Welcome to the Clinician Researcher podcast, where academic clinicians learn the skills
to build their own research program, whether or not they have a mentor.
As clinicians, we spend a decade or more as trainees learning to take care of patients.
When we finally start our careers, we want to build research programs, but then we find
that our years of clinical training did not adequately prepare us to lead our research
program.
Through no fault of our own, we struggle to find mentors, and when we can't, we quit.
However, clinicians hold the keys to the greatest research breakthroughs.
For this reason, the Clinician Researcher podcast exists to give academic clinicians
the tools to build their own research program, whether or not they have a mentor.
Now introducing your host, Toyosi Onwuemene.
Welcome to the Clinician Researcher podcast.
I'm your host, Toyosi Onwuemene, and it is an absolute pleasure to be talking with you today.
Today I want to talk to you about the things you control and the things you do not control
in your academic career.
And the reason it is so important to talk about is because over the last couple of weeks,
we've had conversations with many faculty, and they are so frustrated.
They are so angry.
They are so mad.
And what's interesting is that we start a conversation, and it just keeps going and
going and going, and they can't stop talking about this thing that makes them so angry,
that makes them so frustrated, and why nobody can see things like they see it, and there's
just so much angst and pain and suffering related to this one issue.
And most of the time, the things that we are so frustrated about are things that we actually
have no control over, things that we don't control in the way we want to control.
Like, if we could just smack someone upside the head and show them our way, then they
would see that our way was the right way.
Oh, that would be so awesome, but it's not the way it is.
Instead, it looks as if sometimes we're talking across from each other.
The person who's in charge doesn't want to step up in the way that they're supposed to,
and there's so much that's going on, and it's overwhelming.
And the challenge for many of us is that we are so overwhelmed by the challenges that
are happening around us that we have no control over, and we leave the things that we control,
and we leave forward progress in our academic careers to manage things that we don't control.
And so one of the things I want to do in today's episode is I want to explicitly call out the
things we have no control over.
I'm going to explicitly call them out.
And the reason I'm explicitly calling them out is so that you can see where you do have
control, because it's so easy to be frustrated by the things we don't control that we miss
– the things that we actually do control, and the things that we can double down and
move forward in a way that's so powerful.
Okay?
So number one thing that we don't control is our institutional policies.
Okay.
Now, I recognize that if you work very hard and lobby enough people and talk to a lot
of people and eventually, you know, work hard, you can have policies changed.
You absolutely can.
And maybe you could stay just sit in, or you could, you know, get petitions signed or,
you know, throw a tantrum.
You could do many things.
How far you get depends, right?
Depends on your position within the institution, depends on your hierarchy, your leadership
roles.
And even then, you may have a leadership role and not necessarily have power to change these
policies that are entrenched in our institution.
But it's important to recognize, especially the less of a senior leadership role you have
in your organization, the less likely you have power to change policies.
Now, with enough effort over many years, talking to the right people, lobbying of the right
groups, you might be able to change it.
But what a lot of investment into something that you primarily do not control.
The policies around who is available to help researchers write their grants, submit their
grants, policies around how many weeks it takes to submission or to the final deadline
for your grant to be canceled or not canceled.
Those are things you don't control.
Now, granted, they may affect your life.
And I'm not saying that they don't affect your life.
Policies affect us all.
And many times the kind of policies that we're dealing with that make us so frustrated are
policies that were written in the 1920s when we were in a 1920s world.
And now that we're in 2024, these policies are still in effect because they worked back
then doesn't mean that they work now.
However, the policy change is not yours at this time.
Perhaps after you've done all these amazing things and you've risen to be dean of your
institution, perhaps then you can just take a red pen and say X to the policy.
And even when you get there, you'll find out that, oh, policies don't change that easily.
Because one of the illusions we have is this whole idea of positional authority.
If the dean just steps in and says, this is the way it is and that's the way it is.
And I have to say that I've seen a lot of people in authority and I realized that influential
leadership will always be more powerful than positional leadership.
And so we have this idea and I think it comes from our training because medicine is so hierarchical.
This idea that one person holds all power, they're going to come in and they're going
to say, no, this is the way it has to be.
And I tell you that when those things work, they only work for so little.
I mean, for so long, right?
They only work for so long.
And then it goes away because you, maybe as a division chief can say, you must work with
her to submit her grant now and people will undermine you even when other people are asking
them to do the thing they're supposed to do.
So what you realize is that it takes a lot beyond just positional authority to make people
do things and nobody can really make anybody do things they don't want to do.
So you have no control over institutional policies, but what do you have control over?
You have control over the way you show up in your academic career.
What does that mean?
It means that the currency of academics remains grants and publications.
How can you move forward your research and writing so that you can get the currency that
you need?
You may say, well, if I don't do the research, if their policies won't let me get the research
forward, then I can't write papers.
Is it a hundred percent true?
What is true is that there might be some manuscripts you won't be able to write right away because
these policies may be getting in the way.
