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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 an absolute pleasure to be talking with you

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today.

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Thank you so much for tuning in.

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Today, I'm talking about why your career doesn't make sense.

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Even the title is kind of ridiculous, but I finally, you know, I woke up today and I

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just thought, why doesn't it all make sense?

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And one of the things that got me started thinking about this is that recently I wrote

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my intellectual statement for promotion.

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And so it's this four-page, four-to-five-page document where you tell the story of your

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academic contributions, right?

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You tell the story of how your clinical and your scholarship and your education all come

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together to tell this amazing story of your contribution.

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Anyway, I will tell you that I feel like I wrote a great story.

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It was actually fun to write because I was like, yeah, then I can weave this into this

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and then I can make it make sense.

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I mean, it's what you practice when you write proposals.

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You string things together, you find the connections, you tell a beautiful story.

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And so over time of doing that over and over again, it becomes something that you can do

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a little bit more easily each time you do it.

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And so the first time I went up for promotion, it was actually a little bit stressful trying

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to feel like, okay, this didn't really make sense, but then I did this and then I did

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this.

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And now that I've done it over and over again, it doesn't feel as stressful because it's

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like, you know what?

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How do we make the story work?

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How do we make the story fit?

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So then it helps me recognize, oh, wait a minute, you know what?

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It doesn't make sense.

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It doesn't make sense from this perspective looking forward.

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It really makes sense looking backwards.

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And so one of the things I want to talk about is why?

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Why doesn't it make sense?

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Especially as you're going forward in your career and to think about strategies that

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you can think through as you are trying to make sense of your career.

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And actually, spoiler alert, it really only makes sense in retrospect.

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Okay, so the first thing I want to tell you and something you may not know is that we

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are all making it up as we go along.

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And now this may send alarm bells off in your ears.

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You may be like, no way, my mentor is such a superstar, definitely wasn't making it up

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as he went along.

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I just want to say it again, that we're all making it up as we go along.

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And really, it is in retrospect that we're making the story make sense.

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And to be honest, in retrospect, it makes sense.

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Of course it made sense that I went from this project to this project that was seemingly

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disparate and they came together and created this amazing thing.

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But in reality, we are making it up because we don't really understand or know the next

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step or maybe more appropriately, we don't understand the consequences of every next

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step we take.

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And so the reality is for each step forward, when somebody says, hey, can you come and

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do X, Y, Z, maybe they say, we'd like you to give this talk, it is related to what you're

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doing.

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And so it makes sense that you say yes.

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But what you don't know is that you're going to give a talk in a place where three other

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people are going to hear you and they're going to say, we would like for you to come and

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chair the session.

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Do you see what I'm saying?

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So in reality, we are saying yes to things and we're doing things, but we're not in control

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of what it leads to next.

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And so in reality, when we do one thing and then it leads to something else and we're

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deciding in the moment whether it fits and we're saying yes or we're saying no, or maybe

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we think it fits, but our life doesn't work in that.

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For example, let's say you have an ill parent and it's like, you know what, I really would

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love to do this, but I really need to travel out West to be with them all.

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You know what I'm saying?

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And so at the end of the day, we have no control over what's next, what the consequence of

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every decision we make is.

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We control our decision making and we control what we say yes to and we control what we

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say no to.

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But the consequence of the yes, the consequence of the no, we don't control.

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And so in reality, every step of our career, we are creating in real time and that's why

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it doesn't make sense.

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And one of the reasons it also doesn't make sense is because we look ahead to the careers

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of those who've gone before, our mentors, and they have amazing looking careers and

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we're like, I can't believe you did this and you did that and it looks so awesome.

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But I finally took the courage and I asked one of my mentors, I said, so how did you

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get here?

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And he was like, well, you know, it's just being open and saying yes to opportunities

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when they come.

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And that was so dissatisfying.

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It's like, no, that cannot be the way your career came together.

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Can you just tell me, can you lay it out for me?

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And so we're asking people to lay out a path that they did not lay out for themselves.

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And of course, in retrospect, they can say, oh yeah, this doc connects to this doc connects

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to this doc connects to this doc.

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And in retrospect, we now they're telling their story and then we want to say, okay,

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well, why don't I now recreate this career based on these steps that this person took?

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But here's the challenge, the exact environment, the cultural norms, the experiences or the

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opportunities that existed 20 years ago are different from the opportunities that existed

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now.

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And if we want to take somebody's path and transplant it from 1984 and bring it into

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2024, yeah, it's going to be very different.

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It's not going to be vastly different.

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It's going to be greatly different.

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Like there's a chasm between the two experiences, right?

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They're not the same experience.

