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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 such a pleasure to be talking with you today.

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Today in particular, I'm talking about promotion and why it's never too early to be thinking

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about promotion.

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Even before you start your faculty job, you should be thinking about promotion.

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And today I'm here to talk to you about five reasons why it's important to think about

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promotion early.

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I will tell you that when I first applied for promotion, and this was about 2019, it

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was such a stressful experience.

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And the biggest stressor was that I was writing this intellectual statement where I needed

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to tell my life story of how I had contributed in scholarship, in clinical work, and in education.

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And I felt so stressed.

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I felt like I was trying to justify my existence.

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And so every time I was writing, I was like, well, you know, here I have done all this

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work and I really felt like I was trying so hard to justify what I was doing.

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And so it was really important when one of my colleagues said, oh, no, it's not, it shouldn't

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be stressful.

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This is just a way to tell people what you're doing, because if you don't tell them, then

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they actually don't know.

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And so what you're doing is telling them what you're doing.

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And that was so important.

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That was so helpful because it helped me reframe.

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At first it was like, well, why do I have to prove myself?

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But then it was like, it's true.

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When you are applying for promotion, it's not just the people within your division who

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may or may not know what you're doing.

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It really is faculty within the School of Medicine and they don't even know who you

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are really.

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Maybe they've heard of you or, you know, they know of you clinically, but they don't know

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what scholarship you've done.

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And so it was really an opportunity for me to sit back and think about, well, how will

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people know unless I tell them?

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And so that took the pressure off.

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It wasn't so stressful anymore.

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Actually, it was stressful the first time.

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The second time around, not so stressful because I was like, okay, you want to know what I've

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done in education?

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Boom, boom, boom.

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You want to know what I've done for my publications?

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Here they are.

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You know, it was just much easier because it didn't feel like I was trying to justify

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my existence as much as it felt as if I was really just trying to help people understand

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what my scholarship was.

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Okay.

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So it's an important process.

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And I think it's a process that everyone should come, should go through.

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And you may be like, oh, no, I'm not interested in the promotion stuff.

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And I would say that even if you're not interested in promotion, it is still important for you

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to think about it.

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Okay.

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Let's talk about reason number one.

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So the first reason why it's important to think about promotion early is because early

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on you get to understand what your institution values.

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Why does this matter?

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Well, if you are a clinician scientist or an aspiring clinician researcher, then you

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care about scholarship.

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So if you're at an academic institution, your academic institution also cares about scholarship.

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And they are explicit, I hope, about what parts of scholarship they actually value.

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But the only way you understand it is by going and looking in the promotion materials where

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they lay out, okay, if you're a clinician scholar, this is how you, this is what we

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value.

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These are the number of publications or these are the kinds of publications we value.

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These are the kinds of clinical work that we value.

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These are the kinds of educational investments that we value.

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But you don't know unless you go look for it.

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And one of the things that's really important is that many times, and we know the feeling

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of our clinical work overwhelming everything that we do, such that it's like, I don't have

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time to think, I'm so busy clinically.

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Well, you know, if we're not careful, clinical work overwhelms everything we do.

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And then when it comes to time for the annual review or it comes to time for promotion,

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it's like, well, I've been so busy, I haven't had time to do all the scholarship.

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And people look at you and they're like, well, these are the metrics.

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And if you don't meet them, then you just don't meet them.

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And so it's really helpful from the very beginning to know, oh, you want me to produce three

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original research manuscripts every year?

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Oh, okay.

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But I'm full time clinical and I don't have any research time.

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How would you like me to accomplish that?

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Powerful questions.

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And it just helps you, it helps you be clear about what you can and cannot accomplish easily.

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And if you understand what the metrics are or what's valued by your institution, it helps

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you start to think about how do you align what you do or how do you align what you care

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about with what your institution cares about?

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So the very first and perhaps the most important thing is that understanding the metrics for

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promotion helps you understand what your institution values.

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And when you understand what your institution values, you make informed decisions.

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But I'm getting ahead of myself.

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It is important to understand what your institution values.

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Now if you're someone who's early, early, and you haven't even gotten the faculty job

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yet, it is so important to understand.