However, there are some manuscripts that are not affected by the policy.
And even for your manuscripts that are affected by the policy, how can you get around this
particular problematic policy?
It may be interfering, but is it completely impeding your forward motion?
And it's likely that it isn't.
And so the question is, how can you, instead of looking to somebody else to first change
the policy before your life is in order, how can you move forward in spite of the current
policy?
So number one, you do not control the policies that have been established for so long, but
you control your ability to move past and move your work forward in spite of the policy.
That's number one.
Number two is that you do not control the way other people see you.
You don't.
You know, here's the challenge, because when we're coming up in medical school, we're coming
up in our training, we are working so hard to get the good evaluation, right?
So we figure out who's the good, who's the attending we need to show up for, who's the
resident who's going to be in charge of our evaluation.
And we show up for them, we do all the right things.
And then they write our evaluation.
Are we in control of how they see us?
We're not.
We are working so hard.
And some of our greatest disappointments in our training have come from when we thought
we put in our best and the attending was like, oh, mediocre.
I'm still feeling the pain from that, when that happened to me as an intern.
Oh, it hurt.
Yes.
But you try your best, you do everything you think they want you to do, and still they
are unimpressed.
And that's because you don't control them, right?
Even the people that you were able to impress, you didn't control them being impressed by
you.
You showed up at your best and they were impressed.
And then there are people who were not impressed when you showed up at your best.
And so what you realize is that you don't control what they think of you, but you control
what you think of yourself.
Why does that matter?
It matters because every time you show up desperately trying to get somebody else's
attention, you are not putting in energy and effort into what you can do.
And so you show up looking desperate.
And you know what?
Nobody likes a desperate person.
Remember when you were in college and there was that kid, the kid who was asking everybody
out, nobody wanted to date this person because they were so desperate.
And so every time you're working so hard to change the opinions of others about you, you're
working too hard because you can't change their opinions.
What you can do is change the way you show up.
It's change the way you think about yourself.
Is expand your perception of yourself.
Expand yourself concept.
What do you need to do that?
Maybe you need to go for a career development or professional development activity, grow
in your skills, expand your skills, grow for you.
And you be impressed by you because the more you impress yourself, and I'm not talking
about being egotistical or saying I'm everything and there's nothing really much to show for
it.
Now there are a lot of people like that and they do a good job.
They're able to kind of egotistically just move through everything, but that's not you.
You care about doing a good job.
And so what if you go get the skills that make you do a good job, make you impressed
at your level of growth and not focus on what other people are thinking about you.
And the more you do that, what you'll find is that people will be impressed because what?
You're growing.
You have power over your ability to grow.
You're taking the steps needed to grow your skills and people can see that.
And so when you stop focusing on how you can change other people's thoughts and perceptions
of you and you start working on increasing your own self-perception, it has that reverse
effect of actually affecting other people's perceptions, but your power lies in changing
yourself.
And so instead of focusing on what other people think of you, focus on what you think of yourself
and take the steps to grow in skill.
Focus on you.
Number three is that we do not control the way the hospital system works, how RVUs are
evaluated, what generates RVUs, what counts as clinical effort, what doesn't count as
clinical effort.
We control none of that.
And I don't know how many of you get so mad where you're like, wait a minute, I'm doing
this much work and you tell me it counts for nothing.
What?
There's so much of that going on where we're angry because we think we're putting more
effort than our colleague over there who seems to be coasting in life and making it.
And so you're like, well, if you would just change that person's effort, then I'll feel
better about myself.
You know what?
You don't have power over that person's effort or what the institution counts as RVU worthy
or worthy of effort.
And so what can you do?
You can get an understanding.
Get clear.
So here you are trying to move a research program forward and you feel like you're drowning
in clinical work.
Make that known and ask, how can I shrink the clinical footprint because I really want
to grow in my research?
And so then you might find out that, well, all clinical work is not created equal and
that the person who's supervising the fellows clinic carries the same effort as the person
who's doing a three half day clinic.
And you're like, oh, okay.
Well, how do I negotiate into the fellows clinic so that I can get that time too?
And it's just about becoming savvy.
Have institutional knowledge.
Find out what is important.
Find out what makes up the numbers.
If you're like, okay, I didn't even know my RVU targets or you super exceeded your RVU
targets and you had no idea, find out what are the targets?
What are the different clinical opportunities?
What are the things that you put in the least effort from your perspective that gives you
the biggest bang for your buck?
Are there procedures you can do where perhaps the effort of the procedural clinic is different
from the effort of the regular clinic?
I don't know what the answer is for you in that specialty, but you don't control how
things are set up, but you control your access to knowledge.
You may not know, but you can find the people who know.
Expand your networks to ask and ask questions.
Ask them of your bosses.
Ask them of your division chiefs.
Ask them of your faculty.
Ask them of people who've been around for a long time.
Ask questions.
