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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 today.

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Today I want to talk to you about the things you control and the things you do not control

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in your academic career.

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And the reason it is so important to talk about is because over the last couple of weeks,

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we've had conversations with many faculty, and they are so frustrated.

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They are so angry.

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They are so mad.

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And what's interesting is that we start a conversation, and it just keeps going and

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going and going, and they can't stop talking about this thing that makes them so angry,

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that makes them so frustrated, and why nobody can see things like they see it, and there's

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just so much angst and pain and suffering related to this one issue.

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And most of the time, the things that we are so frustrated about are things that we actually

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have no control over, things that we don't control in the way we want to control.

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Like, if we could just smack someone upside the head and show them our way, then they

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would see that our way was the right way.

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Oh, that would be so awesome, but it's not the way it is.

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Instead, it looks as if sometimes we're talking across from each other.

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The person who's in charge doesn't want to step up in the way that they're supposed to,

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and there's so much that's going on, and it's overwhelming.

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And the challenge for many of us is that we are so overwhelmed by the challenges that

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are happening around us that we have no control over, and we leave the things that we control,

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and we leave forward progress in our academic careers to manage things that we don't control.

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And so one of the things I want to do in today's episode is I want to explicitly call out the

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things we have no control over.

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I'm going to explicitly call them out.

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And the reason I'm explicitly calling them out is so that you can see where you do have

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control, because it's so easy to be frustrated by the things we don't control that we miss

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– the things that we actually do control, and the things that we can double down and

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move forward in a way that's so powerful.

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Okay?

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So number one thing that we don't control is our institutional policies.

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Okay.

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Now, I recognize that if you work very hard and lobby enough people and talk to a lot

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of people and eventually, you know, work hard, you can have policies changed.

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You absolutely can.

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And maybe you could stay just sit in, or you could, you know, get petitions signed or,

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you know, throw a tantrum.

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You could do many things.

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How far you get depends, right?

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Depends on your position within the institution, depends on your hierarchy, your leadership

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roles.

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And even then, you may have a leadership role and not necessarily have power to change these

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policies that are entrenched in our institution.

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But it's important to recognize, especially the less of a senior leadership role you have

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in your organization, the less likely you have power to change policies.

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Now, with enough effort over many years, talking to the right people, lobbying of the right

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groups, you might be able to change it.

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But what a lot of investment into something that you primarily do not control.

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The policies around who is available to help researchers write their grants, submit their

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grants, policies around how many weeks it takes to submission or to the final deadline

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for your grant to be canceled or not canceled.

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Those are things you don't control.

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Now, granted, they may affect your life.

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And I'm not saying that they don't affect your life.

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Policies affect us all.

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And many times the kind of policies that we're dealing with that make us so frustrated are

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policies that were written in the 1920s when we were in a 1920s world.

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And now that we're in 2024, these policies are still in effect because they worked back

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then doesn't mean that they work now.

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However, the policy change is not yours at this time.

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Perhaps after you've done all these amazing things and you've risen to be dean of your

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institution, perhaps then you can just take a red pen and say X to the policy.

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And even when you get there, you'll find out that, oh, policies don't change that easily.

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Because one of the illusions we have is this whole idea of positional authority.

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If the dean just steps in and says, this is the way it is and that's the way it is.

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And I have to say that I've seen a lot of people in authority and I realized that influential

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leadership will always be more powerful than positional leadership.

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And so we have this idea and I think it comes from our training because medicine is so hierarchical.

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This idea that one person holds all power, they're going to come in and they're going

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to say, no, this is the way it has to be.

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And I tell you that when those things work, they only work for so little.

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I mean, for so long, right?

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They only work for so long.

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And then it goes away because you, maybe as a division chief can say, you must work with

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her to submit her grant now and people will undermine you even when other people are asking

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them to do the thing they're supposed to do.

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So what you realize is that it takes a lot beyond just positional authority to make people

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do things and nobody can really make anybody do things they don't want to do.

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So you have no control over institutional policies, but what do you have control over?

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You have control over the way you show up in your academic career.

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What does that mean?

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It means that the currency of academics remains grants and publications.

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How can you move forward your research and writing so that you can get the currency that

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you need?

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You may say, well, if I don't do the research, if their policies won't let me get the research

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forward, then I can't write papers.

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Is it a hundred percent true?

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What is true is that there might be some manuscripts you won't be able to write right away because

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these policies may be getting in the way.

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However, there are some manuscripts that are not affected by the policy.

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And even for your manuscripts that are affected by the policy, how can you get around this

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particular problematic policy?

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It may be interfering, but is it completely impeding your forward motion?

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And it's likely that it isn't.

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And so the question is, how can you, instead of looking to somebody else to first change

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the policy before your life is in order, how can you move forward in spite of the current

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policy?

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So number one, you do not control the policies that have been established for so long, but

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you control your ability to move past and move your work forward in spite of the policy.

