Going against the status quo is hard but you should do it anyway

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 Toyosi Onwuemene, and it is an absolute pleasure to be talking with you today. Thank you so much for tuning in. Today I want to talk about going against the status quo, why it is so hard, and why you should do it anyway. I'm talking about going against the status quo, why it's hard, and why you should do it anyway.

1:26 I am reminded of when I first started my faculty career, gosh, about 11 years ago now or more, and I came to my faculty position knowing that I wanted to do research, but not necessarily having had the background to succeed as a researcher. I thought my clinical training was enough to allow me to succeed as a researcher, and I didn't realize there was so much more that was needed. I didn't realize that there were skills I was missing. I didn't realize I needed training. When I said, this is what I want to do, and people to some extent either didn't take me seriously or didn't believe that I could, I found myself doing what I didn't want to do.

2:11 I came to do research, even then my research aspirations were not very specific. It was very vague, which is fine. There are different stages, and sometimes you know your call to something even if you don't know what the details of it are. I knew I wanted to lead research. I knew I wanted to be in research, but I didn't know exactly what it was. Part of my confusion was that the research I had started didn't necessarily have space in the new place that I was in. Another area that I wanted to get into was closed off to me, at least so I was told or so I thought. But there was a lot I didn't know. There was a lot of knowledge that I was lacking.

2:52 In reality, clinicians work to take care of patients. That's what we do. Our training is about taking care of patients. When you say, I want to step outside of our training, my training, and I want to do something different, you're going against the status quo. Yeah, there may be other people who are doing it. But the prevailing number of physicians who go into research is few relative to those who go into clinical care. Clinical care is the default for clinicians. It's not being a physician scientist. If you're going to go against the grain and do your thing as a leader of a research program, you're going to understand that it's going to be hard.

3:34 It's hard exactly because you are starting a course that's not the default course, but it's also important because it is the way that you establish yourself and fulfill your purpose. The reason you're not satisfied with only being a clinician, not to say that that's an only, but the reason you're not satisfied with doing that alone is because you feel like there is more. If you're going to answer that call, if you're going to pay attention to the yearnings that you have inside you, you're going to want to step outside the box and do something different. That is challenging. I tell people who are trying to make the transition into research that, hey, this is a hard path.

4:18 It's not supposed to be easy. Easy is going with the flow, jumping on the bandwagon, letting the current carry you. That's easy. Now, swimming against the current? Yeah, that's hard. That's hard. It's hard because you're going against the flow. It's not hard because it has to be hard. It's just hard because the very nature of the thing you've chosen to do is difficult. You're swimming against the current. You're going to have to exert more energy. You're going to have to grow muscles. You're going to have to be strong. You're going to have to have stamina because every time you take a break, the current carries you in the opposite direction.

5:03 So I'm talking about the status quo, why it's hard, going against it is hard, and why you should still do it anyway. Okay. The first thing to recognize is that social pressure and conformity will always push you towards doing what is accepted, what everybody else is doing. Again, if you wanted to do what everybody else was doing, you would already be doing it and you'd be satisfied. You'd be like, this is the life, exactly what I want to do. This is just it for me. And it's okay if that's it for you. But if you're listening to me, it's probably because there's more. You know that there is more. You know that whatever it is that you're doing right now is not enough. And it's not because you're a discontent, you're malcontent or you're discontented in any way.

5:49 It's just because you want to grow. You want to reach for a different way of making an impact or making an impact to a larger population of people in a way that's different from your training. And you feel it, you feel the difference, you want to do something different. But everybody around you, or at least many of the people that you see around you, are going one way. And so there is pressure to conform to doing what everybody else is doing, even when you feel as if you should be doing something different. And I'm not saying that you should resist the pressure or you should conform to the pressure. I'm just saying the very fact that you're choosing to do something that everybody else is not doing puts pressure on you.

6:32 And it's a natural pressure of just socialization. We want to go with the crowd. We want to do what everybody else is doing because it's easier that way. And the moment you're trying to do something different, you start to put yourself in a place of isolation because people don't resonate with what you're doing. They don't understand it. Sometimes they just have no idea why you're doing what you're doing. What do you mean you're not going to spend four days a week seeing patients? What are you going to be doing? What do you mean you're spending only 25% of your time in clinical care? What do you do? Are you even working? And people don't understand.