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And so in retrospect, people can tell us their stories, but in reality, as you're looking

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forward, you're making it up as you go along.

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They were making it up, you are making it up.

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And so I just want to encourage you to have confidence in what you're making up.

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You're like, but I don't see the future.

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I know nobody sees the future and in reality, we're just making it up as we go along.

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We look at other people's careers and we're like, okay, they did this, therefore I should

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do this, but we don't have the same opportunities.

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We don't have the same challenges.

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And so in reality, we're making the best of it as we speak.

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And so if you're feeling uncertainty, it's real, but it's also that what you need to

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be confident in is that you're making the right decisions as long as you're doing the

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best, next best thing.

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Okay.

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I see all that to bring you to number two, which is that the basic structure doesn't

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change.

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Okay.

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So we are making this up as we go along, but the basic structure of academic medicine doesn't

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change.

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And what is the basic structure?

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The basic structure is that we're creating knowledge.

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We're creating new bodies of knowledge.

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And sometimes the ways in which we're creating new bodies of knowledge is reorganizing knowledge

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that's already known, right?

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Very few of us are actually in the process of uncovering bodies of new knowledge, right?

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I think the basic scientists are kind of in that space where it's like, we didn't know

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what this gene did, but now we know.

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But for many of us, there's a sense of what's known, it's all over the place.

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And then we gather all that information, we pull it together and we present knowledge

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in a new way.

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So the basic structure of creating new bodies of knowledge or organizing knowledge for somebody

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else to consume doesn't really change.

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And that's why the basic tenets of writing and research are kind of the same.

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The foundation remains the same.

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Now the political environment is changing, how things are funded is changing, what the

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expectations are is changing, who is doing this work is changing, what people think is

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interesting to study is changing, what the funders want to fund is changing.

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But the basic structure of creating new bodies of knowledge or reshaping knowledge for the

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consumption of others doesn't change.

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The basic foundation of educating the next generation of physicians doesn't change.

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So there are some things that kind of to some extent are part of the foundation of academic

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medicine.

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Clinical care doesn't change.

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We will always be providing clinical care to people within academic medical centers.

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So maybe we won't, but people will be getting care one way or the other, whether it's happening

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in an academic medical center or outside it.

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Clinical care, education, and creating new bodies of knowledge through research are kind

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of the foundational tenets.

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Why is that important?

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It's like, even though we're making it up as we go along, there's still kind of like

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a basic structure in which all of this really exists.

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It's all around this, kind of like this, people say it used to be a three-legged stool, and

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now it's like a unicycle and it's all clinical.

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But in reality, clinical care doesn't advance unless research allows us to figure out what's

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the next best thing for patients.

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And so the structure remains the same.

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And so what I want you to think about is that even though you don't understand your career,

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make sure that you're building within the structure that helps you make sense of the

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career.

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It's like, well, as long as the structure is remaining the same, what am I doing clinically?

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What am I doing research or as far as scholarship, calm my educating the next generation, as

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long as you're keeping those in mind, that structure is unchanging and maybe should provide

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a little bit of comfort.

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Maybe it doesn't.

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But anyway, I just want to share that that structure doesn't change.

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Okay, what is changing is the entire universe.

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The world is changing.

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And whether we like it or not, the world is changing and that change is hard.

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But let me talk about a couple of ways in which the world is changing.

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So number one, people are coming and going, right?

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People are really what make up the culture of an environment or the culture of an institution,

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right?

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And this particular personality is so strong and it really affects the culture of the organization.

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But when this person leaves, somebody else steps into their role with a different personality,

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different interests, and it changes the culture of the organization.

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And so even though you may have been there for a while or maybe you just arrived, people

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are coming and going.

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And as people are coming in and leaving, it's changing the environment, what people value,

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what people are interested in, what priorities people have, what projects they want to push

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forward.

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It changes as people come and go.

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And so even though you're the same, even though you haven't changed, people around you are

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changing and because of that, our environment is changing.

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What else is changing?

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What we prioritize as a society is changing, right?

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Whether we prioritize funding the NIH or whether we prioritize funding research or we prioritize

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entertainment and culture or whether we prioritize educating the next generation, that is changing.

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In reality, people say, well, there's no money.

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In reality, it's not that there isn't money.

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It's like, what do we prioritize enough to put money in, right?

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There's always going to be money all around.

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People are creating money all the time through new businesses, through new ventures.

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But if what we're seeing is, well, we no longer prioritize funding things in this way, yes,

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that's changing too, right?

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Whether we feel like the NIH is the next best place to put all of our hard-earned tax dollars

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or how much of the tax dollars do we want to put in the NIH or how much do foundations

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want to fund projects that are important to them or how much is industry now playing a

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role in what's being funded at academic medical centers, it is changing.

