Why your career path may not make sense

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. Today, I'm talking about why your career doesn't make sense. Even the title is kind of ridiculous, but I finally, you know, I woke up today and I just thought, why doesn't it all make sense?

1:23 And one of the things that got me started thinking about this is that recently I wrote my intellectual statement for promotion. And so it's this four-page, four-to-five-page document where you tell the story of your academic contributions, right? You tell the story of how your clinical and your scholarship and your education all come together to tell this amazing story of your contribution. Anyway, I will tell you that I feel like I wrote a great story. It was actually fun to write because I was like, yeah, then I can weave this into this and then I can make it make sense. I mean, it's what you practice when you write proposals. You string things together, you find the connections, you tell a beautiful story.

2:06 And so over time of doing that over and over again, it becomes something that you can do a little bit more easily each time you do it. And so the first time I went up for promotion, it was actually a little bit stressful trying to feel like, okay, this didn't really make sense, but then I did this and then I did this. And now that I've done it over and over again, it doesn't feel as stressful because it's like, you know what? How do we make the story work? How do we make the story fit? So then it helps me recognize, oh, wait a minute, you know what? It doesn't make sense. It doesn't make sense from this perspective looking forward. It really makes sense looking backwards. And so one of the things I want to talk about is why? Why doesn't it make sense? Especially as you're going forward in your career and to think about strategies that you can think through as you are trying to make sense of your career.

2:55 And actually, spoiler alert, it really only makes sense in retrospect. Okay, so the first thing I want to tell you and something you may not know is that we are all making it up as we go along. And now this may send alarm bells off in your ears. You may be like, no way, my mentor is such a superstar, definitely wasn't making it up as he went along. I just want to say it again, that we're all making it up as we go along. And really, it is in retrospect that we're making the story make sense. And to be honest, in retrospect, it makes sense. Of course it made sense that I went from this project to this project that was seemingly disparate and they came together and created this amazing thing. But in reality, we are making it up because we don't really understand or know the next step or maybe more appropriately, we don't understand the consequences of every next step we take.

3:45 And so the reality is for each step forward, when somebody says, hey, can you come and do X, Y, Z, maybe they say, we'd like you to give this talk, it is related to what you're doing. And so it makes sense that you say yes. But what you don't know is that you're going to give a talk in a place where three other people are going to hear you and they're going to say, we would like for you to come and chair the session. Do you see what I'm saying? So in reality, we are saying yes to things and we're doing things, but we're not in control of what it leads to next. And so in reality, when we do one thing and then it leads to something else and we're deciding in the moment whether it fits and we're saying yes or we're saying no, or maybe we think it fits, but our life doesn't work in that.

4:32 For example, let's say you have an ill parent and it's like, you know what, I really would love to do this, but I really need to travel out West to be with them all. You know what I'm saying? And so at the end of the day, we have no control over what's next, what the consequence of every decision we make is. We control our decision making and we control what we say yes to and we control what we say no to. But the consequence of the yes, the consequence of the no, we don't control. And so in reality, every step of our career, we are creating in real time and that's why it doesn't make sense. And one of the reasons it also doesn't make sense is because we look ahead to the careers of those who've gone before, our mentors, and they have amazing looking careers and we're like, I can't believe you did this and you did that and it looks so awesome.

5:18 But I finally took the courage and I asked one of my mentors, I said, so how did you get here? And he was like, well, you know, it's just being open and saying yes to opportunities when they come. And that was so dissatisfying. It's like, no, that cannot be the way your career came together. Can you just tell me, can you lay it out for me? And so we're asking people to lay out a path that they did not lay out for themselves. And of course, in retrospect, they can say, oh yeah, this doc connects to this doc connects to this doc connects to this doc. And in retrospect, we now they're telling their story and then we want to say, okay, well, why don't I now recreate this career based on these steps that this person took?

5:58 But here's the challenge, the exact environment, the cultural norms, the experiences or the opportunities that existed 20 years ago are different from the opportunities that existed now. And if we want to take somebody's path and transplant it from 1984 and bring it into 2024, yeah, it's going to be very different. It's not going to be vastly different. It's going to be greatly different. Like there's a chasm between the two experiences, right? They're not the same experience. And so in retrospect, people can tell us their stories, but in reality, as you're looking forward, you're making it up as you go along.

