Why you might want to think early about promotion

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. Today in particular, I'm talking about promotion and why it's never too early to be thinking about promotion. Even before you start your faculty job, you should be thinking about promotion. And today I'm here to talk to you about five reasons why it's important to think about promotion early.

1:24 I will tell you that when I first applied for promotion, and this was about 2019, it was such a stressful experience. And the biggest stressor was that I was writing this intellectual statement where I needed to tell my life story of how I had contributed in scholarship, in clinical work, and in education. And I felt so stressed. I felt like I was trying to justify my existence. And so every time I was writing, I was like, well, you know, here I have done all this work and I really felt like I was trying so hard to justify what I was doing. And so it was really important when one of my colleagues said, oh, no, it's not, it shouldn't be stressful.

2:04 This is just a way to tell people what you're doing, because if you don't tell them, then they actually don't know. And so what you're doing is telling them what you're doing. And that was so important. That was so helpful because it helped me reframe. At first it was like, well, why do I have to prove myself? But then it was like, it's true. When you are applying for promotion, it's not just the people within your division who may or may not know what you're doing. It really is faculty within the School of Medicine and they don't even know who you are really. Maybe they've heard of you or, you know, they know of you clinically, but they don't know what scholarship you've done. And so it was really an opportunity for me to sit back and think about, well, how will people know unless I tell them? And so that took the pressure off. It wasn't so stressful anymore. Actually, it was stressful the first time.

2:46 The second time around, not so stressful because I was like, okay, you want to know what I've done in education? Boom, boom, boom. You want to know what I've done for my publications? Here they are. You know, it was just much easier because it didn't feel like I was trying to justify my existence as much as it felt as if I was really just trying to help people understand what my scholarship was. Okay. So it's an important process. And I think it's a process that everyone should come, should go through. And you may be like, oh, no, I'm not interested in the promotion stuff. And I would say that even if you're not interested in promotion, it is still important for you to think about it. Okay. Let's talk about reason number one. So the first reason why it's important to think about promotion early is because early on you get to understand what your institution values.

3:32 Why does this matter? Well, if you are a clinician scientist or an aspiring clinician researcher, then you care about scholarship. So if you're at an academic institution, your academic institution also cares about scholarship. And they are explicit, I hope, about what parts of scholarship they actually value. But the only way you understand it is by going and looking in the promotion materials where they lay out, okay, if you're a clinician scholar, this is how you, this is what we value. These are the number of publications or these are the kinds of publications we value. These are the kinds of clinical work that we value. These are the kinds of educational investments that we value.

4:15 But you don't know unless you go look for it. And one of the things that's really important is that many times, and we know the feeling of our clinical work overwhelming everything that we do, such that it's like, I don't have time to think, I'm so busy clinically. Well, you know, if we're not careful, clinical work overwhelms everything we do. And then when it comes to time for the annual review or it comes to time for promotion, it's like, well, I've been so busy, I haven't had time to do all the scholarship. And people look at you and they're like, well, these are the metrics. And if you don't meet them, then you just don't meet them. And so it's really helpful from the very beginning to know, oh, you want me to produce three original research manuscripts every year?

4:57 Oh, okay. But I'm full time clinical and I don't have any research time. How would you like me to accomplish that? Powerful questions. And it just helps you, it helps you be clear about what you can and cannot accomplish easily. And if you understand what the metrics are or what's valued by your institution, it helps you start to think about how do you align what you do or how do you align what you care about with what your institution cares about? So the very first and perhaps the most important thing is that understanding the metrics for promotion helps you understand what your institution values. And when you understand what your institution values, you make informed decisions.

5:42 But I'm getting ahead of myself. It is important to understand what your institution values. Now if you're someone who's early, early, and you haven't even gotten the faculty job yet, it is so important to understand. Because when you go to negotiate, you're like, hey, this role requires that I have three, four publications a year, but you haven't created space in my schedule for me to be able to have any scholarship. How am I going to accomplish this? And it really helps you to begin to negotiate for resources. Because if your institution says it's valued, then you can say, well, you value it so much, how do you help me accomplish it? And then you can come on the same side of the table with the person who's hiring you to say, wow, let's see how we can make this work.

6:24 And so understanding what your institution values is so important, and clarifying it through the promotion materials is important too. Because they may say, oh, we don't expect clinicians to publish anything. Oh, don't worry about that. And then you look and you're like, but it says very clearly that you don't get promoted without these items. How do you reconcile that? It really, really helps you understand clearly. And then you can think about how you want to live, how you want to exist within the institution. Okay, so the very first thing is that it helps you understand, recognize what your institution values. Okay. Number two, it helps you direct your conversations. Now I've alluded to it a little bit in what I said, right?

7:04 It really helps you think as you're having conversations with your mentors or your division chiefs or division directors or your chairs. Every time you come up for the annual review, you're very clear about what you should be talking about, what challenges you've had. I mean, you can talk about any challenges. Hopefully you're not going to your annual review and complaining. But you know, when they say, hey, let's talk about all the things you've accomplished, you can say, yeah, and looking at our promotion documents, these are the things that are still yet to accomplish. These are the resources I need to be able to accomplish that. Or you can say, yeah, according to the promotion documents, here are the things I'm already doing.

