the team.
If for whatever reason you are not a member of the team, when it comes to the time for
the reward, you don't get one.
For example, let's say you've been following this basketball team around for a while and
you didn't know that all along you were actually just the janitor and they were giving you
a suit to wear and you were not allowed to play and nobody told you you were not on the
team.
But they were doing some weird shady things that make you think, am I really on this team
or not?
When it came to time to collect the championship ring, it became clear who was on the team
and who was not on the team.
OK.
And so that's one of the things that comes up, especially for people who are underrepresented
in academia, is a question of who is really on the team and are you counted as an equal
and respected member of the team?
I think this is something that's important to clarify because it defines your role on
the team.
Are you actually there as a true player that is respected for their contributions to making
the team advance?
And so the two components, it's like, what's the game that's being played?
How do we know we win?
And who is a true member of the team?
So I say all that to set the stage for the points that I'm going to raise.
Number one is that the game of academia is confusing.
It's confusing because, you know, in a regular game of basketball, the rule is very clear.
You're trying to get your baskets and then your shots in the basket and you're trying
to do it and prevent the other team from doing it so that at the end you have more shots
in your basket than the other person.
In academia, the game can be confusing because it's not always clear exactly what that game
is.
But I would argue that if we're in academic medicine, if we're in an academic institution,
then scholarship is the win because scholarship is what makes the academic institution academic.
And everything else really rests on the foundation of scholarship.
And I get that patient care is the foundation of our institutions because we must care for
the person, but we care for the person in the context of scholarship and we don't get
to really advance patient care until we can advance scholarship.
So really, scholarship and patient care are integral and one should not have to suffer
at the expense of the other.
And I believe it's possible that both can move forward together.
But academia can be confusing because sometimes what I see people saying is that, no, no,
no, clinical care matters more than scholarship.
And I think the reality is that scholarship and clinical care must move forward and sometimes
scholarship is critical to advance clinical care.
And so the game of academia is confusing and that's why it's important to clarify, hey,
if we're talking about being a team player, let's clarify the game we're playing and
what the rules of the game are.
Okay.
Number two is that academia is about excelling in scholarship, right?
I'm here to excel in scholarship.
If I was here only to excel in clinical care, I wouldn't be here because I'm at an academic
institution because there's an academic focus to my clinical care.
So I would like to argue that academia is about excelling in scholarship within the
context of patient care and within the context of learner education.
Okay.
Number three is that taking on more academic work can hurt your scholarship.
Because in order for you to do scholarship within the context of an academic institution,
you do need to have space created for the scholarship.
And whenever, number one, you're not given space to do the scholarship or your time for
scholarship is taken away in favor of another task, no matter what the task is, then it
hurts your scholarship.
If I take on more non-academic work, it hurts my scholarship and therefore in the grand
scheme of things, it hurts the team and we don't win in the way we're supposed to win
in scholarship.
Okay.
Number four is that when people ask you to be a team player, they're not saying, hey,
you should be a team player.
You need to continue to advance scholarship.
They're saying, hey, you need to be a team player.
You should do less scholarship so that you can take on these non-scholarship tasks because
these non-scholarship tasks make you a team player.
But do they really?
If we are down two physicians in a practice that needs five physicians, then it means
we don't have capacity as a team to take care of the patients we have and then we have to
decrease our capacity.
Right?
So if we are working in a factory and one of the machines breaks down, then it means,
okay, well, we're not able to fulfill our quota today.
But if we say, well, the machine is down, therefore I'm going to try to work like a
machine, I might break in the process and that's a problem as well.
Now, as institutions, we are responsible for making sure that the people who are working
with us do not break in the process.
Let's go back to the sports analogy.
A player is playing and gets hit on the head, has a concussion, the game stops.
The game stops long enough for the player to be carried out, usually on a stretcher,
to be attended to because a hurt player in the game is no benefit to himself or herself
and is not a benefit to the team.
Why is it in academic medicine that we allow people who are hurt to continue to play, they're
getting more hurt while the game is going on and the institution of the team is suffering?
That's not being a team player.
So somebody is saying, hey, I'm not going to give you any extra support or any extra
effort or any extra time for taking on additional work, which I know is actually stressful to
you and your life outside of academia, then they're not really playing a game that is
a good game and that game doesn't lead anybody to win.
Playing with a team full of players who are hurt does not lead the team to a win.
Playing with players who are overstretched beyond their capacity does not lead to a win
for anybody.
So this concept of asking people to become team players by taking on more tasks that
do not enhance their scholarship or the scholarship of the institution is suspect.
Point number five is that when women and people who are underrepresented in medicine are asked
to be team players, they're usually being guilted into taking on projects that may not
advance them.
Hey, be a team player.
Will you take on this task?
It's a guilt strategy.
I've noticed it.
It's a guilt strategy.
Or I should say it's a strategy of inducing guilt.
Oh, be a team player.
Take on this project.
But that project may not advance you.
And if it doesn't advance the player, that means it doesn't advance the team.
Any strategy that doesn't advance the player doesn't advance the team.
OK, let me go back to the basketball analogy.
So this last game I went to play, I went to see my son didn't play in the game the whole
time.
So he didn't get play time, but that's fine.
Play time is not the only time that you get to play.
You get to play also when you're practicing.
You get to enhance your skills.
