How come you are happy?

A 15 step guide to happiness in academic medicine

Recently, I was chatting with a trainee who said, “You seem different than other attendings”

“How is that?” I asked, bracing for the worst.

“You seem happy!”

“Oh, ha, yes, I am!” I remarked. Indeed, ~99% days at work I am pretty upbeat.

“What’s your secret?” he asked.

(PS My secret is not in from this book)

I am going to let you in on my secret(s), but first let me acknowledge that the trainee’s observation is correct. Many are unhappy. In the next few weeks, we will publish data tracking the transition from medical practice to the pharmaceutical industry. It is no surprise that many academics are burning out, job satisfaction is at rock bottom, and transitions to alternative careers are booming. But, I won’t be going anywhere. I plan on working till I am dead— hopefully there are a few decades left! (Also retirement will likely be impossible in future, especially on academic salary ;) ).

I play a thought experiment to ensure I am on track. I imagine that someone gave me 50 million dollars. I ask: what would I do differently? If you say: quit your job— maybe you should quit! For me, I think about all aspects of my work. My clinics— inpatient service— classes I teach— research I conduct— talks I give— articles I write— and I reach the crazy conclusion: I would not change anything. Maybe I would take uber more often, but I wouldn’t change any aspect of my day-to-day work life.

How did I reach this situation? Here is my 15 part plan for workplace happiness.

1. Ask yourself what you really want to do, and, the key corollary: is the university the only place you can do it? Recently Jeff Bien, a former OHSU chief resident, Stanford Heme Onc Fellow, and now Kaiser Physician tweeted this .

   

   https://twitter.com/jungleland/status/1646352985751187457?s=2.

   I think he is spot on! For me personally, I hope the reason I work for a university as a professor is apparent. I am interested in doing research on a variety of important topics that would face resistance anywhere, and far more outside the academy. I enjoy seeing patients and teaching. I doubt my policy and evidence work would do well outside a university setting. I want to help the most rational people when they make irrational decisions.

2. Your self worth should be an internal assessment and not based on external benchmarks. Once you decide what the unique thing is that keeps you in the academy (PS being a trialist does not quality— you should join US Oncology: make more money and more enroll patients), you have to purge yourself of a few emotions. (A) you cannot worry about disappointing or pleasing anyone else. (B) you cannot place any self worth in what anyone thinks of you— if you have imposter syndrome you better read so much and improve yourself so much that it vanishes. You need to reach (C) the state of being where you judge yourself SOLELY on internal measures you set for yourself as to whether you are doing a good job. Reassess every 5 years.

3. Say no to something that might be good for your career. Everyone tells you to say no. I am going to be more specific. Say no to things that you think would actually be good for your career but you don’t enjoy doing. I am done with weekend or after work talks and seminars. Take your Saturday seminar and shove it up your ass. Frankly, you, conference organizer, should move it to a weekday anyway (Btw 9-4 — after 4 is insanity). Now back to you, dear reader. You are probably not that good at actually knowing what is good for your career. Precisely because you believe it however, makes you do things you really don’t want to, and that aren’t good after all. My rule of thumb to say yes or no is to imagine it is tomorrow: would you still want to do it? If the answer is no, you should say no.

4. Say yes to something that you think is not good for your career. This is the KEY point. Say yes to something that you can’t see how it helps you. Take on the med student or college student looking for a project. Volunteer to let the residents shadow you. Teach a class or give a talk to an audience that is not your peer group. It is the work you think doesn’t help you that often builds the greatest joy. Letting go of the incessant desire to get ahead is good for you in myriad ways.

5. Don’t be dependent on others. Working in teams is mandatory, but you should have some portion of your portfolio in projects that are not dependent on anyone. A paper that you are writing by yourself. A Substack, a podcast, a blog … something that depends on no one at the university or beyond. I recommend 25-30% of your time be spent on things that only you control. Teams can work well, but they can also frustrate you. Ultimately, the only person you can control is you. Stop complaining that all your papers are on someone else desk, and they are too busy to proofread it. Write a paper by all by yourself or STFU.

6. Stop writing things no one reads. The sooner you realize that writing invited reviews for journals that no one reads is a waste of your time, the happier you will be. Aspire to write things people read. It will also improve your writing.

7. Pick good mentors not good diseases. The person who works with you— their temperament, humor and personality— is far more important than choosing lymphoma vs myeloma. Tumor types are not boring— boring people can’t find interesting things about all tumor types.

8. Don’t let the perfect be the enemy of the good. If you are working on a paper, and it is getting close to being submitted, it is time to submit it. It will never be perfect, and if you do not advance the ball, you never make progress.

9. Understand which projects are time sensitive and which are not, and don’t pick too many of the former. Some projects are highly scoop-able. The idea is obvious, and many people have access to similar data. Don’t pile too many of these on your plate. They will stress the hell out of you. Pick projects that aren’t time sensitive and no one else could possibly imagine.

10. Papers/ talks/ your career should have stories. If you can’t explain what you are doing to a colleague (not one precisely in your field, but close) in 5-6 sentences, rethink that project. Simplify your ideas till you can make this happen, and try again. If you can’t explain your overall career, might be time to quit.

11. Recognize that each individual goal you are pursuing is not that important. Each individual goal is unimportant. If one paper keeps getting rejected, take it easy. That paper might be shitty. (Or extremely controversial). Preprint it, and move on.

12. Don’t compare yourself to others. Comparison is the thief of joy. Also, the world rewards some of the worst actors and dumbest people. Who cares? Their recognition doesn’t affect you (ha, well except when they set COVID policy ;) —but in that case, attack the idea from all fronts).

13. If someone engages in bad ethical practices— steals your ideas (repeatedly), pushes you to middle author, or cuts you out of a paper you told them about, or isn’t a good friend (many ways this can happen)— don’t cry about it. The idea wasn’t that great anyway, and you should have 40 better ideas by now. Just stop all collaborations and interaction going forward. Cut them out fast. Prolonged contact is always regrettable. They will never change. Apologies are empty words.

14. If you want something done well by someone else, meet them frequently and explain why it matters, not what the task is. Their motivation is most important.

15. Don’t give important projects to people you don’t know well. Start with small projects to test the relationship. Many will fail. The people who do well, should get more and more opportunities.

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