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Because when you go to negotiate, you're like, hey, this role requires that I have three,

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four publications a year, but you haven't created space in my schedule for me to be

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able to have any scholarship.

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How am I going to accomplish this?

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And it really helps you to begin to negotiate for resources.

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Because if your institution says it's valued, then you can say, well, you value it so much,

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how do you help me accomplish it?

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And then you can come on the same side of the table with the person who's hiring you

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to say, wow, let's see how we can make this work.

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And so understanding what your institution values is so important, and clarifying it

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through the promotion materials is important too.

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Because they may say, oh, we don't expect clinicians to publish anything.

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Oh, don't worry about that.

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And then you look and you're like, but it says very clearly that you don't get promoted

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without these items.

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How do you reconcile that?

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It really, really helps you understand clearly.

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And then you can think about how you want to live, how you want to exist within the

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institution.

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Okay, so the very first thing is that it helps you understand, recognize what your institution

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values.

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Okay.

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Number two, it helps you direct your conversations.

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Now I've alluded to it a little bit in what I said, right?

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It really helps you think as you're having conversations with your mentors or your division

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chiefs or division directors or your chairs.

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Every time you come up for the annual review, you're very clear about what you should be

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talking about, what challenges you've had.

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I mean, you can talk about any challenges.

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Hopefully you're not going to your annual review and complaining.

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But you know, when they say, hey, let's talk about all the things you've accomplished,

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you can say, yeah, and looking at our promotion documents, these are the things that are still

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yet to accomplish.

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These are the resources I need to be able to accomplish that.

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Or you can say, yeah, according to the promotion documents, here are the things I'm already

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doing.

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And I think it's important to continue to do X, Y, Z.

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But it's really a great opportunity because it directs your conversations.

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You can be very clear about, hey, this document says this matters to the institution.

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And I want to make sure that you understand that because it matters to the institution,

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it matters to me.

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And so you're able to really focus in and direct your conversations better because you

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recognize fully what your institution values.

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OK, that's point number two.

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Point number three is that it helps you be strategic and intentional.

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OK, let's go back to the fact that clinical care is overwhelming.

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And many times you could just, you know, burn daylight hours just taking care of things

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that are relevant to patients.

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And these are all great things.

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But you could spend a lot of time on the phone doing prior authorizations, playing phone

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tag, trying to catch the patient in between appointments.

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You could spend a lot of time doing all this stuff that's really good, but it's not highly

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valued by your institution.

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And what it allows you to do is to say, hmm, if all the prior authorizations I'm calling

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are not highly valued, how do I minimize the time I, that's you, it doesn't mean the prior

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authorizations are not called.

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But how do you minimize the time you spend calling those prior authorizations?

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And it may be that you have somebody who is a financial counselor whose job it is to help

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call those prior authorizations.

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And then you figure it out and you're like, hey, financial counselor, I have three or

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four of these.

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How can you help me?

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Or you find out that you don't have a financial counselor who's in charge of those things.

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And then you go to your division director and say, hey, division director, I'm spending

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four or five hours a day calling these prior authorizations.

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How can we fix that?

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Right.

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And so what it does is allow you, it allows you to be strategic and intentional because

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you recognize that 80% of what you do is not detailed within what are, what is outlined

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in those documents as the priorities of the institution.

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Now they value your clinical, your clinical expertise, right?

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They value you doing work clinically, but there's a very specific context for what that

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value is.

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So for example, at my institution, they value you being someone to whom specific conditions

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are referred.

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So they want to know, okay, well, are you, are you, are you well known for your expertise

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in a certain disease such that people are referring to you?

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And if you're going to be well known for a certain disease, such that people are referring

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to you, they're referring them to you because they know of you and they know of you perhaps

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because you've given talks or perhaps you've written papers about this particular disease

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situation.

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So you have to understand that when you understand what you have to understand that when you

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understand, but you recognize that when you understand what the promotion metrics are,

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what's valued clinically, then it helps you be strategic about your clinical care.

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So it's like, oh, okay, well, if they want me to be very well known for one area, then

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maybe I need to tailor my clinic to two or three diseases that are most important to

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me and become the expert in these two to three diseases.

