7 skills you may not have learned in medical training

0:00 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.

0:40 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. Thank you so much for tuning in. I want to give a shout out to those who are suffering from the ravages of the storm that came through this weekend. I hope that you are alive and healthy and well and safe, and for those who have had damage from the storms or have had any loss of property or family, I just want to let you know that I'm sending you my well wishes and hoping for a good outcome for all that has happened.

1:45 So I want to thank everyone for listening. Thank you all for tuning in today. Today I want to talk about the things that we can't make excuses about. And I have to say, as I say the title of the podcast episode, I think, hmm, will this be the final version? I'm not sure. But the reason I have this particular episode in mind is because I just came back from a conference and it was a non...well, I can't say it was a non-medical conference because it really was for women physicians specifically. And it was the Wealthy You conference that was hosted by Dr. Latifat Akintade of MoneyFitMD.

2:29 And it was a gathering in Atlanta, well, at least close to Atlanta, and it really was a weekend really focused on topics and issues regarding building wealth. And what was awesome is that we didn't just talk about building wealth financially. We talked about the importance of building wealth socially, relationally, and through the kind of life that we live. And so she talked about three, actually four kinds of assets. One, you know, we all think about the fact that we should buy assets and assets put money in your pocket if you remember, or it's dad, poor dad versus liabilities, right? So buying assets is important. But what Latifat talked about was the importance of being an asset, recognizing that you are the asset, right?

3:14 You're the income generating asset and how important it is to protect that asset that is you. And then the other thing is building a life that is an asset and then creating assets as well. So while I think a lot of people focus on wealth building as buying assets, it really is important to think of yourself first as the asset and then the life you're living or the life you're creating as the asset and the opportunities you have to create assets. So it's a really, really powerful experience. But what it led me to think about, because I'm not really talking about finances today, is I think about all the things we didn't learn in medical school or in residency or fellowship training.

3:58 So for many of us who went through the process, we will hear said over and over again that we were not taught about the business side of medicine. On this podcast, I talk a lot about how we are really not exposed to research. And so what is the expectation that you're going to succeed as a researcher where you have not actually had the research training and now in your life you're not given the space to learn the research skills? And one thing I'm discovering, especially as I'm expanding my horizons, is that, wow, we are not taught very much else as clinicians. Okay, let's just respect our training here and respect the fact that we are taught to be excellent clinicians.

4:43 And I have to say that by the time we are done with our training, we are pretty good. And I know it can't be universal because everybody, you know, we have different challenges in different spaces. But let's just say we learn a lot. And at the very end of our training, we are so focused on, so focused on clinical work that we really haven't learned much else. If we're going to own our own practices, we haven't learned to run those practices. If we're going to do research, we haven't learned to, you know, lead those research teams. If we're going to do anything else besides doctoring, wow, we haven't learned very much.

5:25 And this is not for judgment. It is not for shame. It's just to say that, wow, learning clinical medicine, learning how to care for patients is time-intensive, and it really sucks up everything. And so for those of us who came to medicine after another career, we realized that there was so much more to life beyond medicine, right? Actually all of us came to medicine from a different career. Maybe we were students and we came to medicine. I know that we were students, continuing to be students while we were in medicine, but it was a different trajectory, right? So if your friends had summers, you did not. Your colleagues started earning money very early, you did not.

6:09 So definitely there's like, you know, you go in a different direction in medical school that you were not in or a direction you were not going in when you started. And so clearly for many of us, we came to medicine as full-grown adults. And even though we didn't have a career, we at least had a full life before we came to medicine. And then we go into medicine and it feels as if medicine just sucks up everything. Clinical medicine does at least. And if we are going to have any meaningful experiences outside of clinical medicine, wow, we have to give time, energy, and attention to these things. And that is what I'm here to talk about today. The importance of broadening our horizons so that we are not just very focused, so focused on clinical medicine.

6:55 Okay. I'm going to talk today about seven areas in which you really do need to broaden your focus and not just be focused on clinical medicine. And I think this is so important because we are taking advantage of sometimes in many arenas because of lack of knowledge. And unfortunately, many times we're so busy and it's like, well, I'm too busy. Can you take care of that for me? And that would be okay if the people we're asking to take care of things for us are trustworthy or have our best interests at heart. But many times, let's just say it's not that they're malicious. It's just that nobody cares about our business like we care about our business.