7:13 And they don't understand not because they're not considered or kind, it's just because they don't have a frame of reference for what you're doing. Yeah, they have a general sense of research, but it's like, yeah, but why do you have to take time off to do research? Why does it have to be your daytime job? Why can't you just do it on the side? There is pressure to conform. And you can make, actually, you can make three choices, but there's really two. There are really two choices. One choice is to just go with the crowd and just say, you know what, this is what everybody else is doing here. Let's just go with the flow. Or you can say, this is really what I want to do. I know it's not something you understand. I'm going to do it anyway, even though it's hard.

7:54 The third option, which is not really an option, it's the middle option of lukewarmness or like, you know, being sitting on the fence, like, well, you know, I'm not really going to do this and I'm not going to really do that. I'm just going to stay in the middle. And that may be the worst thing that you can do. You might as well just go with the flow or go against the flow, but sitting in the middle thing, you accomplish nothing. So that's why I say it's only really two choices. You're either going to go with what you want to do, push towards your goal, or you can just capitulate and just do what everybody else is doing. But there is social pressure to conform. You feel it, you know about it, you've experienced it since you were on the playground in kindergarten, and it's real.

8:36 And if you're going to push forward to leading a research program as a clinician, then you got to recognize that you're going to face some social pressure and you have to be ready to decide what you're going to do, whether you're going to conform or whether you're going to push forward into the thing that you know you're supposed to be doing. Okay. The second thing is that there is a risk of repercussion. And it's an interesting thing that we don't think about. When I say I want to lead research and I now want research to be my daytime job, it means I'm not doing as much clinical care. And there are people who feel like they're doing a lot of clinical care and have the burden of clinical care on them.

9:21 And then they look around and say, wait a minute, who is this person who says they're doing research and they're not fully carrying the brunt of the clinical load with us? What's going on? And so people don't like that. And there is a risk of repercussions. There are people who are not going to like you. There are people who don't understand and they don't want to understand and they don't see why. And you have to say you're doing research as part of your daytime job and not like fully being on board with all things in the clinical space and vice versa. Every time you say, I'm going to do something different, it means you're not doing the thing everybody else around you is doing.

10:03 And there are repercussions for that. There are people who are not happy about it. There are people who'll solitize you sometimes. There are people who'll get in your way. And it's not personal. Just the way of people. It's what happens when somebody who's part of a social circle goes a different way. There's isolation and there are real repercussions for going in a different direction. And so yes, there is a risk of repercussion. So what do you do about it? Well, one thing you have to recognize is if you want change in your life, it's hard to stay around the people who are not executing that change and expect something to be different or expect it to be easy.

10:50 It's not going to be easy. But one thing you can do is change your environment or change your community. If you are surrounded by people who don't support you to succeed in a certain way that you want to succeed, then what would happen if you planted yourself in a place where there are people who want you to succeed in that way? Now it doesn't have to mean moving institutions, at least not right away, but it does mean finding a community of like-minded people who want to grow and stretch in exactly that direction and who recognize the value of the direction in which you want to grow in. For example, I have a weekly peer coaching community that I'm part of.

11:31 And these are faculty from different institutions across the country in different disciplines. No one in my group is a medicine, but they all are into research, into publishing, into writing grants. And so we hold each other accountable every week for moving forward academically or in a scholarly way, the way we say we want to. We're making the goals. And so they hold us accountable to the goals we say we want to achieve. And it's a beautiful space. It's not the space of my everyday work, but it's a community that I gather with once a week that reinforces the choices that I've made.

12:13 Yes, there's isolation from people who are in my immediate circle who don't really understand what it is I'm doing. But in joining your group of like-minded people, they create a community that helps me grow. So there is risk of repercussion, and you've got to be intentional about finding community that supports you in the way you need support. Number three is the fear of uncertainty, fear of uncertainty. So you don't know if it's going to work. You're putting in all this effort. You're working towards getting all this grant funding. You're working towards manuscripts. You have no idea that at the end of the day, it's absolutely going to pay off.

12:56 Actually, maybe I'll take a step back and say, you know it's going to pay off. You're just not sure exactly how and when. And you feel the real pressure of people saying, well, when is this going to work? When are you going to get this grant? When is this going to happen? And you feel the real pressure of time running out on you. Like, oh, you have three years to make this work or you're bust. And so there's real fear that you're not going to make it, that you're not going to make the transition, that you're not going to be funded, that you're not going to get manuscripts published. There is real fear. Because you're going the way that's not tried and tested. And it may not even just be in going towards research as a clinician.