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And it may be that that's a decision you make, or you may say, oh, okay, well, maybe here's

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what I'm going to do.

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I'm going to go out and give talks so that people know that I am the go-to person for

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this particular disorder.

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And I'm not telling you what to do.

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I'm just saying that it helps you be strategic and intentional so that you don't get to six

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years down the road when it's time for promotion and you're like, oh, wait a minute, I didn't

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realize that this was recommended or this was important or this was needed.

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You early on are starting to build that into your practice.

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And the earlier the better.

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And it may be that you're like, well, I don't really care about promotion.

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I'm not here to be promoted.

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It's still important to recognize what's valuable and to set yourself up in case you change

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your mind.

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All right.

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As long as you're in an academic institution, why not do the things that the academic institution

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says is important to do so that you can succeed in doing them.

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And if you decide that you don't care, that's fine.

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But if you do decide that you care, then you're not stuck saying, I wish I had paid attention

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to it earlier.

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Okay.

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That was number three.

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It helps you be strategic and intentional.

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Okay.

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Number four is it helps you shape your story.

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So I want to share a story about this before I explain this shaping your story business.

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So for me, I remember the first time I went, I was thinking about promotion and they said,

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oh, you should go talk to this guy who really helps faculty think about promotion.

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And I'm so glad that we had a guy, we had somebody whose job it was to really help faculty

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think through their promotion packets.

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And so this was years before I needed to go up for promotion.

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And I went and he was like, but I don't, he actually, the first thing he asked me to do

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was to write my intellectual statement.

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And I thought, why?

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I don't need to do that yet.

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Why give me busy work?

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I was actually kind of annoyed because I was like, I don't need to do this.

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I don't need to go out for promotion for a few years.

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Why do I need to write my intellectual statement?

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But what he said, and I don't think I wrote it when I first met him the first time, he

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was like, I just don't understand what story you're telling with your CV.

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And I kept trying to say, well, I'm trying to be this person who's doing this.

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At the time I was doing heart transplant rejection, I'm a hematologist.

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So totally, totally didn't feel like it fit.

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And he was saying that I don't get it.

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I don't understand what story you're creating.

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And to be honest, I had a hard time with it too, because I was like, what do you mean

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what story?

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I know exactly what I've done.

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And he was like, I don't see the story.

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But what I realize now is that to some extent, when you are putting together your intellectual

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statement, you're telling a story, you're weaving a story of why your clinical work

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is relevant to perhaps your scholarship, to perhaps your education.

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And what story I maybe should have been telling is that I'm a hematologist.

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I do hematology things.

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I give hematology talks.

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Or if I said it's cardiac transplant, be able to weave in the cardiac transplant into my

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hematology story in a way that's cohesive.

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And so honestly, I wasn't thinking about the story so clearly.

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I wasn't building something coherent.

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But the moment it became clear that the story mattered, I started thinking strategically

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about the work I was doing.

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And I thought to myself, well, I really like this working cardiac transplant, but how do

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I bring it home to me as a hematologist?

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And I started to become a little bit more strategic about the way I showed up academically

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or showed up in scholarship so that I could build a story that made sense.

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And so it really does help you shape your story, because you're thinking, hmm, in a

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couple of years, I'm going to need to write a story.

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Or actually, you should start writing early.

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It's never too early to start writing your intellectual statement, because it forces

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you to think, what story am I weaving together with my educational pursuits and my clinical

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work and my manuscripts and my articles that I'm publishing?

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What story am I telling?

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And really, in the process of starting to tell the story, then you're able to reflect

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on the story and decide, is this a story I actually want to tell?

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And so it's one of the things that's so helpful is that you can start to shape your story

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in advance of needing to shape the story.

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Now, here's the thing about life.

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No matter what happens to you, you can create any story you want out of it.

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And really, you can make all the pieces fit.

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You're like, yeah, heart transplant helped me really think about why I felt like blood

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was the most important thing.

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You could do anything you want.

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You can do anything you want.

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However, it's actually really beautiful when you can be intentional about the story you're

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telling.