7:37 So I just want to talk about seven places in which we could absolutely expand our experience. And perhaps I'll talk a little bit about how you might do that. So the very first thing I'm going to talk about obviously is research. So this is the Clinician Researcher podcast, right? And so I'm very big on research. I also recognize that when I say research, I do mean research and it could be basic science research or health services research or clinical research. There's so many options, qualitative research. But what I'm talking about really is the bigger focus of scholarship and the importance of scholarship as clinicians, right?

8:17 And in reality, sometimes we're so focused on our work clinically that there isn't room for scholarship of any kind. And it is a problem. And I know, I know, just hear me out. Don't judge me just yet. It's a problem because if all we're doing is focused on doing, the reality is that the data, the evidence for the work we're doing is changing. And if we are not paying attention, then the evidence is moving forward while our clinical practice is staying the same. And so scholarship is important, not just to the extent to which we contribute to scholarship, and that's important as well, because in contributing, we have to apply ourselves to understand more, but also in consuming scholarship as well.

9:07 And honestly, for those of us who try to get CMEs completed at the end of the year, if we're not doing it consistently throughout the year, you realize that sometimes it's just you're scrambling to get the education in. And what's realistic is to get the education in routinely as part of your normal practice. And so if you're looking up data routinely as part of your constant practice, that is a form of scholarship that helps advance you. It helps you take better care of your patients because you're keeping track of the evidence. So that's like, to me, the bare minimum of involvement in scholarship is that you are at least learning enough to keep your practice moving forward with the current data, the current evidence.

9:50 So that's kind of, I think, the bare minimum. And then all the way to the other extreme is where research is really the major part of your practice. And I recommend that because research is a full-time job. And to be honest, anything short of full-time research is part-time research. And you know how you do on a part-time job, you make a part-time income. So it's that if you really want a fully-fledged research program, it is hard to get there on a part-time schedule, especially if you've not really had the training and research as your PhD colleagues. And so if you're going to be someone who's going to be leading in research, leading in scholarship, you do need to create space for it.

10:36 And the very beginning of that is learning research methodology, partnering with people who have the research methodology expertise so that you can bring your clinical expertise and add synergy to the team. And so for those of us who are pursuing this track as research scientists, in addition to being clinicians, it is an ongoing struggle to grow the skills that you really didn't learn in your clinical training. And it's important to be strategic about learning what you need, but also partnering with those who already have the knowledge but are looking for a clinical partner in their research endeavors. Now, you have to be careful because it depends on what you want to do.

11:17 If you want to lead a research program, then you have to really gather the skills for leadership. If you're just looking to participate, oh, there are so many people who would love to have you participate in one way or the other, but you do want to have enough knowledge so you can be a full-fledged participant really contributing significantly. Okay. So the first thing that I think is important for clinicians to use to broaden their scope beyond just their clinical work is research. Okay. Number two is finances. So yes, I did talk about coming from a financial conference, and so finances are pretty much top of mind right now. And I have to say that I'm speaking, again, in general about finances.

11:59 And so I hope that we learn to manage money before we went into medical school. For many of us, though, we didn't really know very much, right, because we went through education to the next...one educational level to the next educational level. And for many of us, we didn't even really have a chance to have a job. Now if you went straight through medical school and you supported your medical school with loans, then you were probably also taking up loans to pay for medical school. And maybe you had some financial training at the time, but probably not, because it's not part of our clinical training. And yeah, people are willing to borrow you a lot of money, but not necessarily give you the tools to manage that money wisely.

12:42 And so here we are on the other side of our training, and we do need to know how to manage finances. We need to know how to manage finances if we need a clinical unit. And so yes, we might have an MBA who is working with us to be able to manage the financial unit, but it is so important for us to be educated as well. And so I know physicians who've gone on and got MBAs or who've gone on and done some additional financial certification, and that's great. But whatever you do, you need financial knowledge. You need financial knowledge in your personal life, right? You need financial knowledge if you're leading a division. You need financial knowledge. If you're leading a research program, because budgets and administering the funds that you've received are part of that process.

13:28 And then you need financial knowledge for your life, for wealth building, for retirement planning, because as a clinician, you have come to the game later than your peers, right? There are people who graduated with you from high school who've already made a million or two, right, in their retirement funds. And you are maybe a little bit behind them. Perhaps you've caught up already, but you need to understand strategy to say, well, how do I make up for the lost time? Oh, that's not really taught in our clinical training. And again, that's okay, because clinical training is not supposed to teach you that. But what it's supposed to help you recognize is that, okay, well, this is an area in which you are lacking in a skill.