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Priorities of where people are putting money is changing.

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And that's why you feel the pinch of clinical work because clinical work over the last couple

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of decades has really become the biggest bringer in of money.

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If I can say that, the biggest way in which money is made in academic medical centers

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and hence the pressure for people to do more clinically.

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So the whole environment is changing.

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The world is changing around us.

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And hopefully we're changing with it.

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And if we're not changing with it, then we're feeling the strain of the change of the world

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and we're feeling the uncertainty of the changing world around us.

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But that's one of the reasons why it feels like our careers don't make sense because

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when we look at the people who have had successful careers, they didn't live in our world when

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they were building careers.

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And so it doesn't make sense because they can't make sense of it.

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They can't tell us, well, this is the way it works because when I was 32, I got my first

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R01 because you know what, people don't get their first R01s at 32 anymore.

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That age has moved up.

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So the advice that they have for you and what they were doing at age 32 is going to be different

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from what you're doing at age 32.

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At age 32, you're like, wait, wait, I'm just trying to grow this young family.

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I don't even have time yet.

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So you just have different challenges.

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And that's why it doesn't make sense because the people who would otherwise make it make

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sense can't understand this new environment in which you are living.

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And they recognize that the advice that they had for themselves when they were coming up

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is not necessarily advice that's going to help you advance as you're coming up as well.

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And that's why number four is that the people who came before are mentors.

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They really can only tell their stories in past tense.

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They can't tell you, oh, this was what was happening.

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Therefore I set myself up to do this.

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To some extent, they can do it now because they're looking backwards, that it's hard

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for us to be able to do it.

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And so I want you to understand when you speak to mentors and you're asking for advice, don't

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ask them to tell you what to do.

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Ask them to tell you how they thought about decisions that they made.

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Because in reality, the careers we're building are step by step, right?

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One step leads to the next step, leads to the next step, leads to the next step.

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And we don't see how all the steps come together.

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But what we're doing is we're saying, what's the next best decision right now?

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What's valued at my academic institution?

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What are the pillars of clinical research, clinical scholarship and education?

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And how do I fit within those things?

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And there are other pieces.

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You know, what I haven't talked about is administration.

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There are other pieces to do what happens in academic medical centers.

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But where do you fit?

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And how do you think about your career and how did they think about their career?

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And how can you apply principles of how they thought to your career?

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So I'm saying don't ask them, what do I do?

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Because honestly, they don't know.

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But what they can give you, what's really helpful is for them to give you the frameworks

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about which they thought about their careers.

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They're like, well, this is why I chose this opportunity in that moment.

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This is why it made sense.

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Because it helps you think about your decision making.

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Because again, you're making it up as you go along.

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But it's not a random process.

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There are good decisions and there are not so great decisions, right?

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And sometimes it's like, what are the principles that make a good decision?

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And this is something that those who've gone before can help you with.

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They can't lay out the path for you because again, they're reconstructing now post having

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made these decisions.

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What they can do is share their decision making in that moment, what were they thinking?

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And how does that help you as you moving your career forward?

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The fifth thing I want to share is that the uncertainty is very, very hard to bear.

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We would love to be able to see what the next 10 years look like.

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We would love to be able to say, okay, in 15 years, I'm going to be a full professor.

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I'll have my own lab.

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We'd love to be able to say that.

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And to be honest, people are always asking us to do that all the time.

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They're saying, look five years into the future, what are you going to be doing?

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Look 10 years into the future, what are you going to be doing?

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And so it's confusing because here we are kind of making up the future.

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We know we're making it up because we're like, I don't know what I'll be doing in 10 years,

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but there's the sense that you're supposed to be following this path to get there.

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These questions don't make it easier because there's a sense that you should be certain,

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but you are uncertain.

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You're not sure.

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You're not sure this research thing is something you want to be doing long-term.

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You're not sure you want to be writing grants forever and ever and ever.

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You're not sure you want to do this thing again.

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You're not sure.

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And I just want to encourage you that not being sure is part of being human.

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It's just normal.

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Not being sure is normal.

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The uncertainty of life being lived one day at a time is real for everybody.

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Things are happening.

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People that we love are being lost.

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People who've been around in our institutions for so long are suddenly moving into industry

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and it's like, wait a minute, you were like the quintessential academic.

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What are you doing in industry?

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People are changing and things are happening and it just doesn't feel like a world that

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we understand.

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And I wanted to share that, yes, there is uncertainty.

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And if you're feeling the uncertainty of what your career will look like next, I want to

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just assure you that it's normal.