6:46 They were making it up, you are making it up. And so I just want to encourage you to have confidence in what you're making up. You're like, but I don't see the future. I know nobody sees the future and in reality, we're just making it up as we go along. We look at other people's careers and we're like, okay, they did this, therefore I should do this, but we don't have the same opportunities. We don't have the same challenges. And so in reality, we're making the best of it as we speak. And so if you're feeling uncertainty, it's real, but it's also that what you need to be confident in is that you're making the right decisions as long as you're doing the best, next best thing. Okay. I see all that to bring you to number two, which is that the basic structure doesn't change.

7:30 Okay. So we are making this up as we go along, but the basic structure of academic medicine doesn't change. And what is the basic structure? The basic structure is that we're creating knowledge. We're creating new bodies of knowledge. And sometimes the ways in which we're creating new bodies of knowledge is reorganizing knowledge that's already known, right? Very few of us are actually in the process of uncovering bodies of new knowledge, right? I think the basic scientists are kind of in that space where it's like, we didn't know what this gene did, but now we know. But for many of us, there's a sense of what's known, it's all over the place. And then we gather all that information, we pull it together and we present knowledge in a new way.

8:10 So the basic structure of creating new bodies of knowledge or organizing knowledge for somebody else to consume doesn't really change. And that's why the basic tenets of writing and research are kind of the same. The foundation remains the same. Now the political environment is changing, how things are funded is changing, what the expectations are is changing, who is doing this work is changing, what people think is interesting to study is changing, what the funders want to fund is changing. But the basic structure of creating new bodies of knowledge or reshaping knowledge for the consumption of others doesn't change.

8:50 The basic foundation of educating the next generation of physicians doesn't change. So there are some things that kind of to some extent are part of the foundation of academic medicine. Clinical care doesn't change. We will always be providing clinical care to people within academic medical centers. So maybe we won't, but people will be getting care one way or the other, whether it's happening in an academic medical center or outside it. Clinical care, education, and creating new bodies of knowledge through research are kind of the foundational tenets. Why is that important? It's like, even though we're making it up as we go along, there's still kind of like a basic structure in which all of this really exists.

9:35 It's all around this, kind of like this, people say it used to be a three-legged stool, and now it's like a unicycle and it's all clinical. But in reality, clinical care doesn't advance unless research allows us to figure out what's the next best thing for patients. And so the structure remains the same. And so what I want you to think about is that even though you don't understand your career, make sure that you're building within the structure that helps you make sense of the career. It's like, well, as long as the structure is remaining the same, what am I doing clinically? What am I doing research or as far as scholarship, calm my educating the next generation, as long as you're keeping those in mind, that structure is unchanging and maybe should provide a little bit of comfort.

10:22 Maybe it doesn't. But anyway, I just want to share that that structure doesn't change. Okay, what is changing is the entire universe. The world is changing. And whether we like it or not, the world is changing and that change is hard. But let me talk about a couple of ways in which the world is changing. So number one, people are coming and going, right? People are really what make up the culture of an environment or the culture of an institution, right? And this particular personality is so strong and it really affects the culture of the organization. But when this person leaves, somebody else steps into their role with a different personality, different interests, and it changes the culture of the organization.

11:07 And so even though you may have been there for a while or maybe you just arrived, people are coming and going. And as people are coming in and leaving, it's changing the environment, what people value, what people are interested in, what priorities people have, what projects they want to push forward. It changes as people come and go. And so even though you're the same, even though you haven't changed, people around you are changing and because of that, our environment is changing. What else is changing? What we prioritize as a society is changing, right? Whether we prioritize funding the NIH or whether we prioritize funding research or we prioritize entertainment and culture or whether we prioritize educating the next generation, that is changing.

11:54 In reality, people say, well, there's no money. In reality, it's not that there isn't money. It's like, what do we prioritize enough to put money in, right? There's always going to be money all around. People are creating money all the time through new businesses, through new ventures. But if what we're seeing is, well, we no longer prioritize funding things in this way, yes, that's changing too, right? Whether we feel like the NIH is the next best place to put all of our hard-earned tax dollars or how much of the tax dollars do we want to put in the NIH or how much do foundations want to fund projects that are important to them or how much is industry now playing a role in what's being funded at academic medical centers, it is changing.