14:09 And that's okay, because you are great at learning new skills. And those skills do really need to continue to be built up. And so financial training, financial education is an important component of our lives, no matter what we do. Whether we stay in the clinical space only, or we branch out and do different things like administration or research leadership, finances are so, so important. And I want to just recommend that we think about how can I go get the financial education that I need? Okay.

14:49 Next to that is business education. Okay, so I don't want to lump financial education and business education together. They do go together clearly, but they're different. So for those of us who are thinking, okay, well, we want to go maybe establish our own practice or be part of a practice, understanding business principles or entrepreneurial principles are so important. To be honest, entrepreneurial principles show up in research as well. Because for example, I think the easy connection is basic science research. Let's say you've been working on this molecule that has therapeutic properties, right? You finally get to a point in your research where, oh, this looks promising.

15:32 The preliminary data shows that perhaps it could go to clinical trials. Okay, well, how do you take a molecule that is now showing promise and take it to where it is commercially viable? And you may be like, that's not my problem. My problem is just to do the work in the lab. But how do you do that? If you want to, do you have the knowledge? And again, I'm not asking you to drop everything and go find our entrepreneurial education, go get entrepreneurial education or go get a business education. I'm not saying that. I'm just saying that as part of your clinical work, there are opportunities to understand entrepreneurship, to understand business principles.

16:19 And yeah, we didn't learn them in our clinical training, but holy cow, it is kind of important. Because when we go and we're advocating for things that we need, whether clinically or in the research space, many of the times we're talking to business people. They're MBAs. They're running our organizations, whether we like them or we don't like them. For whatever reason, we may or may not like them, but there they are. They're the people with the financial background. They're the people with the business degrees. They're running your unit. And once in a while, you're going to need to talk to them, especially if you're moving into leadership in any way. If you're leading large grants, wow, it matters.

17:01 If you're leading a division or you're leading a department or maybe you even want to be dean, wow, you got to deal with these people. And if you're going to, and I don't mean these people like, oh my gosh, those people, but just you got to deal with people who are business savvy, who think in business terms, who think of people as units producing dollars. And this is no judgment of them. It's just, that's the what they've been brought up to. They've been brought to think that way. And so when they look at your unit and they're like, well, I don't understand why none of these doctors are making any money. Can we fire some of them? You need to understand that they think differently from you.

17:45 And if you had the language to be able to talk to these business oriented people, you might be able to make a bigger impact than if you just went there whining and complaining. If you understand the language of pro forma or making a case and looking at the profit and the loss, you may be able to get through to them a little bit more efficiently compared to if you just came and said, this is horrible. The way you're treating patients is the wrong thing. You're going to burn for this. Oh my goodness, I'm getting carried away. But you know, it's very emotional because we really care about our patients.

18:27 We are here to take care of our patients. And for many of us, the way we've been brought up in medicine, we're ready to die to care for patients. Please don't die to care for patients. I want you to live another day to care for patients. Well, I'm saying that we are very oriented towards patient care and not really considering the business of medicine. And unfortunately, or fortunately, depending on what way you want to look at it, the business of medicine drives our experience of medicine. Now, I recognize that I'm talking, I think, to mostly clinicians who are doing research. And so you may be like, oh, the business of medicine is not my problem. But that already you know is a fallacy, right? The business of medicine, whether you get money through grant funding or you get money through clinical work, or you get money through a dedicated educational activity, or you get money through administrative work that you do or for your administrative work, money is money.

19:22 And institutions, businesses run on money. And so it is important for you to understand business principles so that you can have good conversations that are effective and help you advocate well for the people that you work with or for the groups that you lead and you serve. Okay, so there you go. We talked about business knowledge. The other knowledge that I think is so important is managerial knowledge. Okay, so this I separate from leadership, because to be honest, physician training is leadership, right?

20:04 You are leading, you are standing up and saying, I think this patient has a diabetic foot ulcer, I believe we should get a CT scan, let's have the transport person come and get the patient to take them to the CT to have a look at those, those to take, you know, look at the legs, let's make sure ortho is called, you're leading a team. And usually you're leading a multidisciplinary team, especially as you rise up in your training. So leadership really is a part of clinician training is something we've done a lot of. And so I don't, I didn't list leadership there, but I did list management, management of people and relationships. Ooh, very, very challenging.

20:46 That is something we're not necessarily taught managing the people side of things. So yes, we've led, we've, you know, we've, we've, we've led teams, we've done so successfully. We've led teams to be able to care for patients. We've led families to be able to come to difficult conclusions, but what we haven't learned is how to manage people and what we begin to recognize in our roles, in our clinical roles. Wow. We're managing relationships with nursing staff or allied health staff, or perhaps it's your advanced practice provider. You're managing those relationships. And many a physician have I heard from who said, I had no idea.