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I want to reassure you that it's okay.

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It's the way it is.

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Because we're making it up as we go along, part of that is the uncertainty of not knowing

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what this step will lead to.

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And part of that is recognizing that because it's uncertain, because it's fuzzy, because

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we are making it up as we go along, what we can do, what we do control is the next decision,

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the next best step.

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And that's number six.

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We know enough to take the next best step.

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Now seven years from now, we can look back and say, if only I had done this, right?

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You have more information, so now you would make a different decision.

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Well, the information you have right now is the information you use to make the next best

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decision.

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So what do you do right now?

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You gather as much information as makes sense and then you make the next best decision.

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You don't paralyze yourself by trying to get all the information possible.

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You get as much information as you can within a reasonable timeframe and you make the right

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decision.

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What's the next thing I should be doing?

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And that is enough.

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In a sense, what you want to do is you want to look ahead and you want to see the big

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picture, what it all looks like, what this big puzzle is coming together to look like.

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And I assure you that it's beautiful, but you can't see it.

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All you can see is what's right in front of you.

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And so what you've got to do is to make the next decision for what's right in front of

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you, given the information you have, gathering all the information you can, getting the best

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advice that you can, what's the right decision to make, and then you make that decision.

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Number seven is I want to remind you that because you can only take one step at a time,

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if you're making, if you're in the, with the decision, with the, with the information you

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have, if you're making the next best decision, you got to trust that you're building a masterpiece.

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You've got to trust this whole experience, this whole journey of our lives is really

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an experience of trust.

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I mean, it really is.

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If you think about it, did you choose your mom and dad?

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No.

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And for some of you, you're like, if you could have, you would have gone and chosen a different

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set of parents.

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And for some of you, you're like, I locked out.

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I got the best parents in the world, but we didn't choose, right?

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We made the most of what we had.

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And somehow through no real effort of our own, here we are, we got this far.

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Like if you survive your first year of life, it's not because you tried hard.

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It's because life circumstances worked out such that you were able to survive your first

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year.

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And if you've come this far, yes, you worked hard and I'm not negating any of your hard

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work, but I'm saying that so many things came together for you to come to where you are.

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And so if all of your life has really been one big step of faith, which honestly it is,

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then you should recognize that whatever you're building in your career is a masterpiece.

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And why do I know it's a masterpiece?

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It's a masterpiece because you care, right?

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Physicians and you listening to me, you may not be a physician, but when you care enough

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to think about what should my career be like, what should I be doing?

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You are intentional.

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You're somebody who wants the best and you don't control the big picture, but you do

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control the next step.

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And if you're making the right decision or the good decision with every next step, then

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you can trust that it is coming together to unfold something that's beautiful and something

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that's great.

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You can trust that every great step comes together to make a great masterpiece.

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You can trust that every step you take comes together to create a masterpiece.

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Okay, I said seven things.

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We're making it up as we go along, but the basic structures are unchanging.

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The world is changing around us and the people who went ahead can only tell their stories

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and past tense.

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And it's the uncertainty that's hard to bear, but the uncertainty is a sign that we're in

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the right place.

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And what we do is we know enough to take the next best step.

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And as we're making each next step, making the right decision for what's next, we have

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to trust.

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We have to walk by faith knowing that what we're building is a masterpiece.

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I want to encourage you that your career may not make sense to you right now.

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It may not look like what your mentor is describing they did 20, 30 years ago, but I want you

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to understand that you are one of the smartest people in the world.

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You are thoughtful.

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You are kind.

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You want to do good in the world.

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And I encourage you that as long as you are just taking the right next best step, you're

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going to find yourself in a really beautiful place and the place you've always wanted to

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be.

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And as long as there's intention in your heart about where you want to go, even though you

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can't see exactly how to get there, I want you to trust that that's where you're going

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and that you're going to look back and you're going to have created an amazing career that's

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going to have really touched so many lives and blessed so many people.

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And you'll look back and you'll tell somebody your story, the story of how your career came

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to be so amazing.

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And they'll look to you and they'll say, I wish I could just recreate this career, but

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they won't be able to because each of us is creating an individual and amazing masterpiece.

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All right.

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It's been a pleasure to talk to you about that today.

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Again, I invite you to sign up for coaching.

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If you do not already have a coach to work with, would love to work with you.

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Reach out to me via direct message on Instagram.

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I'm also on LinkedIn.

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I'm also on Facebook.

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Look me up and let's talk about how I can serve you in your academic career.

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It's been a pleasure talking with you today.

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I look forward to talking with you again on the next episode of the Clinician Researcher

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podcast.

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Have a great day.

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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.