12:41 Priorities of where people are putting money is changing. And that's why you feel the pinch of clinical work because clinical work over the last couple of decades has really become the biggest bringer in of money. If I can say that, the biggest way in which money is made in academic medical centers and hence the pressure for people to do more clinically. So the whole environment is changing. The world is changing around us. And hopefully we're changing with it. And if we're not changing with it, then we're feeling the strain of the change of the world and we're feeling the uncertainty of the changing world around us. But that's one of the reasons why it feels like our careers don't make sense because when we look at the people who have had successful careers, they didn't live in our world when they were building careers.

13:32 And so it doesn't make sense because they can't make sense of it. They can't tell us, well, this is the way it works because when I was 32, I got my first R01 because you know what, people don't get their first R01s at 32 anymore. That age has moved up. So the advice that they have for you and what they were doing at age 32 is going to be different from what you're doing at age 32. At age 32, you're like, wait, wait, I'm just trying to grow this young family. I don't even have time yet. So you just have different challenges. And that's why it doesn't make sense because the people who would otherwise make it make sense can't understand this new environment in which you are living.

14:13 And they recognize that the advice that they had for themselves when they were coming up is not necessarily advice that's going to help you advance as you're coming up as well. And that's why number four is that the people who came before are mentors. They really can only tell their stories in past tense. They can't tell you, oh, this was what was happening. Therefore I set myself up to do this. To some extent, they can do it now because they're looking backwards, that it's hard for us to be able to do it. And so I want you to understand when you speak to mentors and you're asking for advice, don't ask them to tell you what to do. Ask them to tell you how they thought about decisions that they made.

14:53 Because in reality, the careers we're building are step by step, right? One step leads to the next step, leads to the next step, leads to the next step. And we don't see how all the steps come together. But what we're doing is we're saying, what's the next best decision right now? What's valued at my academic institution? What are the pillars of clinical research, clinical scholarship and education? And how do I fit within those things? And there are other pieces. You know, what I haven't talked about is administration. There are other pieces to do what happens in academic medical centers. But where do you fit? And how do you think about your career and how did they think about their career?

15:34 And how can you apply principles of how they thought to your career? So I'm saying don't ask them, what do I do? Because honestly, they don't know. But what they can give you, what's really helpful is for them to give you the frameworks about which they thought about their careers. They're like, well, this is why I chose this opportunity in that moment. This is why it made sense. Because it helps you think about your decision making. Because again, you're making it up as you go along. But it's not a random process. There are good decisions and there are not so great decisions, right? And sometimes it's like, what are the principles that make a good decision?

16:14 And this is something that those who've gone before can help you with. They can't lay out the path for you because again, they're reconstructing now post having made these decisions. What they can do is share their decision making in that moment, what were they thinking? And how does that help you as you moving your career forward? The fifth thing I want to share is that the uncertainty is very, very hard to bear. We would love to be able to see what the next 10 years look like. We would love to be able to say, okay, in 15 years, I'm going to be a full professor. I'll have my own lab. We'd love to be able to say that. And to be honest, people are always asking us to do that all the time.

16:54 They're saying, look five years into the future, what are you going to be doing? Look 10 years into the future, what are you going to be doing? And so it's confusing because here we are kind of making up the future. We know we're making it up because we're like, I don't know what I'll be doing in 10 years, but there's the sense that you're supposed to be following this path to get there. These questions don't make it easier because there's a sense that you should be certain, but you are uncertain. You're not sure. You're not sure this research thing is something you want to be doing long-term. You're not sure you want to be writing grants forever and ever and ever. You're not sure you want to do this thing again. You're not sure. And I just want to encourage you that not being sure is part of being human. It's just normal. Not being sure is normal.

17:36 The uncertainty of life being lived one day at a time is real for everybody. Things are happening. People that we love are being lost. People who've been around in our institutions for so long are suddenly moving into industry and it's like, wait a minute, you were like the quintessential academic. What are you doing in industry? People are changing and things are happening and it just doesn't feel like a world that we understand. And I wanted to share that, yes, there is uncertainty. And if you're feeling the uncertainty of what your career will look like next, I want to just assure you that it's normal. I want to reassure you that it's okay.