Your skills are enhanced the more you play.
But I could see that it was a tough game.
And I could see that in that game, they only wanted to field their very, very best players.
So literally the same five kids played the entire time.
I got it.
It was a really tough game.
I was a little worried.
I was like, wow, never seen elementary school.
Actually, they were not elementary age.
They're middle school.
They really played.
It was one of those really important fights.
Or I should say it was a game.
It was a really important game.
But anyway, so he didn't play on the game, but that's fine.
As part of the team, we expect that throughout the season, there are games that he's going
to be able to play.
And there might be games where he may not play as much.
But at the end of the day, there is development of the player that comes every time the player
is asked to play.
If a player is not asked to play throughout the season, then they're not being developed.
And that means the team is not being developed.
And if any of those five players have major injury and none of the other players have
been developed, then that means that the team doesn't really get to move forward in the
same way.
So I think I'm saying all of this to say that any game that does not benefit players and
benefit players by helping them advance and grow is not a good game for either the team
or the players, as long as these team members are actually part of the team.
So any game that says some people don't get support to advance doesn't actually advance
the whole team.
Any game that says some people are the only ones responsible for X, Y, Z, whatever that
may be, is not really a game that's good for the team or for the player.
So what I want to say with my point number six is that when people ask you to be a team
player, I'd like to ask you to pause.
Ask them to define the game, ask them to define the win, and help clarify that you're actually
a member of the team.
And this is important because I think what we're seeing in academia is that there are
a couple of games being played at the same time.
It's not all a cohesive game that clearly leads to a win.
And that's okay.
You know, you think about a basketball season, there are several games being played all on
the way to the championship game.
And so it's fine.
But you want to be clear.
When someone says, hey, be a team player, say, hey, what's this game?
And how do we know that we win?
And am I a member of the team?
Am I?
Am I a member of the team such that when the win happens, I am also part of the win?
And this is the point at which I want to stop and recognize this concept of Simone's Maxims.
I don't know if you've heard of them.
Dr. Simone is a guy who wrote an article.
Actually, he did a lot more than write that article.
But that article anyway was introduced to me by a colleague.
And he would always bring up the article whenever we got upset with the institution.
Like I can't believe this happened to me.
It's like the institution doesn't love you back in Simone's Maxims.
So I think there are like maybe seven to 10 Maxims.
And it just reminds you of how you and the institution are different.
For example, it talks about how the institution has a long time horizon.
And so you can't be comparing yourself to the institution.
The institution will be here long after you get back and long after you're done.
And so you want to be clear that your time horizon is different from the institution's
horizons.
One of the favorite things, one of the favorite pieces of advice from that article my colleague
would bring up each time is that the institution doesn't love you back.
This is important because sometimes there's this sense that as clinicians, our job is
to sacrifice ourselves on behalf or on the platform of the institution, which is not
appropriate.
Because if we burn ourselves in the process of trying to bring light to the world, then
at the end, there is no light and we're still gone.
And so when people ask you to be a team player, you want to be clear, what is this game that
we're playing?
Because not every game is a good game.
Not every game leaves everyone in the team with a win at the end.
Not every game is considering all team members to be equivalent, equal, respected members
of the team.
So especially if you are underrepresented in the academy, you want to be clear when
people ask you to be a team player that you understand the game, understand the win, and
to clarify that you are a respected team player who's going to be part of the win when the
win is announced.
So my very final point to you is that you should ask these questions so that you can
decide for yourself if it is in fact a game you want to play.
You should decide for yourself if it is in fact a game that you want to play.
I will say that every game is not a game to be played.
It's like the Hunger Games.
It's like, oh, these are games.
But at the end of the game, some people die.
Is this the game you want to play?
You got to decide that.
And so my call to action this week is to ask yourself if the game you're playing is the
one you want to play.
And I'm going to ask you, if you're not clear what game it is you're playing to go clarify,
please don't play a game where at the end you burn up as part of the games being played.
Don't play it.
But if you're going to play it, you want to play it intentionally.
You want to know that, oh, OK, this is the game I play where at the end I'm sacrificed
at the end of the game.
You want to know.
Because if you want to do that, you should do that.
That's called being in the military.
It's like I am serving on behalf of my nation.
And if I die in the process, this is the price I choose to pay.
It's serving the military, but it's not playing a basketball game.
Playing a game is not the same as serving the military.
But what I want you to do is to clarify what you're doing, what game you're playing when
people ask you to be a team player so that you can decide, is it time?
Is it time to stop being a team player?
All right.
I am glad to have brought you that episode.
Clearly, I have a lot of thoughts in my mind surrounding that episode.
I'd like to hear your thoughts.
And I also want to invite you to consider coaching, because I think it transforms your
life as a clinician, especially a clinician who's trying to build a research program,
when you might not actually have the support to do that.
So let's talk about how I can help you shape the career that you actually want to have.
For everyone else, I invite you to please share this episode with somebody else who
needs to hear it, because it's important that we are playing games that we want to play,
and that at the end of our sacrifice, at the end of our really pulling, we know that the
award that's coming to the team is also coming to us.
And I invite you to please share it with someone else who needs to hear it today.
All right.
Thank you for listening.
I look forward to talking with you again the next time.
Thanks for listening to this episode of the Clinician Researcher Podcast, where academic
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