Are publications really necessary?

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 such a pleasure to be talking with you today. I want to thank you for tuning in, and I am talking today about publications. Are they even necessary? Do you really need publications in this academic career? What is this thing about publications?

1:22 I want to talk about them because, you know, have you ever heard the phrase publish or perish? I don't know where that came from. I'm sure there's a great origin story, but already I hear it and I'm like, really, publish or perish? What does that even really mean? Are you really going to perish if you don't publish? Yes, it does allude to the fact that in academic environments, publications are so valued, and if you don't publish, then there's just the sense that you don't belong, and maybe you may not be promoted like you'd want to. So yeah, there are some consequences of not having publications, but do you die? No.

2:02 Your life continues. Anyway, so I'm just telling you that publish or perish is not real, but, you know, in not in the sense of the word of like actual perishing. Anyway, I digress, but I think it's important to talk about publications because, wow, they're so much anxiety and dread and worry and fear that's around publications sometimes. And to be honest, there's so much anxiety and pressure over publications that people are making stuff up just to publish. And I want to talk about publications. I want to talk about it, not from the perspective of, oh my gosh, I'm going to advance my career and I'm going to be promoted or I'll be able to, you know, gain a higher salary because I have this new promotion.

2:49 I'm not going to talk about it from that perspective. I think enough people talk about publications from the perspective of currency, of academia, why it's needed for promotion and tenure. And I think all of that is great. It's just not very motivating. Like yeah, publish because if you don't publish, you can't be promoted. That just to me is not very motivating. It's like, who says I want to be promoted? I mean, you do, but it's like the connection between publication and promotion is so far you know, it's like, okay, how do you make the connection today? I mean, it's far, right? You start your faculty career job now and in six years you need to have published enough to be able to be promoted.

3:30 Maybe it's seven years for some of you, eight, nine. You got to have published enough to be promoted, but what's going to sustain you today other than this stick? I mean, I'm sorry, this carrot on a stick in the far future that, you know, eventually you'll get there and maybe you'll be promoted. It sustains you today. What are the benefits of publication right this moment? And the reason it's important is because in order to succeed at any goal, you really do have to break it down into its small steps and enjoy the journey. You got to enjoy the journey. And if you don't enjoy the journey, wow, it's going to be really hard to sustain it over the long term. You might be able to do it at a frenzied pace for a month, two months, three months.

4:11 Maybe you could get to 12 months, but you're not going to sustain a 30 to 40 year career, God helping you live long, long, long, right? God helping you live a long life. You're not going to sustain that kind of frenzied energy over a long career. And you know, honestly, some people are able to sustain the frenzied energy over a six year career. And then they get tenure and they're like, I'm done, no more publications. And that kind of is a sad thing because, you know, it's not about just promotion and tenure. Please people hear me. Publications are not just about getting promoted. And if you just are working, working, working to churn out publications just so you can get promoted, I would like you to consider whether you are in the right career, whether this is what you really want to be doing.

5:00 Because your academic journey, your faculty journey is not about, you know, brownie points or stars or gold stars or rewards. It really is about building a career that is satisfying to you, that you're able to look back on and say, wow, this was the career I had. Look at all the impact I made. And publications are part of that impact. But I do want to talk today about a couple of reasons why you should consider publishing. And I'm talking about reasons that benefit you today. And I hope that if you are not kind of already working to get some of your ideas out and getting them published, I encourage you to definitely do that.

5:45 Or if you are and you're discouraged and you're like, oh, I don't want to do this anywhere. This is too hard. I just want to encourage you again that it is really worth doing. And I want to give you five reasons to think about when it comes to publishing. The first thing is growth of your personal knowledge. And I will say that as physicians, we are full of knowledge, right? We went through medical school and the whole process of medical school was to pump your head full of knowledge, at least the first two years were. And half of that time is spent pouring knowledge into your head. And the other half is spent mopping the knowledge off the floor and trying to get it back in your head because clearly it's not sticking.

6:30 But when you're on the wards as a third and a fourth year, second year for some of you, you recognize that a lot of that information does stay because it's knowledge you need to advance patient care. But when you start to take care of patients, when you move in medical school from trying to memorize all these facts to actually caring for patients, the facts stick better in the context of actually taking care of the patient. It's like, oh, the pathophysiology of renal failure makes sense because I've cared for a patient with renal failure. I've kind of seen it unfold. It's not just the thing in the textbook I've memorized. It's the patient experience that I had.

7:12 You remember how that knowledge struck better when you had the experiential knowledge? Yes. And when you're writing a publication, writing manuscripts for publication is the same thing. It's that you have this knowledge, but when you actually have to go dig up references and figure out how to put it together in a cogent way in a manuscript format and submit it for publication, you really do grow in your personal knowledge. You become someone who has knowledge on this topic because you've written about it. And it's just so powerful. It's the reason why when people are looking for speakers, they go looking for people who've published on things because it means these are people who are reading the literature and are well versed with what's going on with this topic.