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And so that's what I recommend is be intentional about the story you're telling and understanding

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your promotion and tenure requirements allow you to be intentional about the story early

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on so that it doesn't look half hazard when you come to telling the story.

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OK, number five is that it focuses you.

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It focuses you.

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In life, there will never be enough time to do all the things you don't want to do.

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And I love that quote.

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And it's not mine.

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It comes from a book I read that goodness now I do not remember it.

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But anyway, it's an important quote.

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It's not mine.

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And I will put it in the show notes so you know who said it.

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But it's just it's true.

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There's just too many things to do.

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And to be honest, everyone's kind of screaming loudly and trying to get you to do what they

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want you to do.

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And and you're busy all the time.

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But here's here's the thing.

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The moment you discover that many of the things you do are not actually valued, then you start

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to ask yourself, well, what should I be doing?

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What should I focus on?

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And it helps you focus on the things that drive the highest value.

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So everything is important, but not all things matter equally.

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And the question is, they're important, but should they be important to you or should

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they be important to someone else?

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And I would argue that anything you do that other people can do better, faster, cheaper

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than you, because, you know, you are a highly paid wage earner.

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Does that sound bad?

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What I'm saying is that if we were to calculate your hourly hourly rate, it's worth enough

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such that you should say, well, who is earning a lower hourly rate?

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Who might do this job better so that I can do the things that really are tailored to

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to my pay rate to what I'm supposed to be doing?

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And I'm saying, what are the things that only you can do?

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And can you focus on those things?

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Especially those things that are valued by your institution.

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And then delegate all the things that are important to do, but maybe not for you to

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do.

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For example, let's go back to the issue of prior authorizations.

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You know, there are people who can call prior authorizations.

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There are very few prior authorizations.

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And yeah, sometimes it gets to the appeal and you're needed.

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But there's a lot that other people can do for you such that you should be able to delegate

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those four to five hours that you're investing every week to do a prior authorization.

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And if you can't, or if you don't think you can, because you always can, it's like what

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conversations do you need to be having to be able to hand those off so that you can

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focus on the things that only you can do and that other people can't help you with?

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What are the things that only you can do?

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Well, only you can really see the patient, make the recommendation and bill the patient.

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Now, people can support you to do that.

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But what are the things that only you can do?

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Move your research forward, submit the manuscript.

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I mean, people can help you within your research program.

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But more often than not, if it's your research and you're not moving it forward, it's probably

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not moving forward.

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If it's clinical care, if you're not there to see the patient, somebody else will see

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the patient, especially if the patient needs to be seen right away.

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So I'm saying that it is important for you to think about the things that you, only you

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can move forward.

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And if you don't move it forward, somebody else will not move it forward and really focus

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in on that, especially as it is highlighted by your institution as something that matters

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or something that's important to them.

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Okay, so five things I've talked about the importance of thinking about promotion early.

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Number one, it helps you see what your academic institution actually values and it helps you

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decide how you want to tailor your experience or not to the things that they value or have

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great conversations about how you can accomplish these things if you don't actually have the

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time or space to do them.

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Number two, it helps you direct your conversations.

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It helps you decide what to focus on during these important conversations and it also

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helps you negotiate the resources that you need to make these things come to pass.

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Number three, it helps you be strategic and intentional because you start to think, should

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I be investing my time in these things that are not prioritized by my institution?

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And it helps you be strategic about the way you spend your time.

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Number four, it helps you shape your story.

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As you're thinking about what you're going to be writing, you start to be intentional

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about the way you're living your career so that you can write about a career that actually

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makes sense, a career path or a career trajectory that actually tells a great story.

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And number five is that it focuses you.

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It allows you to decide what is the 80%, what's the 20% and to focus in on the 20% that yield

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the highest value in your academic career.

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All right, I hope that's been helpful to you.

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That's really the end of today's podcast episode.

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Thank you so much for listening.

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As always, I bet somebody else would benefit from listening to this podcast episode and

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I invite you to share it with them.

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Thank you so much for listening.

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I'll see you next time on the Clinician Researcher Podcast.

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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.