7:44 And I think it's important to continue to do X, Y, Z. But it's really a great opportunity because it directs your conversations. You can be very clear about, hey, this document says this matters to the institution. And I want to make sure that you understand that because it matters to the institution, it matters to me. And so you're able to really focus in and direct your conversations better because you recognize fully what your institution values. OK, that's point number two. Point number three is that it helps you be strategic and intentional. OK, let's go back to the fact that clinical care is overwhelming. And many times you could just, you know, burn daylight hours just taking care of things that are relevant to patients.

8:29 And these are all great things. But you could spend a lot of time on the phone doing prior authorizations, playing phone tag, trying to catch the patient in between appointments. You could spend a lot of time doing all this stuff that's really good, but it's not highly valued by your institution. And what it allows you to do is to say, hmm, if all the prior authorizations I'm calling are not highly valued, how do I minimize the time I, that's you, it doesn't mean the prior authorizations are not called. But how do you minimize the time you spend calling those prior authorizations? And it may be that you have somebody who is a financial counselor whose job it is to help call those prior authorizations.

9:10 And then you figure it out and you're like, hey, financial counselor, I have three or four of these. How can you help me? Or you find out that you don't have a financial counselor who's in charge of those things. And then you go to your division director and say, hey, division director, I'm spending four or five hours a day calling these prior authorizations. How can we fix that? Right. And so what it does is allow you, it allows you to be strategic and intentional because you recognize that 80% of what you do is not detailed within what are, what is outlined in those documents as the priorities of the institution. Now they value your clinical, your clinical expertise, right? They value you doing work clinically, but there's a very specific context for what that value is.

9:51 So for example, at my institution, they value you being someone to whom specific conditions are referred. So they want to know, okay, well, are you, are you, are you well known for your expertise in a certain disease such that people are referring to you? And if you're going to be well known for a certain disease, such that people are referring to you, they're referring them to you because they know of you and they know of you perhaps because you've given talks or perhaps you've written papers about this particular disease situation. So you have to understand that when you understand what you have to understand that when you understand, but you recognize that when you understand what the promotion metrics are, what's valued clinically, then it helps you be strategic about your clinical care.

10:34 So it's like, oh, okay, well, if they want me to be very well known for one area, then maybe I need to tailor my clinic to two or three diseases that are most important to me and become the expert in these two to three diseases. And it may be that that's a decision you make, or you may say, oh, okay, well, maybe here's what I'm going to do. I'm going to go out and give talks so that people know that I am the go-to person for this particular disorder. And I'm not telling you what to do. I'm just saying that it helps you be strategic and intentional so that you don't get to six years down the road when it's time for promotion and you're like, oh, wait a minute, I didn't realize that this was recommended or this was important or this was needed.

11:15 You early on are starting to build that into your practice. And the earlier the better. And it may be that you're like, well, I don't really care about promotion. I'm not here to be promoted. It's still important to recognize what's valuable and to set yourself up in case you change your mind. All right. As long as you're in an academic institution, why not do the things that the academic institution says is important to do so that you can succeed in doing them. And if you decide that you don't care, that's fine. But if you do decide that you care, then you're not stuck saying, I wish I had paid attention to it earlier. Okay. That was number three. It helps you be strategic and intentional. Okay.

11:56 Number four is it helps you shape your story. So I want to share a story about this before I explain this shaping your story business. So for me, I remember the first time I went, I was thinking about promotion and they said, oh, you should go talk to this guy who really helps faculty think about promotion. And I'm so glad that we had a guy, we had somebody whose job it was to really help faculty think through their promotion packets. And so this was years before I needed to go up for promotion. And I went and he was like, but I don't, he actually, the first thing he asked me to do was to write my intellectual statement. And I thought, why? I don't need to do that yet. Why give me busy work? I was actually kind of annoyed because I was like, I don't need to do this. I don't need to go out for promotion for a few years.

12:37 Why do I need to write my intellectual statement? But what he said, and I don't think I wrote it when I first met him the first time, he was like, I just don't understand what story you're telling with your CV. And I kept trying to say, well, I'm trying to be this person who's doing this. At the time I was doing heart transplant rejection, I'm a hematologist. So totally, totally didn't feel like it fit. And he was saying that I don't get it. I don't understand what story you're creating. And to be honest, I had a hard time with it too, because I was like, what do you mean what story? I know exactly what I've done. And he was like, I don't see the story. But what I realize now is that to some extent, when you are putting together your intellectual statement, you're telling a story, you're weaving a story of why your clinical work is relevant to perhaps your scholarship, to perhaps your education.