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That's number one.

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Number two is that you do not control the way other people see you.

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You don't.

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You know, here's the challenge, because when we're coming up in medical school, we're coming

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up in our training, we are working so hard to get the good evaluation, right?

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So we figure out who's the good, who's the attending we need to show up for, who's the

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resident who's going to be in charge of our evaluation.

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And we show up for them, we do all the right things.

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And then they write our evaluation.

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Are we in control of how they see us?

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We're not.

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We are working so hard.

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And some of our greatest disappointments in our training have come from when we thought

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we put in our best and the attending was like, oh, mediocre.

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I'm still feeling the pain from that, when that happened to me as an intern.

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Oh, it hurt.

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Yes.

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But you try your best, you do everything you think they want you to do, and still they

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are unimpressed.

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And that's because you don't control them, right?

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Even the people that you were able to impress, you didn't control them being impressed by

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you.

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You showed up at your best and they were impressed.

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And then there are people who were not impressed when you showed up at your best.

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And so what you realize is that you don't control what they think of you, but you control

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what you think of yourself.

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Why does that matter?

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It matters because every time you show up desperately trying to get somebody else's

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attention, you are not putting in energy and effort into what you can do.

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And so you show up looking desperate.

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And you know what?

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Nobody likes a desperate person.

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Remember when you were in college and there was that kid, the kid who was asking everybody

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out, nobody wanted to date this person because they were so desperate.

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And so every time you're working so hard to change the opinions of others about you, you're

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working too hard because you can't change their opinions.

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What you can do is change the way you show up.

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It's change the way you think about yourself.

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Is expand your perception of yourself.

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Expand yourself concept.

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What do you need to do that?

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Maybe you need to go for a career development or professional development activity, grow

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in your skills, expand your skills, grow for you.

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And you be impressed by you because the more you impress yourself, and I'm not talking

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about being egotistical or saying I'm everything and there's nothing really much to show for

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it.

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Now there are a lot of people like that and they do a good job.

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They're able to kind of egotistically just move through everything, but that's not you.

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You care about doing a good job.

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And so what if you go get the skills that make you do a good job, make you impressed

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at your level of growth and not focus on what other people are thinking about you.

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And the more you do that, what you'll find is that people will be impressed because what?

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You're growing.

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You have power over your ability to grow.

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You're taking the steps needed to grow your skills and people can see that.

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And so when you stop focusing on how you can change other people's thoughts and perceptions

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of you and you start working on increasing your own self-perception, it has that reverse

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effect of actually affecting other people's perceptions, but your power lies in changing

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yourself.

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And so instead of focusing on what other people think of you, focus on what you think of yourself

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and take the steps to grow in skill.

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Focus on you.

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Number three is that we do not control the way the hospital system works, how RVUs are

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evaluated, what generates RVUs, what counts as clinical effort, what doesn't count as

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clinical effort.

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We control none of that.

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And I don't know how many of you get so mad where you're like, wait a minute, I'm doing

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this much work and you tell me it counts for nothing.

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What?

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There's so much of that going on where we're angry because we think we're putting more

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effort than our colleague over there who seems to be coasting in life and making it.

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And so you're like, well, if you would just change that person's effort, then I'll feel

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better about myself.

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You know what?

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You don't have power over that person's effort or what the institution counts as RVU worthy

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or worthy of effort.

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And so what can you do?

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You can get an understanding.

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Get clear.

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So here you are trying to move a research program forward and you feel like you're drowning

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in clinical work.

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Make that known and ask, how can I shrink the clinical footprint because I really want

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to grow in my research?

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And so then you might find out that, well, all clinical work is not created equal and

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that the person who's supervising the fellows clinic carries the same effort as the person

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who's doing a three half day clinic.

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And you're like, oh, okay.

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Well, how do I negotiate into the fellows clinic so that I can get that time too?

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And it's just about becoming savvy.

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Have institutional knowledge.

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Find out what is important.

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Find out what makes up the numbers.

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If you're like, okay, I didn't even know my RVU targets or you super exceeded your RVU

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targets and you had no idea, find out what are the targets?

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What are the different clinical opportunities?

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What are the things that you put in the least effort from your perspective that gives you

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the biggest bang for your buck?

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Are there procedures you can do where perhaps the effort of the procedural clinic is different

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from the effort of the regular clinic?

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I don't know what the answer is for you in that specialty, but you don't control how

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things are set up, but you control your access to knowledge.

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You may not know, but you can find the people who know.

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Expand your networks to ask and ask questions.

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Ask them of your bosses.

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Ask them of your division chiefs.

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Ask them of your faculty.

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Ask them of people who've been around for a long time.

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Ask questions.

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Because if you are stressed and you're running around feeling like your head is cut off because

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you don't know where to go, you're anxious and you're worried and you're just nervous

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and you just feel like you're run ragged, there are people who are living a poised life

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at your academic institution and you should go talk to them and say, hey, I feel like

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I have a lot of anxiety and I feel like I'm busy all the time.

