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Welcome to the Clinician Researcher podcast, where academic clinicians learn the skills

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to build their own research program, whether or not they have a mentor.

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As clinicians, we spend a decade or more as trainees learning to take care of patients.

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When we finally start our careers, we want to build research programs, but then we find

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that our years of clinical training did not adequately prepare us to lead our research

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program.

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Through no fault of our own, we struggle to find mentors, and when we can't, we quit.

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However, clinicians hold the keys to the greatest research breakthroughs.

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For this reason, the Clinician Researcher podcast exists to give academic clinicians

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the tools to build their own research program, whether or not they have a mentor.

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Now introducing your host, Toyosi Onwuemene.

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Welcome to the Clinician Researcher podcast.

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I'm your host Toyosi Onwuemene, and it is always a pleasure to talk with you.

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Thank you so much for tuning in.

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I am speaking because you are listening.

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Thank you so much.

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So Jay, I'm talking about how to handle frustration with the system.

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Plug in any system you want here.

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I am definitely talking about health systems.

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I'm talking about academic medical centers, but it's whatever system you want to plug

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in because there's always the system, either the system of grant submissions, the system

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of research administration, the system of seeing patients in the clinic.

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There's always a system.

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So I'm going to give some thoughts about how to handle or some thoughts to consider about

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how to handle frustration with the system.

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So I think when I was a younger faculty member, when I was earlier in my career, I feel like

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that was not that long ago.

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I was so much the crusader, like, oh my gosh, this is wrong.

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I can't believe how terrible this is.

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Somebody should fix it right now.

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And then I would go marching to my division chief and I would say, hey, this is a problem.

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And here's my one page proposal that I spent all night agonizing over about how best to

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fix it.

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And you know, kind person that he was, he did not laugh at me outright, at least not

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to my face, but clearly must have been thinking, okay, she just, just was born yesterday.

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What is she doing?

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But I was really serious about my crusades and I would get angry and I'm like, I can't

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believe, I can't believe you haven't done, oh my goodness, I was such a crusader.

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And you know, it's not a bad thing.

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I think, you know, I was young, I had a lot of energy.

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I'm still young, actually, I will tell you.

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But just, I had a different perspective then than I do now and a different understanding

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of how much, how valuable my time was and how valuable my energy was.

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And a lot of my energy just went into all these crusades that sadly I've won none of

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those crusades.

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And maybe I'm a little bit wiser now, but actually it just, the memory was triggered

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for me by a recent person that I met and she's a little bit younger.

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She just started her faculty career, maybe about a year, two years ago.

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And we were having a conversation about how the clinic sucks and this person doesn't know

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how to do this and I can't believe this patient didn't get scheduled for an appointment with

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me on time.

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And wow, there was a lot going on and she was so hot, she was so mad.

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And I remember, I remember that experience of being so angry all the time because people

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should know better, should do better and they're not.

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Anyway, so it was actually that conversation that sparked this podcast episode because

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I want to share with her and with actually me when I was there and with people who are

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in the same place of frustration, I want to just share with them thoughts about how to

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handle frustration with the system.

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So I'm going to share seven things.

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So the first thing is to recognize that you don't have the power to change anyone.

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And that's just a fundamental thing to recognize.

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This is so important because you always want to know like what power do you have?

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Let's say you're a superhero.

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What is your superpower?

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Okay, your superpower is that you can breathe underwater like a fish.

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Really great.

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But your superpower is not flying.

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And it's really important because once you know your superpower, you know what your superpower

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is and you know what your superpower isn't, there's some things you just don't try to

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do.

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The superhero who can swim like a fish underwater but cannot fly should not be trying to fly

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because trying to fly may result in an early death.

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Okay, so coming back from the superhero talk for you, okay, maybe you're not a superhero,

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but you got to know what powers you have, right?

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And I hope you have the power of influence because that's really good.

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That works.

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But the power to change someone else, the power to make them do what they don't want

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to do, the power to make them see things like you see it so that they can do it the way

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you want it done, you don't have that power.

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I'm just very sure you don't have that power.

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Now if you told me that you go around threatening people and they're afraid and you use fear

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to drive them, okay, that might work.

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There's a lot of fear tactic use in medicine.

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Okay, okay.

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There's a lot of strong arming and there's a lot of manipulating.

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Sure, you can do all that.

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It's a lot of work, but sure.

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But just recognize that until you have no power to change them, I mean, you can for

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as long as you're wielding fear as a strategy or you're wielding manipulation, it might

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work for a little bit.

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If you're really good, maybe it'll work for a while.

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But ultimately, even if you win them over, you win them over grudgingly, not because

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it's something you want to do.

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And as soon as you stop wielding whatever stick that you have, it will go back to normal

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pretty quickly.