7:56 They have knowledge because they've had to write about the topic. And so writing about a topic does give you knowledge. It helps you advance. And it's really awesome. I don't know about you, but you know, the first year of medical school was the most frustrating year. We were learning so much and it's like, what is the point of all this knowledge? And can my brain take any more? And then when I finally got to the words, it was like, oh my gosh, this is so awesome. I'm so glad I'm learning all the things I'm learning because of all the people I'm able to help. It is so incredible. It's that same personal satisfaction with knowledge that's actionable, with knowledge that helps people move forward. Personal knowledge is one of the gifts of writing manuscripts for publication.

8:38 And I want to invite you to do it because yeah, you know, you see all these patients, but when you have to put into words and when you have to like look in the literature and say, okay, where does this fit relative to what people are saying? How is this different from what the literature is saying? It really enhances your knowledge base. It is so awesome. It is so personally satisfying. And I invite you, if you have not kind of like just, you know, enjoyed the experience of kind of knowledge of writing. I mean, the experience of like growing in your knowledge as you write, it's absolutely worth it and I recommend it. Okay, so personal knowledge is one of the gifts of publishing.

9:20 The second is conversation with the scientific community. And I'm keeping it positive here because conversation with the scientific community actually also refers to peer review, but I'm not really talking about peer review right now. I'm talking about what you have to do to be able to actually write a manuscript for publication. You need to know the literature. Okay, you don't have to know everything, but you need to know a broad swath of the literature related to your topic that you're publishing on. So you are having a conversation with other scientists indirectly through their work, right? You go and you say, well, we found this amazing thing. It's like great, good for you. How does it converse with what's already in the literature? Like how does it compare?

10:01 Is this the same? Is it different? What's new about your work? What's novel? What's interesting? Tell us about your work in light of everything that's going on. And it's so important. It's the reason why when we write manuscripts for publication, we have all this list of citations, right? Because we've looked up other papers. I hope you're not just putting numbers on the page. I hope you've actually looked at these citations. But you really are in conversation with the scientific community, with other people through their work. That's a beautiful thing. It's a beautiful thing because science doesn't happen in a vacuum. And our data is totally impartial, but the way we interpret the data is not, right? I am a biased person interpreting my data in a biased way.

10:43 The data is not biased. My interpretation of the data is biased. And the question is, is it biased toward the way it's reported in the literature? Was it biased against it? And so, being in conversation with the literature allows you to sort that out and talk about it. And maybe that at the end, you're sticking with your biases as opposed to what's like, where the literature is leading you. And that's fine, but you're going to be explicit and you're going to state it. You're going to be explicit about it. And then you're going to get past the reviewers, right? But this is not about the reviewers. So I'm not talking about that kind of science communication today. But it's a great conversation because the work you do, the patients you see, none of it is happening in a vacuum.

11:26 And so the opportunity to converse with the scientific community is amazing. It's great because it enhances you. It's not just knowledge that you're growing in. It's also growing in the discourse and the ability to communicate your work scientifically. And that's really awesome. Number three is that you're growing in skills. So we've talked about the growth as far as like knowledge growth, the growth as far as knowing how to converse with the scientific community through the work of others who have come before you, but also growing in the skill of writing. Now I will tell you that there are many scientific manuscripts that I read and I'm like, okay, didn't understand exactly what they did, but it sounds really cool.

12:13 But you know, the more you do it and the more seasoned journals, I'll call them seasoned journals that you go after, the higher the quality of your writing needs to be, the higher the quality of your synthesis, the higher the quality of the work that you pull together. And so it challenges you. It challenges you to grow in skill. It challenges you to grow in quality. It challenges you to do the case reports, but then move beyond the case reports to case series and then move beyond that to clinical studies or to actual clinical trials, to different things.

12:53 So you're not really understanding what your area of research is, but it really helps you grow in skill because writing a manuscript is not just about the writing, which is amazing because you're growing your writing skills and your science communication. That's awesome. But it's also about all the skills you have to grow in to be able to have something to put down on the manuscript, right? You've got to first of all, do the work or make the observation or do the analysis before you now say, oh, I'm going to put it on paper and I'm going to submit it as a manuscript. And the fact that you are in the process of writing and publishing regularly allows you to keep looking for opportunities to continue to grow things that you can put on paper and share with the scientific community.

13:36 So it's really great because it helps you grow in your research skills. It helps you grow in your writing as well. And I call it a keystone habit. And so a keystone habit comes from Charles Duhigg, the power of habit, where there's one habit you start doing that changes everything else around you. For example, you start exercising and all of a sudden you change the way you eat. So it's a keystone habit. When you start to write for publications, it's a keystone habit because the more you write and publish, the more you look for it to write and publish. So it's kind of like a self-fulfilling prophecy, so to speak, or feedback loop really of continuing to help you create what is needed for the next manuscript and then the next manuscript and then the next one after that.