18:18 It's the way it is. Because we're making it up as we go along, part of that is the uncertainty of not knowing what this step will lead to. And part of that is recognizing that because it's uncertain, because it's fuzzy, because we are making it up as we go along, what we can do, what we do control is the next decision, the next best step. And that's number six. We know enough to take the next best step. Now seven years from now, we can look back and say, if only I had done this, right? You have more information, so now you would make a different decision. Well, the information you have right now is the information you use to make the next best decision. So what do you do right now?

18:59 You gather as much information as makes sense and then you make the next best decision. You don't paralyze yourself by trying to get all the information possible. You get as much information as you can within a reasonable timeframe and you make the right decision. What's the next thing I should be doing? And that is enough. In a sense, what you want to do is you want to look ahead and you want to see the big picture, what it all looks like, what this big puzzle is coming together to look like. And I assure you that it's beautiful, but you can't see it. All you can see is what's right in front of you. And so what you've got to do is to make the next decision for what's right in front of you, given the information you have, gathering all the information you can, getting the best advice that you can, what's the right decision to make, and then you make that decision.

19:52 Number seven is I want to remind you that because you can only take one step at a time, if you're making, if you're in the, with the decision, with the, with the information you have, if you're making the next best decision, you got to trust that you're building a masterpiece. You've got to trust this whole experience, this whole journey of our lives is really an experience of trust. I mean, it really is. If you think about it, did you choose your mom and dad? No. And for some of you, you're like, if you could have, you would have gone and chosen a different set of parents. And for some of you, you're like, I locked out. I got the best parents in the world, but we didn't choose, right? We made the most of what we had.

20:34 And somehow through no real effort of our own, here we are, we got this far. Like if you survive your first year of life, it's not because you tried hard. It's because life circumstances worked out such that you were able to survive your first year. And if you've come this far, yes, you worked hard and I'm not negating any of your hard work, but I'm saying that so many things came together for you to come to where you are. And so if all of your life has really been one big step of faith, which honestly it is, then you should recognize that whatever you're building in your career is a masterpiece. And why do I know it's a masterpiece?

21:15 It's a masterpiece because you care, right? Physicians and you listening to me, you may not be a physician, but when you care enough to think about what should my career be like, what should I be doing? You are intentional. You're somebody who wants the best and you don't control the big picture, but you do control the next step. And if you're making the right decision or the good decision with every next step, then you can trust that it is coming together to unfold something that's beautiful and something that's great. You can trust that every great step comes together to make a great masterpiece.

21:57 You can trust that every step you take comes together to create a masterpiece. Okay, I said seven things. We're making it up as we go along, but the basic structures are unchanging. The world is changing around us and the people who went ahead can only tell their stories and past tense. And it's the uncertainty that's hard to bear, but the uncertainty is a sign that we're in the right place. And what we do is we know enough to take the next best step. And as we're making each next step, making the right decision for what's next, we have to trust. We have to walk by faith knowing that what we're building is a masterpiece.

22:38 I want to encourage you that your career may not make sense to you right now. It may not look like what your mentor is describing they did 20, 30 years ago, but I want you to understand that you are one of the smartest people in the world. You are thoughtful. You are kind. You want to do good in the world. And I encourage you that as long as you are just taking the right next best step, you're going to find yourself in a really beautiful place and the place you've always wanted to be. And as long as there's intention in your heart about where you want to go, even though you can't see exactly how to get there, I want you to trust that that's where you're going and that you're going to look back and you're going to have created an amazing career that's going to have really touched so many lives and blessed so many people.

23:25 And you'll look back and you'll tell somebody your story, the story of how your career came to be so amazing. And they'll look to you and they'll say, I wish I could just recreate this career, but they won't be able to because each of us is creating an individual and amazing masterpiece. All right. It's been a pleasure to talk to you about that today. Again, I invite you to sign up for coaching. If you do not already have a coach to work with, would love to work with you. Reach out to me via direct message on Instagram. I'm also on LinkedIn. I'm also on Facebook. Look me up and let's talk about how I can serve you in your academic career. It's been a pleasure talking with you today. I look forward to talking with you again on the next episode of the Clinician Researcher podcast.

24:07 Have a great day. 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.