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So it's just important to understand your superpower so that you don't invest time

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pretending to have a superpower that you don't have.

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And I will guarantee you have no power to change others and you know that.

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You intuitively know that.

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And so I hear people say, oh, I told him exactly what to do.

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I told him exactly how to do it.

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And he still didn't do it.

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It's like, yep, yep, that's not your superpower.

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All right, that's number one.

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Number two, I mean, I think this is really important to sit down and consider.

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Again, I always talk about Simone's maxims because somebody quoted it to me and I think

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it's still an important paper today.

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And this is this kind of comes, I mean, it's along that flavor.

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But it's just you need to recognize that systems are the way they are because they work.

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Yes, it may be completely dysfunctional.

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It may be totally crazy.

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And like you can't believe anyone lived like this.

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And everybody may be whining and complaining about it, but they don't get to become the

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way they are by accident.

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Your clinic and the way it runs inefficiently did not happen by accident.

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Your academic system and the way tenure and promotions happen did not happen by accident.

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The challenges that people experience in being underrepresented in the academy, those are

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things that don't happen by accident.

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They happen because they serve a purpose.

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Systems are the way they are because they work for some people.

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And usually they work for people with enough influence that going against the grain is

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usually not safe for other people, right?

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Systems are the way they are because they work.

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They serve a purpose.

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Systems work.

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They may not work in a way that seems functional to you, but they are the way they are because

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they work.

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And the reality is the moment they stop working for the majority, then they change.

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But you are frustrated about systems that have been in place sometimes for 70, 80, 90

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years.

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Some of you have institutions that are older than old.

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They've been around for a few hundred years.

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Wow.

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That's a lot of tradition, a lot of bias, a lot of just whatever it is that skews the

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culture of an environment has been going on for so long.

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You have to recognize that they are there because they work.

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You may not feel like it works.

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You may not feel like it's functional for patients.

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You may not feel like it's functional for your career.

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I'm not going to argue that, but they work.

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That's why they're still there.

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And the moment they stop working for the majority, they get overturned.

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And so I want to just emphasize that.

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So you recognize that even though you're super frustrated, even though you feel like something

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should change, there are people who would prefer that things remain completely unchanged

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because the way the system is suits them just fine.

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For example, I remember a time that I was trying to get a badge at the VA, at the VA

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hospital, the Veterans Administration Hospital, and I went to line up.

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I forget if this was fellowship.

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I think this was fellowship because I had a VA that I was connected with for clinic

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for my fellowship.

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And I went to go get a badge because I think my badge was expiring.

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And so I get there.

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It's probably like, I mean, it's after clinic now and I make it.

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I'm just in time.

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It's like 10 minutes to 12.

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And there's nobody in line.

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Can I just tell you that there's nobody in line?

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OK.

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So I'm waiting because I'm next.

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And there's nobody in line.

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This person who's working keeps working until it's 12 o'clock, then gets up, puts a sign

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outside the door saying off to lunch.

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And that was it.

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The whole place is shut down.

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I got there 10 minutes earlier, 10 minutes before lunch hour.

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Still didn't matter.

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The whole place shuts down at noon and then it's over.

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I say to myself, do I go back without this ID or do I wait for them to come back from

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lunch?

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And I decided to wait.

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I waited the whole hour sitting outside the window.

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I mean, sitting outside the office and finally got my ID.

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Eventually.

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It took a long time.

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But you know, if you've ever had experiences with VA hospitals, and again, that's been

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several years and at least a decade since I worked in a VA hospital.

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So clearly, I'm sure things have changed now.

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But I'm just saying that things work the way they work because they work.

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Because it's the culture, right?

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The culture of a place is just the collective experience that everybody is having.

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And different people experience a culture differently, but everybody comes together

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to create the culture.

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And so the culture we have serves a purpose, even if it's a bad purpose.

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It serves a purpose and that's why it's persisted.

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That's why it hasn't gone anywhere.

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So you just got to understand that this problem is older than you.

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Whatever problem you're frustrated by is usually older than you.

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In fact, it may be older than several generations of your family members.

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You just got to recognize that because here you are coming trying to, in a sense, fight

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against a pillar of your institution, a pillar, like a structural cultural pillar.

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That's what you're trying to come against.

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So you just want to recognize the impossibility of that task.

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Okay, number three is that you want to decide what's most important to you.

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I mean, the issues that we're bothered by are big issues.

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A patient wasn't seen, a patient wasn't treated appropriately, someone's treated disrespectfully.

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You heard about there's so many things and they are all important.

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They are.

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You have to decide what is most important to you.

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What are you here for?

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This is so important, especially for people who are underrepresented in the academy.

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Why are you here?

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It's so important to clarify.