21:27 They were so upset. In fact, I've had, I've had issues too, where I was like, oh, really? They were mad and complaining about me. How is it that I had no idea? There are many managerial issues as far as managing people that really we don't get any training for. Meanwhile, it's an inherent part of the work we do. So you don't escape if you're like, oh yeah, I don't really do clinical. I don't have to manage people. Yes, you do. As you're building a research program, you start to have staff that work for you. I hope they are working for you as you're getting grants and funding people to be able to work within your research program. And then all of a sudden you have to learn to manage them. And all of a sudden there's a person who doesn't show up for work three weeks in a row.

22:08 Meanwhile, you are paying them every week. What do you want to do about that? How do you handle it? Who do you talk to? And for many of us, it's like, wait a minute, I'm focused on my research. I don't have time for this. And yeah, you don't have time for it, and yes, you must address it. Where do you get the education you need to manage people? Okay. So I'm just sharing areas that you need to think about and address, though I'm not necessarily telling you exactly where you go get this information. But yes, so the fourth thing we talked about is the importance of management. The fifth thing that I want to talk about is the importance of relationships.

22:51 So this one's a little bit different because to be honest, we've been doing relationships all of our lives. But I think the aspect of it I want to talk about is the fact that when you finally transition, well first of all, to be honest, let's go back to the very beginning. Who you were before you went into medical school is completely different from the other person who showed up on the other side of medicine. And so if your parents knew you at the very beginning or your family members knew you, let's just say that you were a very different person at the very end and you continue to transform. And one of the ways in which you've changed is how busy you are and how you don't have as much time perhaps compared to other people to do the things that people your age do.

23:41 So let's say for example, your friends on the weekends will go skiing maybe every other weekend or go to the mountains for a nice guy's trip or a girl's trip. And your schedule doesn't allow you to do that that often. And in fact, maybe financially you can't do that as often right away because you're taking time to build it up. And so to some extent, there are expectations of relationships around you or of people around you who maybe used to know you or who don't even really know you but are in community with you. And there is a difference in expectation. And sometimes you feel that tension because people feel like, well, you should be in the same group as us.

24:24 You should be doing this. You should be available for golf on Monday mornings. And maybe at some point in your life, you will be available for golf on Monday mornings. But that likely is not you at this point in your career. How do you manage those relationships? How do you manage those expectations? How do you manage those? Now I'll say personally for me, one challenge I've had is people schedule meetings at night. I am an early morning riser. Now that doesn't so much have to do with my clinical training as much as that, you know, if I'm on call, I haven't slept for the week before because I've been on call. I just I want to catch up on sleep the next week for sure.

25:04 And so when people are like, oh my gosh, we have a party, it's coming up and we'd love you to come. How do you navigate those relationships and those expectations? Now you may say, hey, that's common sense. And I just want to tell you that it is not common sense. It takes tact and wisdom and grace to be able to manage these. Now I'm even talking about relationships outside of work. But let's even talk about relationships at work. How do you manage your division chief who says you should take this role, it's gonna be great for your career. And you're like, I hate that role. I know it's gonna suck. No thank you. How do you politely say to somebody who is higher than you in the hierarchical order that no, thank you.

25:46 I don't care for your recommendation. And some of us have no challenges doing that to say, hey, this is a really great opportunity, but I don't think it's for me. But some of us struggle. Some of us struggle where we're like, well, I don't want to make this person mad. Why don't I just say yes? And then we end up saying yes to things that we don't want to say. And so yeah, we need coaching to be able to help us manage those relationships, especially the hierarchical relationships that maybe make us feel as if we are not choosing but that others are choosing for us. Now in the research space, it's the mentor mentee relationship where you feel like you owe the mentor. So whatever they ask you, you're like, of course I'll do it. Not because it's something you want to do.

26:27 But now you feel the obligation of, wow, this person is invested in me. How can I say no? Just because they've invested in you doesn't mean you don't get to say no. But I can see that there is a challenge because there's a power differential. And sometimes mentors are not such great people in terms of how they treat people or how they take no. And I'm not calling out mentors specifically or wanting them to look bad. I'm just saying our parents struggle with that too. The moment you look to be growing up and saying, I don't want to do this thing you're recommending, parents struggle with it. It's a similar issue. And so yeah, people, people relationships hard. And you might say, oh, I should know how to do this.