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How are you doing things differently?

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They're going to tell you a thing or two that you didn't know before.

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So instead of worrying about the way the institution sets up its RVUs and clinical effort and all

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of that, get the information you need so that you can negotiate more effectively.

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The more information you have, the more effectively you can negotiate.

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All right.

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That was number three.

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Number four is that you have no control over your division chief or your chair and whether

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they choose to put you up for promotion or not.

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You have no control.

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They decide.

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They look and they're like, oh yeah, you're not ready.

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Or they say, hmm, I don't know.

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I don't know if you'll ever be ready.

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But what you do have control over is the metrics.

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You can go figure out what are the metrics for promotion?

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How many publications have people who are coming up at the associate professor level

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have?

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How many talks have they given?

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How many grants do they have?

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Okay, on my track, maybe grants don't count.

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How many things have they had that allow them to be eligible for promotion?

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You can go look at the promotion and tenure documents, which are public, and you can go

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talk to people who've been recently promoted to say, hey, how did you make this work?

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Or talk to people who are on the promotions and tenure committee and say, hey, how does

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it work at my institution?

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There are people you can get information from so that you can build your portfolio such

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that you are competitive to be put up for promotion.

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You cannot control your division chief's thoughts, but you can ask.

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You can say, hey, you don't feel like I'm ready for promotion.

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What would it take for me to be ready?

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I want you to ask this question from the very beginning.

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Don't wait until it's time for promotion and then say, oh, I'm not ready.

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Ask from the very beginning on your first day, in your first year at your first annual

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review.

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Don't even wait for the annual review.

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Ask.

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I'd love to be ready to go up for promotion in about three years.

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What are the things that are still missing on my CV?

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If your institution is anything like mine, there are some gurus who are the go-to people

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for faculty members to talk to when it comes to things about promotion and tenure.

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One of those in particular, I remember I met very early on in my faculty career and I was

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so frustrated when he looked at my CV and my intellectual statement, he was like, I

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just don't know what you're building here.

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I just have no idea.

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This just doesn't come together for me.

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I was so frustrated.

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I was so angry.

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What I didn't realize is that he was doing me a service.

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He told me he didn't understand.

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That was feedback to me to go and figure out how to write a cohesive story that helps me

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define what I really wanted to contribute to as a scholar.

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You may not control your division chief's ability to put you up for promotion or not,

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but what you can do is get information about what the metrics are so that you can do what

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is necessary to be ready for promotion.

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Show it to other people and say, what is missing?

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What are the gaps?

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That you can fill those gaps and then the rest of it is not up to you.

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But if your division chief still won't put you up for promotion, even after you've met

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all the metrics, then you at least have done enough that you potentially are marketable

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to go elsewhere.

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And so you're not in control of them, but you are in control of the information you

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have access to and how you show up.

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Finally, when it comes to grant writing and manuscript publications, you are not in control

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of whether your grants get funded or your proposals or your manuscripts are accepted.

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You are not in control of that.

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What you are in control of is to give it your best work, is to get the help you need to

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grow in the skills that you need, is to take the time to learn to write well, is to write

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from the reader's perspective, is to take writing courses, is to take grant writing

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courses.

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You have control over your opportunities to grow as a skilled writer.

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And no matter how skilled you are, you always have opportunity to grow.

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No matter how skilled you are in communication, you always have opportunity to grow in scientific

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communication.

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And so although you don't have power over whether the grant is funded or the manuscript

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is published, you have power over the way you show up and present your information and

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present your writing.

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You should be proud every time you submit a manuscript or a grant that you put a lot

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of good work into.

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You should sit back and say, good for you, no matter the outcome, no matter the outcome.

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Because the time you celebrate is not when the grant is funded.

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They'll tell me about it.

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It is a happy time.

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But you celebrate when you do the work and you put things in.

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When you do the work and you submit the manuscript, that's when you celebrate.

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That's what you have control over.

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Okay.

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So I talked about five things that you control and that you don't control.

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One, you don't control your institution policies.

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You don't control the way RVUs work in the system.

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You don't control whether your division chief puts you up for promotion or not.

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You don't control what other people do.

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You control what you do.

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But just recognize that you're a very powerful person.

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There's so much that you do control.

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And there's so many things that we don't control that we spend so much time agonizing and being

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frustrated about.

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And at the end of the day, let's leave those things that we have no power to control and

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work hard to move through and to put forward effort into the things that we do control.

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All right.

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That is the end of today's episode.

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Again, if there is anyone who is interested in working with me as a coach, I would love

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to hear from you.

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Send me a direct message through LinkedIn, also on Instagram and Facebook.

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And even if you're not interested in being coached, I want you to please share this episode

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with someone who needs to hear it, especially someone who's so frustrated in the academy.

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All right.

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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 next time on the Clinician Researcher 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.