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I mean, and sometimes we feel like, oh, we're here to build community.

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We're here to do this.

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And it's like, yeah, you could do all those things anywhere else.

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But why are you here specifically?

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Like, what did you come to get from here that matters to you?

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What is it?

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I mean, this is really important because you want to be very clear on why you're here,

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why you're in this place, why you're in the system.

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What did you come to get?

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For example, sometimes, let's say, you know, one of my fellows will be like off on a crusade

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and it's like, wait a minute, wait a minute, why did you come again to fellowship?

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I came to be certified, to be board certified in this area.

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Okay.

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Does this help you get that certification?

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I mean, you just want to be clear.

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Like, does it help you get to your goal?

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You want to be clear.

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It's like, well, no, I want to make sure it doesn't happen like this for someone else.

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It's a problem that's older than you.

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And after you leave, this problem will still be here.

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But you, you may leave without the certification you came for if you're not able to finish

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the work that you're actually supposed to do.

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And so it's just really important to clarify your goals for any environment.

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And we always have a goal.

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We always have a goal in our interaction in any environment.

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It's very rarely that we don't have a goal.

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And patient care, it's part of that experience, but it's not our primary.

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It's not our only goal, right?

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Or solving the problem of unhappiness in medicine is a great goal, but may not be your primary

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goal.

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It would be nice to do your work, get your outcome and make everybody happy.

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But if you have to choose, you want to know which takes precedence.

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And that's important.

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What is most important to you?

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Peace of mind, joy, harmony, all those things.

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You just got to recognize your values and nobody can tell you what those are.

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You'll be happy to work with you and help you figure it out.

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But you want to know that you know what's most important to you so you can clarify how

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much energy and investment you really want to put into handling or changing your frustration

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with the system.

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Okay, you've decided what's important to you.

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You're like, yes, this is something I really want to intervene in.

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Physicians are no longer happy.

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I'm going to do this initiative that's going to make all physicians happy.

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So decide on your intervention.

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It's one thing, you know, everybody can complain.

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I mean, oh my goodness, who doesn't love a good complaint?

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You sit down, you gripe, you're all angry, you all get so mad and then you can miss a

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rate because you're all experiencing the same thing.

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So everybody feels so good.

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Oh, yeah.

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I mean, so amazing.

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So awesome.

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So sweet.

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But you're in leave complaining and determine what intervention do you want to champion?

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What is the answer to the problem of not enough providers to see too many patients?

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What is your answer to that question?

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Great.

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How do you determine to solve it?

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Oh, you have a plan, an incentive plan for all physicians who see more patients than

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they're supposed to.

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Good for you.

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Figure out the intervention.

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It's so important because I think so many people get stuck in griping that they haven't

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determined what intervention they want to see or what intervention they want to champion.

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And you can make change happen.

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Absolutely.

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If you're very clear about what that change brings you, what gift it gives to you and

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what the intervention is that you have to make a difference.

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Okay.

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So determine after you decide what's most important to you.

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You're very clear about your goals for your stay here.

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Determine the intervention.

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So it's measurable, right?

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I made this intervention and this is the outcome that I got, right?

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Now in going to implement your intervention, whether that is you're trying to influence

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somebody else who's a decision maker, or you're trying to make a proposal to get people to

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buy in, whatever it is, it is important for you to decide upfront what you can and cannot

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live with.

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This is important.

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For example, one of my mentees had a situation where she really was frustrated by the way

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her clinical environment was.

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I mean, she was so frustrated.

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She was like, they don't do this, they don't do that.

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There's not enough support.

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It was a litany of complaints.

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And so at some point you have to decide, okay, wow, this, you know, I've been complaining

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since the day I got here.

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This is the way it seems to always be.

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What can I live with?

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What can I live without?

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What can I live with?

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Right.

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So you're making the decision that's too well, oh, okay.

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I guess this is just the way they work here.

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Can I live with it or can I just not work like this?

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And it's so important because the moment you recognize that you cannot work in a clinic

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where MAs are not available to support you, it's good.

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You now know what you can and cannot live with.

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What if you're like, it doesn't matter that there are no MAs.

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I'll work with one of the nursing staff who's not an MA, right, or one of the nursing staff,

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right?

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MAs are not nursing staff, but they're sometimes on their way to becoming nursing staff.

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So you decide that, oh, okay, I can't do this.

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Or you decide, well, you know, that's not such a big deal.

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You're the only one to decide what you can and cannot live with because the reality is

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that it is more likely that this problem that preceded you is going to succeed you.

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It's just more likely than not.

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I'm not trying to be pessimistic here, but you want to say to yourself, if change will

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never happen no matter what I do, to what extent am I prepared to live with things if

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this is the way they always will be?

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But you just want to make a decision.