27:07 I'm an adult. But I have to tell you that it's a skill that needs to be learned. And just because you don't have the skill doesn't make you a bad person. But it does mean you need the skill. So think about that and think about going to get that skill. Okay. Number six is planning for retirement. I know I talked about finances and number two. And here I am talking about planning for retirement. So I'm not going to talk too much about it. But just saying that you love to work and you see yourself working forever and ever and ever, which is fine. But are you thinking about what, you know, when you finally do decide to throw in the towel on your clinical work, what does the rest of your life look like?

27:49 How do you get there? How are you doing retirement planning? And it's a really important conversation to have. It's a really, it's an important thing to think about. Some of us outsource these decisions. I'm going to say even when you outsource them, you should be aware, you should be savvy in thinking about what do you want your life to look like? Do you want to wait until retirement for your life to look like that? And having conversations around what are the appropriate strategies for wealth building. That's important. And we're not taught in med school or in our clinical training, but we do need to understand this. And then it's also important, especially for those of us who are employed as academic faculty, because sometimes, especially compared to our compadres in private practice, we make a lot less.

28:39 And so it's like, well, you're making a lot less. This is great. You have such great flexibility. What does that say about your retirement schedule? So you had said at 65, you want to retire based on what you're earning right now. Or you can be able to retire at 65, or you can need to push it to 78. That sounds awful. But these are the important things to realize and to think about, because you understand that you're doing certain things for a certain benefit today. But you do want to recognize how they fit in the context of your bigger life. Okay. Number seven is legacy. How do you leave a legacy? And now this is the kind of thing I feel like people are like, well, when I'm 80, I'll think about my legacy.

29:20 When I'm 70, I'll think about the legacy I want to leave. And I would say that if you're thinking about legacy building when you're older, I hope you'll have the time to really build the legacy you want. But the reality is that the legacy you're building starts now. And building legacy is something that we don't authentically, immediately, automatically know how to do. We need help to learn how to do that. And if we were thinking in terms of building legacy right now, it might change the way we interact with mentees. It might change the way we interact with people around us. It may change the kind of work we do. Because when we ask ourselves, hey, 20, 30, 40, 50 years from now, when I am no longer here, what will be left?

30:05 What will be the evidence that I was here? What is the evidence? And that's so important because I have to say that many times we as clinicians, we love to give to our patients. We absolutely do. And in reality, we will always have people who remembered how well we cared for them and how much we loved on their kids. But for some of us, there is a need for more tangibility to that legacy. It's not just how many patients did I serve, but like, what is the mark, the indelible mark I left on my community? What is the indelible mark I left upon my family? And you may think this is something that should just come naturally as you age, but it doesn't.

30:45 It takes time to consider legacy, to begin to ask yourself, am I going to be able to leave this legacy if I'm working the way I'm working now, or if I'm doing the kinds of things I'm doing now? Legacy building is not an accident. It doesn't just happen. It is an intentional strategic move or a series of intentional strategic moves that people make to get to the intended destination of building legacy. So those are the things I just wanted to share for you to consider as things that we didn't learn as clinicians, but are super important for our future. And for that reason, I want you to be thinking about it and to see how can you get a little bit of an education or maybe a lot?

31:33 Where can you go? What circles can you go to? What communities can you be part of so that you can get the knowledge that you need? Okay, I'm going to summarize those seven, research, finances, business, management of people, relationships, retirement, and legacy. Those are the seven areas that I think, I mean, they're not exhaustive, right? This is not, oh my gosh, you need these seven areas and you're done. It's just easy, right, to give you a list of seven. There are other things beside this list that you should be thinking about. But I want to say at the end of this that just because you weren't taught in medical school, just because it wasn't part of your clinical training, doesn't mean it's not important for you.

32:14 And just because your faculty appointment or your academic institution doesn't give you these opportunities for development in these areas, doesn't mean you shouldn't go out and get them for yourself. And so whatever opportunities you have to grow in the area in which you desire, go out and do it. Don't wait for permission. Go out and do it. And don't say I'm too busy, because what you're really saying is I don't prioritize it. You will always be too busy to do the things you don't prioritize. And so I invite you to think about what are the priorities for yourself, for your life? What is the legacy you want to leave? And are you doing the things to get you to the destination you want to go to?

32:59 Or are you kind of just floating with a plan to end up at a destination if somebody else is choosing? All right. It's been a pleasure talking with you today. Thank you so much for listening. I look forward to talking with you again the next time on the Clinician Researcher Podcast. Thank you for listening. 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. If you found the information in this episode to be helpful, don't keep it all to yourself.

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