13:25 And what story I maybe should have been telling is that I'm a hematologist. I do hematology things. I give hematology talks. Or if I said it's cardiac transplant, be able to weave in the cardiac transplant into my hematology story in a way that's cohesive. And so honestly, I wasn't thinking about the story so clearly. I wasn't building something coherent. But the moment it became clear that the story mattered, I started thinking strategically about the work I was doing. And I thought to myself, well, I really like this working cardiac transplant, but how do I bring it home to me as a hematologist? And I started to become a little bit more strategic about the way I showed up academically or showed up in scholarship so that I could build a story that made sense.

14:13 And so it really does help you shape your story, because you're thinking, hmm, in a couple of years, I'm going to need to write a story. Or actually, you should start writing early. It's never too early to start writing your intellectual statement, because it forces you to think, what story am I weaving together with my educational pursuits and my clinical work and my manuscripts and my articles that I'm publishing? What story am I telling? And really, in the process of starting to tell the story, then you're able to reflect on the story and decide, is this a story I actually want to tell? And so it's one of the things that's so helpful is that you can start to shape your story in advance of needing to shape the story.

14:54 Now, here's the thing about life. No matter what happens to you, you can create any story you want out of it. And really, you can make all the pieces fit. You're like, yeah, heart transplant helped me really think about why I felt like blood was the most important thing. You could do anything you want. You can do anything you want. However, it's actually really beautiful when you can be intentional about the story you're telling. And so that's what I recommend is be intentional about the story you're telling and understanding your promotion and tenure requirements allow you to be intentional about the story early on so that it doesn't look half hazard when you come to telling the story. OK, number five is that it focuses you. It focuses you.

15:36 In life, there will never be enough time to do all the things you don't want to do. And I love that quote. And it's not mine. It comes from a book I read that goodness now I do not remember it. But anyway, it's an important quote. It's not mine. And I will put it in the show notes so you know who said it. But it's just it's true. There's just too many things to do. And to be honest, everyone's kind of screaming loudly and trying to get you to do what they want you to do. And and you're busy all the time. But here's here's the thing. The moment you discover that many of the things you do are not actually valued, then you start to ask yourself, well, what should I be doing? What should I focus on? And it helps you focus on the things that drive the highest value.

16:17 So everything is important, but not all things matter equally. And the question is, they're important, but should they be important to you or should they be important to someone else? And I would argue that anything you do that other people can do better, faster, cheaper than you, because, you know, you are a highly paid wage earner. Does that sound bad? What I'm saying is that if we were to calculate your hourly hourly rate, it's worth enough such that you should say, well, who is earning a lower hourly rate? Who might do this job better so that I can do the things that really are tailored to to my pay rate to what I'm supposed to be doing?

16:58 And I'm saying, what are the things that only you can do? And can you focus on those things? Especially those things that are valued by your institution. And then delegate all the things that are important to do, but maybe not for you to do. For example, let's go back to the issue of prior authorizations. You know, there are people who can call prior authorizations. There are very few prior authorizations. And yeah, sometimes it gets to the appeal and you're needed. But there's a lot that other people can do for you such that you should be able to delegate those four to five hours that you're investing every week to do a prior authorization. And if you can't, or if you don't think you can, because you always can, it's like what conversations do you need to be having to be able to hand those off so that you can focus on the things that only you can do and that other people can't help you with?

17:45 What are the things that only you can do? Well, only you can really see the patient, make the recommendation and bill the patient. Now, people can support you to do that. But what are the things that only you can do? Move your research forward, submit the manuscript. I mean, people can help you within your research program. But more often than not, if it's your research and you're not moving it forward, it's probably not moving forward. If it's clinical care, if you're not there to see the patient, somebody else will see the patient, especially if the patient needs to be seen right away. So I'm saying that it is important for you to think about the things that you, only you can move forward. And if you don't move it forward, somebody else will not move it forward and really focus in on that, especially as it is highlighted by your institution as something that matters or something that's important to them.

18:31 Okay, so five things I've talked about the importance of thinking about promotion early. Number one, it helps you see what your academic institution actually values and it helps you decide how you want to tailor your experience or not to the things that they value or have great conversations about how you can accomplish these things if you don't actually have the time or space to do them. Number two, it helps you direct your conversations. It helps you decide what to focus on during these important conversations and it also helps you negotiate the resources that you need to make these things come to pass. Number three, it helps you be strategic and intentional because you start to think, should I be investing my time in these things that are not prioritized by my institution?

19:13 And it helps you be strategic about the way you spend your time. Number four, it helps you shape your story. As you're thinking about what you're going to be writing, you start to be intentional about the way you're living your career so that you can write about a career that actually makes sense, a career path or a career trajectory that actually tells a great story. And number five is that it focuses you. It allows you to decide what is the 80%, what's the 20% and to focus in on the 20% that yield the highest value in your academic career. All right, I hope that's been helpful to you. That's really the end of today's podcast episode. Thank you so much for listening. As always, I bet somebody else would benefit from listening to this podcast episode and I invite you to share it with them.

19:58 Thank you so much for listening. I'll see you next time on the Clinician Researcher Podcast. 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.