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If your decision is no matter what they do, I'm going to stay, that's important.

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But if you're like, you know what, I cannot live like this.

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This is not the way I've envisioned my clinic experience.

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I don't want to do this.

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You want to make sure that you decide which pieces you can do, which pieces you would

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prefer not to have to do.

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Okay.

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The next thing is to set a time with which to see the intervention through because the

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thing about interventions is that they can take a long time.

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They need an awful long time for you to see it through, but you've got to decide, okay,

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I have 12 months for this intervention or I have three weeks for this intervention or

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I have two weeks.

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Whatever your timeframe, set it, set it.

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This is how much it's kind of like when you think about making an investment in the stock

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market, actually, to be honest, this is more like gambling with slot machines because I

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told you you can't change anybody, but we're just going through emotions here.

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It's like a slot machine.

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You put in a lot of coins, eventually you're going to hit, eventually.

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But you may lose a lot trying to hit this one round, right?

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So you just have to decide, it's like, I'm just going to do X number of dollars.

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In the moment you get to the X number of dollars, you're done.

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Even if it's like, I bet the next one's going to be it.

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Even if that's how you feel, you just say, oh, that's enough.

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It's the same thing.

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You're going to set the time with which to see your intervention through and you're going

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to say, no matter what, no matter how close I am, three months from now, seven months

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from now, two years from now, I'm going to be done.

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And you want to make sure to set the time so that you can really make the investment

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push as hard as you want.

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And then turn around and decide, you know what, the time I set for it, it didn't work.

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No thank you.

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And the final thing is be okay with quitting.

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In medicine, we struggle to quit things.

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We just feel like, nope, we must see it all the way through.

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We don't want to not do our obligation.

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But you know what, when you get to a place where you're like, you know what, people are

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hard to change.

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And I've done all the best that I can.

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I've created an intervention.

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I've seen it through.

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And wow, nothing's changing.

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It's okay to quit the crusade.

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It is okay to quit.

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And you may not quit medicine.

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You may not say, I'll never practice again.

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Or you'll never say, you may not say, oh, I don't want to do this clinical research

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thing anymore.

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Whatever it is, you don't have to quit the whole thing.

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But be okay with saying to the crusade, I've served you enough.

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It's time to move on.

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And it's important to do that because if you think about how much energy you expend trying

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to fight for what should already be yours, or trying to make people see reason, or trying

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to make them come around to your way of thinking, it's a lot of energy.

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And it's energy that you are not spending doing things that actually move you forward.

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You are stuck in, to some extent, the past of what could be you or how people might respond

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instead of really moving forward into your space of creativity, whatever that looks like.

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And so it's important to quit so that you're released.

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It takes too much energy trying to convince people to do things that they actually don't

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want to do.

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So when you have seen your intervention all the way through, you set the right time, the

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time frame that feels authentic to you, and you don't, if you don't achieve it, then you've

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got to be okay with saying, you know what?

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Okay, I quit.

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You don't have to quit everything.

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Remember, you just have to quit the one thing, that one thing that's really frustrating, and

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you want it to champion.

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You have to be willing to say, okay, maybe not me, maybe not me.

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If you struggle, if you struggle, definitely reach out to me.

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Let's talk about which of our programs may be a fit for you, and definitely reach out

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and let me know how I can support you.

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Again, remember that we have a webinar coming up December 20th at 12 p.m.

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When you have no research mentor, please sign up on our website, clinicianresearcherpodcast.com.

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You can also sign up on our coaching website, www.coedcoach.com.

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All right, to summarize how to handle frustration with the system, number one, recognize that

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you have no power to change others.

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Number two, remember, assistance are the way they are because they serve a purpose.

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They work, even though they may not work to your benefit.

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You want to decide what's most important to you, why you're really here, making sure you're

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not losing sight of what you really came to do in this environment.

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Determine the intervention.

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Don't just sit and complain, and decide what you can and cannot live with, set a time within

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which to see the intervention through, and finally be okay with quitting the crusade.

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All right, somebody needs to hear this episode, please share it with one person today.

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Just one person.

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Let's transform the lives of clinicians, scientists everywhere, one clinician scientist at a time,

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or one aspiring clinician scientist at a time.

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All right, it's been a pleasure talking with you today.

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Thank you so much for listening.

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I look forward to talking with you again the next time.

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Thanks for listening to this episode of the Clinician Researcher Podcast, where academic

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clinicians learn the skills to build their own research program, whether or not they

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have a mentor.

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If you found the information in this episode to be helpful, don't keep it all to yourself.

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Someone else needs to hear it.

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So take a minute right now and share it.

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As you share this episode, you become part of our mission to help launch a new generation

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of clinician researchers who make transformative discoveries that change the way we do healthcare.