An old friend — a surgical resident in a top-tier academic program — recently asked me for career advice. “I love being a surgeon,” she said. “But I hate research. I’ve known that for a long time. My husband keeps asking me why I still do it.”
The career choice seems strictly dichotomous when you work in a university hospital. You’re academic, or you’re irrelevant. Publish, or forego the opportunity to be a leader.
It’s a false choice. I say jump with both feet into something you like doing. Apply your talents there, and whatever your thing is, you’re more likely to achieve something meaningful with that than slogging away at something you don’t believe in.
My friend’s father is a small-town surgeon, the kind whose patients stop him in the grocery store to thank him for saving their lives. He is not, however, an academic. When my friend was interviewing for residency positions, a faculty member made this tone-deaf remark: “You can amount to so much more than your father,” meaning she could become a leading academic. My friend still laughs at this near-sighted arrogance. Of course, she did not accept a position in the program that belittled the work of a beloved community surgeon.
Some people have a wonderful affinity for science. Their work makes the world a better place. For the rest of us, the academic superhighway feels more like a Los Angeles traffic jam, with no one really getting anywhere. The worst of it is, the only way to get ahead is to get in front of somebody else. That zero-sum feeling leads to cynicism, when instead we should be building a bigger and brighter world.
Our advisors in academic surgery limit us with their good intentions. They teach us to follow the path that led to their success.
But while I still work hard emulate their surgical technique, I decided to pursue passions of my own. I joined a tech start-up as a product leader. I also accepted a part-time position practicing trauma and acute care surgery. I hardly opted out. I opted for a different path.
There are two sad results of the restrictive expectations placed on young doctors: Smart and ambitious people resign themselves to doing work that doesn’t inspire them. And real problems remain unsolved, because academic research is not the right approach for every problem. I’ve always wanted to tackle the big, messy, human problems.
Recently I accompanied Punit Soni, our fearless leader at Robin, to meet a group of specialists at a leading research hospital. Our meeting was an everyday example of the academic mindset failing to solve a real-world problem. During our interaction, I learned a great deal about the history of informatics in their particular specialty. I learned they still face hard problems. But we saw no spark of interest when we talked about solutions. While I saw them as experts, Punit saw bureaucratic obstructionism. We were both right. Their department — their specialty — might make more progress if expertise didn’t get in the way of imagining a solution.
Sometimes an outside perspective is refreshing. Working with talented folks from the technology industry has given me that perspective. That plus the buoyant idealism of the Stanford GSB, which has stayed with me since my MBA days. After the GSB, I could never accept a zero-sum version of the world.
For people who cannot see beyond the world of academic medicine, the narrow definition of success can create a stifling environment. The false choice between academics and failure leads some doctors to opt out of medicine. I believe it has also contributed to some of our colleagues’ tragic decision to opt out through suicide.
The endgame of a system that measures success by publications… is a system that values publications, not necessarily real achievements. Not lives saved, or cancers cured, or self-image restored, or companies built.
Medicine should promote a more diverse set of life choices. We should celebrate all the ways doctors work to make the world a bigger and brighter place.