14:24 So it really does help you grow in your skills. The next one, which is number four, is expertise. Okay, you're the one writing about it. You are the expert. You know, recently I wrote a manuscript and I wrote the manuscript because I was part of the guidelines writing committee for the American Society for Atheresis. And as part of that, I created, you know, I developed one of their new fact sheets. And having put in all that energy, I remember thinking, I was like, there is no way this is not going to become a review paper. There's just no way. I mean, I mean, we were clearly writing the guidelines, so that was its own paper. But I felt like so much work had gone into this new fact sheet that it needed to become its own review paper.

15:07 And so I pulled the work together and I wrote it and I submitted it and it was, you know, accepted and it was published. And then all of a sudden people start coming out of the woodworks asking me to review papers that are similar. And many times I had to say, but no, this is not my area of expertise. I mean, well, this is not my area of expertise. They're like, wait a minute, but you wrote about it. Yeah, but yeah, but how do you convince people that you're not the expert after you've just written one paper? Very hard to do. Because you know what? It is a rare topic and you are one of very few people who've written about it. And now everybody wants to hear your opinion.

15:49 And to be honest, you kind of are the expert. The person who writes about it is the expert because they're the ones thinking about it in ways that nobody else is thinking about it. And so if you want to become an expert, if you want to become the expert, the go-to expert, you choose one area and you're right in it and you're right in it and you're right in this field until you are tired of writing in this field. You'll never get tired because you'll always find new things to write about. But you become the expert. That's how you become the expert, by writing about things. And so it's a great thing to grow in expertise. And it's a great thing to grow in expertise because the next time you go around to writing on the same topic, you're a different person coming to this second piece of writing than you were the first time you came to this space.

16:37 And you now have some understanding under your belt of this field that you didn't have the first time. And then multiply that by 20, multiply that by 30. Now 30 papers later, you have nuances of understanding, nuanced understanding that nobody else has because you are the expert writing in this space. And so expertise is one of the gifts of writing for publication. The last one, number five, is raising the next generation. When you first start out, you want to be first author on everything. And when you can't be first author on everything, you're like, well, can I be co-first author?

17:21 And it's important, it's necessary in our field because there are some fields where being first does not necessarily mean you did everything. Anyway, the different fields have different conventions. But in my field, as a clinician scientist, the first author is usually the one who's done the bulk of the work and then they're working together with the senior author. So there is a convention where the first author is kind of doing the most work. And so when you first get started, you are the one doing the most work and you're mostly doing it in collaboration with a mentor. But as you advance, then you start to move.

18:02 And you have other people work with you and you start to move to the place of being the senior person, the last author on the list. And that's awesome because it means you are now mentoring another generation to write and publish. And it's so powerful, it's so beautiful because, you know, by yourself, you can only write so much, but the moment you start mentoring others to write manuscripts, that's so awesome because you can really, you know, triple your impact, quadruple your impact because now you have other people that you are writing through or you are mentoring to write with.

18:43 And it's so beautiful, it's so awesome. Now, the thing about that is that you are going to have to put in work to help bring them up to the excellence with which you already write. You get good at writing when you've written a couple of times, right? You get good at synthesizing the literature and writing the discussion. And when a younger person, a trainee now comes to you and says, hey, I want to write a paper with you, you're good at that stuff because you've done it. But now you have to teach them and you've got to be patient and you've got to help them, you know, go through and do a great job. It's a commitment, it's a challenge, but it's also really rewarding. You're raising the next generation of scientists and that's really awesome.

19:24 But you don't get to do that until you've put in the work of writing manuscripts for publication to yourself, until you've put in the work of going through reviewers and knowing how the reviewers will come at your manuscript and knowing how to respond to the reviewers. You don't get to lead others in doing this work until you've done it well. And so that's a beautiful thing that as you are, if you are still kind of at the place where you are writing as first author, most of the time, just recognize that you are building a skill set that you're going to pass on to another generation of scientists. And that's a really, really incredible thing. Okay, so I've given you five reasons, five reasons why you should enjoy writing manuscripts for publication today.

20:10 Don't wait until promotion and tenure six years from now. Enjoy it today. And those five reasons are personal knowledge, conversation with the scientific community indirectly through their writing, growth in skills, not just the skills for writing, but also the skills for doing the research, expertise because hey, you're writing about it. Now you know more than everybody else than reason next generation, which I think may be the most beautiful thing about writing for me today. All right, if that has been helpful to you, I want to invite you to please leave a review on our website. If you've been listening and you've enjoyed any of these podcasts, episodes, and they've been helpful to you, I want to invite you to please leave a review because it helps people find us.

20:53 It helps people, it helps validate the podcast as a source of good information. What do you do when you go and you want to buy something on say a merchant like Amazon, you look at the reviews, like is this worth buying? Is this worth listening to? And so I invite you if you are enjoying this episode or if you've enjoyed other episodes that we've done to leave us a five star review and I appreciate you in advance for doing that. All right, it's been a pleasure talking with you today and thank you for taking the time to listen and I look forward to talking with you again the next time.

21:37 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. Someone else needs to hear it. So take a minute right now and share it. As you share this episode, you become part of our mission to help launch a new generation of clinician researchers who make transformative discoveries that change the way we do healthcare.