13:36 It may even be in the topic of research or the choice of research. You're not doing what everybody else is doing. You're choosing to blaze a new trail. And it might not work. And I want to say that fear of uncertainty shouldn't stop you. Because yes, it might not work. And that is part of the journey, part of the beauty of the journey. The thing is, the moment you say, I'm going to change and go in a different direction, you've already declared yourself as someone who is willing to innovate and pivot and flex and move as needed to accomplish what's needed.

14:16 You've already won. Because what you've done is you've chosen a path that makes you a certain kind of person that is able to weather storms and be flexible. That is the gift that you have for making a choice of going against the grain, of going against the stethoscope. That's what you have. And so yes, it may not work. But that is not the thing. The thing is that you're the kind of person who can laugh in the face of uncertainty because you know that the substrate that's being created can flex in a different direction. Yes, the line of research that you've chosen may not work. And you're going to be okay because you're going to figure out a new line of research that takes the skills you already had in one line of research and makes it work.

15:04 You are that kind of person. And so no, you may not know what the future brings. But what you're very clear about, what you should be clear about, is the fact that you're growing into somebody who can face an uncertain future, face it head on, and succeed. That is a skill that is amazing, incredible, and absolutely worth celebrating. Number four challenge of going against the grain is that because there is no built-in infrastructure for someone like you who's doing something different, there may not be resources for you. There might not be support.

15:44 You know I will argue that there are always resources. The challenge is not the resources because we always talk about limited resources, limited resources. No, the challenge is not the limitation of the resources. The challenge is the limitation of the person who is guarding the resources and whether they choose to release resources or not. And so we have the challenge not of limited resources, but of people who may not believe in the dream enough to release resources. Like, I don't even believe in that. What is that? What is the limit? So you may feel a lack of support, and support is important. And if people don't want to give it to you, how can you negotiate for it?

16:26 And if you're having difficulty negotiating, where do you go with that support already exists? Where do you go with the resources already are? And so maybe in your clinical space, people are not very supportive of clinicians doing research. They need more support for clinicians doing clinical work. Where at your institution are there people who are doing the kind of research you want to do? They may not be in the clinical space. They may not be in the clinical space, but they're already doing the research. They're already advancing the work, and that's a space that you should go explore. In that space, there are resources to do research because people are already doing it.

17:09 And if they're doing it, it means that there's infrastructure that supports them in some way. And it may be that they created the infrastructure, but the key is that it exists. Wherever you see people succeeding, there is an infrastructure of support to help them succeed. And if you can't access support in your own immediate neighborhood, where can you go to find the support that you need? Maybe it's that you attend workshops at other institutions across the country. Now we're in the day where there's so many virtual opportunities, so you don't have to feel stuck. But there may not be support, and yet, and yet, you still have the opportunity to find a space where you can be supported.

17:56 Number five is that you may experience resistance. I laugh because isn't that what I've been talking about the whole time, resistance? Well, the kind of resistance I'm talking about specifically right now is resistance from those who should support you. For example, maybe it's your division leadership. Maybe it's your department leadership. Maybe it's your dean. And they're like, what is this? I mean, they say they support you, but then they don't give you the resources that support you. So to some extent, you feel the resistance, or they say they support you, and then you feel as if they might be undermining you. You feel the resistance, and if you feel resistance, it's real. I just want to just acknowledge that the resistance you feel is real.

18:39 Because the challenge is sometimes we don't acknowledge that it's real, and then we're spending so much time in two minds trying to say, well, are they resisting me, or am I just imagining it? I just want to say, just throw it out. Just say, it is a real resistance. You're not imagining it, and move forward. What does that help you do? It helps you take away all the time that you're investing in spending that energy trying to figure out whether you're making it up or not. There's this term called gaslighting that I think is apt, where I want to say when people are gaslighting you, sometimes it's not personal. And sometimes they're not trying necessarily to deny your reality.

19:22 It's that they have no clarity about your reality. For example, someone who wants you to succeed as a researcher, they came from an era 30 years ago where there was a lot of support, and they forget what it's like right now for the person who's starting out with a very busy clinical load and little support and not having the infrastructure to do research. They forget. And so when you say, wait, I'm not supported to do this, they're like, what do you mean? What are you talking about? There's all this support. There's all this funding, but you're not seeing it. So there is resistance and sometimes from spaces in which you hoped that there would be support. And so I want you to acknowledge that there's a resistance and then build a plan, build a plan to move forward despite the resistance.

