Latest / The Hidden Load: For the educators and leaders in medicine who hold everyone up. / The Stagnant Mirror: Knowing When to Leave Medicine Roles with Dr. Santina Wheat
Transcript
- Santina Wheat: Welcome to the hidden load for the educators and leaders in medicine who hold everyone up. We will tackle the hard topics and help you conquer your chaos and get to calm all by starting to acknowledge and remove that hidden load. This podcast is a space for us to name the things that are common, but not normal. Each week, we'll look at the invisible weight you're carrying and explore practical coaching-based tools to help you find more calm, better boundaries, and a sense of purpose that doesn't require you to run on empty. I'm so glad that you've carved time out for yourself today. Let's get into the episode. Welcome back to The Hidden Load. I am your host, Dr. Santina or Tina Wheat. Now, today we are diving into an internal calculation that almost every medical educator and clinical leader will face at least once in their career, usually around the mid-level mark. This is a calculation that does not happen out loud in the faculty lounge. It often happens at 11 p.m. when you're looking at your screen. Or during your early morning commute when you find yourself staring at the steering wheel at the hospital before you open the car door. This is the calculation of whether it is time to leave your organization. In healthcare, deciding to pivot away from an institution is a massive, unquantified hidden load. We are a profession that is built on institutional loyalty loyalty. and longevity. We often climb internal ladders, we build multi-year relationships with our teams, and we invest heavily in the institutional culture. Because of that, the decision to walk away is not just a logistical change, it can be a profound identity crisis. And so today, we are going to unpack three invisible forces that keep us trapped in professional paralysis. The immense friction of institutional inertia, the paralyzing fear that the grass won't be greener on the other side, and The highly specific phenomenon that I am going to call the stagnant mirror. The structural reality that no matter how much you grow, your organization may forever view you as the junior physician who walked through the door on day one. Now, if you are currently trying to decide whether to stay and fight or to gather your things and grow, then this episode was made exactly for you. Let's begin by naming the baseline gravity that keeps us staying in places that no longer serve us. That is the inertia tax. Moving in medicine is nothing like moving in the corporate world. If a corporate executive job becomes available, the executive can just hand in their laptop on Friday and open a new one on Monday. In healthcare, Changing organizations requires a staggering amount of sheer operational friction. Think about the checklist. You have to clear a new state medical board licensing process if you've moved states. You have to go through a six-month institutional credentialing black hole where there's more and more paperwork to provide. You have to completely rebuild your clinical templates, learn a brand new iteration of the EHR. even if it's the exact same company, and build trust with a completely unproven nursing and medical assistant staff. If you're an educator, you are leaving behind the curriculum that you built from scratch or truly made your own, the residents that you recruited, and the junior faculty that you spent years mentoring. The weight of that friction is absolutely immense. And because the energy required to move is so high, we often fall into a cognitive trap known as the sunk cost fallacy. We tell ourselves, I have spent seven years building the Stanley Medicine Clinic. I have spent five years navigating the politics of this GME committee. If I leave now, all of that equity drops to zero. So we stay. We stay out of pure exhaustion. We stay because the devil we know often feels safer than the crushing logistics of the devil that we don't know. But I want you to look closely at what that inertia might be costing you. When you stay in an organization only because logistics of leaving are hard, you are paying the inertia tax with your own professional potential. You are allowing the administrative friction of the system to dictate the ceiling of your career. Now that we've talked about the inertia, let's talk about the most dangerous hidden load of staying. And it's something that often hits mid-career faculty the hardest. That is the stagnant mirror. I want you to think back to the exact day you signed your first post-training contract with your current institution. You walked through the front doors, and let's be completely honest, you were a rookie. You were the junior attending or the junior faculty member. You were the first person. You were the person who spent the first six months simply trying to figure out how to route a complex referral through a broken intranet system, how to clear your charting queue before midnight, and how the department chair preferred their staff meeting memos formatted. If you joined your institution as a trainee, they saw you stumble through even more than that. In those formative years, you naturally operated from a place of compliance. You said yes to every single low impact, high administrative burden task that came your way. Why did you do that? Well, because you were socialized to believe that was how you paid your dues. You sat on the compliance subcommittee, you covered the unpopular holiday shifts, and you stayed silent during major faculty debates because you didn't want to ruffle the feathers of the institutional hierarchy. And during that exact window of time, the institution's collective leadership created a mental blueprint of exactly who you were. They looked at you through a specific lens and pinned a permanent label