Today’s inane image of the day:
At heart, I am a selfless, people-pleaser that would rather suffer in silence than let others down. When I feel like I’ve let someone down, it crushes my soul. This leads me to tumble down the rabbit hole of saying “yes” to things. At work, this often translates into non-promotable assignments [aside: did you know that women are 48% more likely to to volunteer for non-promotable work and even when we learn to say no, we are disproportionately assigned to these types of tasks?]. In medicine, it’s often exceptionally difficult to tease out which tasks are “non-promotable work” and which ones will have indirect benefits through gaining knowledge, learning a new skill, or valuable connections that could lead to career advancement in the future.
Throughout medical training, we are conditioned to be generous with volunteering our time for research projects, organizations, and anything that might help get us to that next step. Understandably, when training is finally done, some of us are left wondering… now what? Especially in an academic environment, it seems like everyone has a million projects they’re working on and those who have “made it” to professorship/leadership were the ones that hustled the most [i.e. said “yes” to everything].
But is that approach sustainable? And most importantly, is that the approach you should take?
My vision for the future – my first “no”
When I started residency, I had a vision for my future that included moving back home to Michigan to work in a private practice group. My vision also included a suburban home and a couple kids. Fast-forward to today… I’m clearly not living that vision. But that’s ok. Goals and career aspirations change with time and life circumstance. Also, exposure to different types of jobs. Sometimes it’s not so much a change in the vision as much as the understanding the options available and being able to articulate how a specific option aligns with your personal values and definition of success.
Before residency, my definition of career success was based on my exposure predominantly to a private practice group and absorbing information about how those anesthesiologists lived their life. It seemed to make sense to me, so I made it a goal. But when I got to residency, I saw a different type of practice. Maybe I’m just easily swayed by my surroundings and that’s how I ended up in an academic job? Either way, my vision for the future shifted [but didn’t completely change… one career aspiration of mine that has remained consistent since medical school: become a hospital administrator].
Anyway, I tell the story of my vision because in a way, it was the first big “no” decision I made for my career. I said “no” to the original vision I had when a new potential came up that seemed to fit better.
Opportunity costs to “yes”
I have been an active member of the American Medical Women’s Association [AMWA] for over a decade. I attribute a lot of my successes in my career to my involvement in the organization on the local and national level. Through the organization, I learned leadership skills, built a network of influential women physicians, and made friends along the way. Like many nonprofit organizations, AMWA relies on volunteers to spearhead a lot of projects and initiatives. The big project that I took on as a third year medical student was the annual conference.
I continued my involvement in the annual conference for years, growing my role with each subsequent meeting. I am proud of the impact I had on the structure of the meeting and our ability to make it a profitable investment. During the pandemic, I spent my limited time away from the COVID ICU transitioning the in-person meeting to a completely virtual format. Since we had a few years of virtual meetings, the investment in time and energy to coordinate was much less, so I kept up my involvement.
This past March, we had our first in-person conference since 2019 [and the 2019 meeting was an International one, so really our last meeting was in 2018]. Over the last 4 years, we lost a lot of the volunteers and leaders that had historic knowledge of the format of the meeting and necessary preparation. So, it felt like a lot of chaos, but we made it work.
Every year, I’ve threatened to leave my role as the Program Director. And every year, I come back for more. Every year, I use one week of my precious vacation time to be part of running this meeting. As a result, every year, I pay the opportunity cost of my vacation time to say “yes.” On top of this, there are often planning phone calls and other tasks that lead up to the meeting that take time away from pursuing other life things. An hour meeting monthly over a year is still 12 hours that I could have spent doing something else.
When you’re considering a “yes,” I seriously want you to think about what opportunity costs exist because of this decision. For many years, I accepted the opportunity costs believing that I would receive indirect benefit from my continued commitment and involvement. But as I’ve progressed in my career, I realized that the indirect benefits for my overall career goals were shrinking while the opportunity costs were growing.
I do not intend to leave the AMWA Program Director role imminently, but that is only because I was able to define the areas I want to remain involved in. This means, I’ve been saying “no” to specific areas of conference planning so I can minimize those opportunity costs. With each “no,” I’ve been able to come to a point where the role feels like the right balance of the work I enjoy while contributing to an organization I care deeply about.
Career coaching
Through a well-being initiative, my organization offered 6 sessions of career coaching that I took advantage of early on as an attending. I was very skeptical of this program. I wondered how talking with someone about career things could concretely help with my wellness. Especially after completing a critical care medicine fellowship year during a global pandemic! It seemed comedic.
But I went into the sessions with an open mind. And I did the exercises. And I explored the questions that I was being asked about my career goals and vision. And I’d actually attribute my promotion in part to this coaching.
What was it about the coaching that made a difference?
During one specific session, I explored some of the pressures of being an academic physician. I work at a world-renowned hospital with incredible researchers, clinicians, and change-makers. I’m surrounded by academic minds that have made industry-changing advances in medicine through research and publications. So, I feel immense pressure to follow that path. But as I said earlier, my career goal has been hospital administration for at least the last decade. How does becoming a professor get me closer to that goal?
It wasn’t clear to me that striving for that title completely aligned with my goal of becoming a hospital administrator. There is value in research and publications, but this question helped me realized that I wanted to spend my time focused on the projects that have clinical operational value. These projects may lead to publications, but publications for the sake of climbing the academic ladder is not my first priority. Additionally, I decided that because mentorship was an important aspect of my career, if a research project or publication could help a mentee, it was worth investing in.
By saying “no” to the pressures of a career path that didn’t align with my ultimate goals, I was able to say “yes” to applying for my current position and devoting all of my energy to the role.
Practice saying “no” to little things [start small]
In order to say “no,” you have to reflect upon what matters to you. What are your priorities? What do you want to achieve in your career? What do you want to achieve in your life? Right now, I’m focused on career advancement, but if I had family, my priorities would be different. It is important to look inward rather than read what everyone else is doing and emulate that.
The next time you are asked to take something on, consider taking some time to reflect upon whether this is an opportunity or just an opportunity cost. If someone is asking you face-to-face, as for some time to consider if you have the bandwidth to give the project your full attention.
Repercussions of “no”
A lot of us are advised to say “yes” to everything when you are just starting off. But being non-selective has its own issues. If you take on a project and do not deliver, that may have a bigger negative impact on your reputation and career than recognizing the project or task was not the right fit for you in the first place [saying “no”]. There may be repercussions of saying “no” [e.g. not getting offered a similar opportunity in the future, negative impression by your supervisor] but only you can determine which outcome is the most probable and determine the right way to approach the situation.