Because if you are stressed and you're running around feeling like your head is cut off because
you don't know where to go, you're anxious and you're worried and you're just nervous
and you just feel like you're run ragged, there are people who are living a poised life
at your academic institution and you should go talk to them and say, hey, I feel like
I have a lot of anxiety and I feel like I'm busy all the time.
How are you doing things differently?
They're going to tell you a thing or two that you didn't know before.
So instead of worrying about the way the institution sets up its RVUs and clinical effort and all
of that, get the information you need so that you can negotiate more effectively.
The more information you have, the more effectively you can negotiate.
All right.
That was number three.
Number four is that you have no control over your division chief or your chair and whether
they choose to put you up for promotion or not.
You have no control.
They decide.
They look and they're like, oh yeah, you're not ready.
Or they say, hmm, I don't know.
I don't know if you'll ever be ready.
But what you do have control over is the metrics.
You can go figure out what are the metrics for promotion?
How many publications have people who are coming up at the associate professor level
have?
How many talks have they given?
How many grants do they have?
Okay, on my track, maybe grants don't count.
How many things have they had that allow them to be eligible for promotion?
You can go look at the promotion and tenure documents, which are public, and you can go
talk to people who've been recently promoted to say, hey, how did you make this work?
Or talk to people who are on the promotions and tenure committee and say, hey, how does
it work at my institution?
There are people you can get information from so that you can build your portfolio such
that you are competitive to be put up for promotion.
You cannot control your division chief's thoughts, but you can ask.
You can say, hey, you don't feel like I'm ready for promotion.
What would it take for me to be ready?
I want you to ask this question from the very beginning.
Don't wait until it's time for promotion and then say, oh, I'm not ready.
Ask from the very beginning on your first day, in your first year at your first annual
review.
Don't even wait for the annual review.
Ask.
I'd love to be ready to go up for promotion in about three years.
What are the things that are still missing on my CV?
If your institution is anything like mine, there are some gurus who are the go-to people
for faculty members to talk to when it comes to things about promotion and tenure.
One of those in particular, I remember I met very early on in my faculty career and I was
so frustrated when he looked at my CV and my intellectual statement, he was like, I
just don't know what you're building here.
I just have no idea.
This just doesn't come together for me.
I was so frustrated.
I was so angry.
What I didn't realize is that he was doing me a service.
He told me he didn't understand.
That was feedback to me to go and figure out how to write a cohesive story that helps me
define what I really wanted to contribute to as a scholar.
You may not control your division chief's ability to put you up for promotion or not,
but what you can do is get information about what the metrics are so that you can do what
is necessary to be ready for promotion.
Show it to other people and say, what is missing?
What are the gaps?
That you can fill those gaps and then the rest of it is not up to you.
But if your division chief still won't put you up for promotion, even after you've met
all the metrics, then you at least have done enough that you potentially are marketable
to go elsewhere.
And so you're not in control of them, but you are in control of the information you
have access to and how you show up.
Finally, when it comes to grant writing and manuscript publications, you are not in control
of whether your grants get funded or your proposals or your manuscripts are accepted.
You are not in control of that.
What you are in control of is to give it your best work, is to get the help you need to
grow in the skills that you need, is to take the time to learn to write well, is to write
from the reader's perspective, is to take writing courses, is to take grant writing
courses.
You have control over your opportunities to grow as a skilled writer.
And no matter how skilled you are, you always have opportunity to grow.
No matter how skilled you are in communication, you always have opportunity to grow in scientific
communication.
And so although you don't have power over whether the grant is funded or the manuscript
is published, you have power over the way you show up and present your information and
present your writing.
You should be proud every time you submit a manuscript or a grant that you put a lot
of good work into.
You should sit back and say, good for you, no matter the outcome, no matter the outcome.
Because the time you celebrate is not when the grant is funded.
They'll tell me about it.
It is a happy time.
But you celebrate when you do the work and you put things in.
When you do the work and you submit the manuscript, that's when you celebrate.
That's what you have control over.
Okay.
So I talked about five things that you control and that you don't control.
One, you don't control your institution policies.
You don't control the way RVUs work in the system.
You don't control whether your division chief puts you up for promotion or not.
You don't control what other people do.
You control what you do.
But just recognize that you're a very powerful person.
There's so much that you do control.
And there's so many things that we don't control that we spend so much time agonizing and being
frustrated about.
And at the end of the day, let's leave those things that we have no power to control and
work hard to move through and to put forward effort into the things that we do control.
All right.
That is the end of today's episode.
Again, if there is anyone who is interested in working with me as a coach, I would love
to hear from you.
Send me a direct message through LinkedIn, also on Instagram and Facebook.
And even if you're not interested in being coached, I want you to please share this episode
with someone who needs to hear it, especially someone who's so frustrated in the academy.
All right.
It's been a pleasure talking with you today.
I look forward to talking with you again next time on the Clinician Researcher Podcast.
Have a great day.
Thanks for listening to this episode of the Clinician Researcher Podcast, where academic
clinicians learn the skills to build their own research program, whether or not they
have a mentor.
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