20:05 Oh, wouldn't it be lovely if everybody came on board and they wanted to support you so much and everybody was lined up just to support you. It would be so beautiful. And it's not that way. You still have to move forward. And here's the thing about resistance. It builds muscle. It builds character. It helps you grow in ways that you can't even imagine. So I encourage you to not let the resistance stop you, but to recognize that it's a sign. It's a sign that you're going in the right direction, in the direction you need to go in because you're swimming against the current when you can feel the resistance of the current to your motion.

20:49 Number six is mindset. And the fact that it's hard for your mindset to change. So the challenge is not the mindset of the people around you. That's not the problem. You can't control that. So it's not the problem. Anything you can't control is not the problem. The thing you can control is your problem and you should focus on it. And that's your mindset. Okay. So other people may not believe this is what you should do, but other people are not the ones who are going to make the effort to make it possible. You are. And so what do you need to do to make your experience different? What do you need to do to succeed in the way you want to? That is a choice you have to make.

21:31 These are decisions you have to make. Nobody can make them for you. People can say, we're not going to support you. We don't believe in what you're doing, but how do you support yourself? Even when it's hard, even when you feel the resistance, even when you feel isolated, even when it feels like everything is against you, how do you move forward? And it really takes you having the right mindset that's geared towards succeeding in the thing that you want to succeed in because you've chosen it. I want to succeed as a researcher. I do. And it's hard and I'm still going to do what it takes. And it's really you growing and being resilient and recognizing that your dream is worth fighting for.

22:17 Yeah, it takes building community. It takes reading. It takes studying. It takes acquiring knowledge that helps you do what you want to do. But it's really you exercising your power to believe, I know I can do this. So then I go forth and I do it. And so it's your mindset that's the most challenging that you have to overcome. You've also come from the background of really being mostly a clinician full time. Now you're saying you want to lead a research program? Okay. Are you willing to think differently about what it means to now be a scientist leading a research program?

22:59 Are you willing to change your habits? Are you willing to think about doing things differently? Are you willing to make the mindset change necessary to achieve the goal that you say you want to achieve? And finally, number seven is that there is the potential for failure. Success is not guaranteed. But here's the thing about success. It depends on how you define it. I say that the success of working to lead a research program is a success of changing who you are. It's a success of expanding your belief system. It's a success of reaching for something you've not done before.

23:40 Sometimes people count success as number of publications, number of grants funded, and yeah, that's one set of metrics or different sets of metrics. But the real journey at the end is you. I mean, the real gift is the journey and the gift at the end of the journey is you. Who will you become? It's the person you have to become to be the kind of person who proposes big audacious things and asks people to put their money down and fund it. That is the gift. The gift of someone who looks at the literature and says, this is a gap and I'm going to fill it. That is your gift. The gift of someone who says, this is a challenging problem and I'm going to tackle it.

24:21 That is the gift. The gift of courage, the gift of perseverance, the gift of tenaciousness, because it doesn't just help you in your life as a research scientist, in your life as a clinician researcher. It helps you in all of life because it takes boldness and courage to live life well and to live life to the fullest. So yeah, there's a chance of failure. You may not make the number of grants you need to make. You may not be able to cover that effort for a period of time. That's not true failure unless you quit and then you lock it in.

25:03 But the more you keep moving forward, the more success is guaranteed, especially because success is not a number of publications. It's not a number of grants. It's not dollars funded. Success is the you you become in the process of pushing forward to an impossible. I want to invite you to go against the grain today. I do. Think about it. This week, as you go forward, what are you going to do that's going to push against the status quo? And what will it take for you to stand firm in pushing against the status quo? What do you need? I want you to think about that.

25:46 I want you to take a step, take a step against the grain this week. Take a step against the grain towards your dream, towards your goal, because it absolutely is worth it. So I'm going to recap those seven things. If you choose to go against the grain, you're going to experience social pressure to conform. You are probably going to experience repercussions. There's the risk of that. You'll experience fear of uncertainty. You may not get the resources you want. You may get resistance from those who are around you, the stakeholders and the status quo. You may struggle with your own ingrained mindset that you need to overcome. And there is the potential for failing as people define failure, but it absolutely is worth it because your dream and your desire to succeed absolutely is worth it.

26:37 It has been a pleasure talking with you today. I invite you to share this episode with somebody else who needs to hear it. Thank you so much for tuning in. I look forward to speaking with you again next time on the Clinician Researcher podcast. Thank you for tuning in. 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.

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