to your profile. Capable, compliant, junior, and needs direction. Now let's fast forward seven, eight, or ten years. Under that exact same roof, An immense amount of incremental growth has occurred within you. You've spent thousands of hours in the clinical trenches. You may have won peer-reviewed teaching awards. You may have completely redesigned a failing rotation. You may have built deep strategic alliances across departments. And you have developed highly sophisticated insights into the structural and operational flaws of the organization. When you look in the mirror in the morning, you see. High capacity, seasoned visionary leader. But here's the structural trap. When you walk into the executive boardroom or the department chair's office, the institution looks at you and still sees the ghost of the rookie from a decade ago. This is the tragedy of institutional typecasting. In the eyes of an established long-standing leadership structure, your professional evolution is entirely invisible because it happened bit by bit under their roof. It's like a parent who still looks at their 35-year-old adult child and tells them that they need to put on a coat before going outside. They're completely blinded by their first impression. or remembering who they were 10 years ago. They watched you trip over the baseline administrative hurdles when you were 30. So they assume you are incapable of strategic vision now that you are 40. Let's trace exactly how this can play out in real time on the academic floor. A major leadership vacancy opens up. Maybe it's a vice chair slot, a residency program director role, or an executive medical directorship. You look at that job description and realize it perfectly matches your current skill set. You apply for it, or you let it be known that you want a seat at that specific table. Or maybe you just hope. That somebody has noticed that you've been working hard and will offer that position to you. But during the selection process, the committee looks past your 10 years of dedication, your clinical equity, and your institutional knowledge. Instead, they pass you over and hire an external candidate from an outside institution. And why do they do that? Well, it's not because the external candidate is objectively better than you. In fact, You might even have a more impressive CV than they do. It's because the external candidate arrives with the immediate unblemished prestige of an unknown quantity. They get to present a polished highlight reel of their past achievements without any of the historical baggage. The committee looks at them and sees an instant authority figure. But when they look at you, they remember the time that you were late to a clinic block five years ago. or the time that you struggled with a difficult patient interaction in your second year of work. You're trapped in the permanent amber of your initial arrival profile. The hidden load of this reality is the immense cognitive dissonance it creates. You spend your days performing high level operational rescue work for your department, but you are perpetually viewed, compensated, and positioned as if you are still learning the ropes. You find yourself trapped in an invisible ceiling where your expertise is exploited to keep the wheels turning, but your leadership capability is completely dismissed when it's time to hand out the keys to the castle. If an organization's leadership refuses to actively update its mirror to reflect the reality of who you have become, then you are staying in a room that will forever require you to bend down just to fit inside their perception of you. Now, don't get me wrong, this won't happen in every organization. And this especially won't happen if there has been significant leadership transition since you've arrived. But if this is what you are experiencing, then it is really time to reconsider. So now we've talked about the stagnant mirror and you feel the crushing weight of the inertia tax. But you are finally ready to start looking at the national job boards. You see opportunities at external institutions that look incredibly attractive. But the moment that you start updating your CV, the next phase of the hidden load sets in. This is the fear of the greener grass mirage. Every single healthcare professional listening to this has heard the exact same institutional warning from well-meaning colleagues or mentors. Don't leave. The grass is never greener on the other side. Every hospital system in the country is broken in the exact same way. Corporate medicine is corporate medicine wherever you go. So you may as well stay put and deal with the problems that you know. And let's be completely fair. There is a legitimate piece of truth in that warning. If you think you are going to leave your current university, hospital, or community clinic, And find an institution that has completely solved electronic health record fatigue, or has unlimited staffing resources, or has zero administrative bureaucracy, then you unfortunately are chasing an absolute fantasy. Every single healthcare logo on Earth deals with budget constraints, compliance drag, and systemic friction. If you pack your bags and move across the country, simply running away. From the fundamental reality of modern healthcare friction, you will inevitably land in a new clinic, log into a new computer, and realize within 48 hours that you just traded a blue corporate master for a red corporate master. To protect yourself from the mirage, you must move completely out of an emotional reaction and execute an objective, cold diagnostic audit. You have to separate universal healthcare friction from systemic institutional stagnation. If you're considering this, I want you to pull out a piece of paper this week, and I want you to run your career through three explicit diagnostic checkpoints. Checkpoint number one. Is the bottleneck a resource issue or a valuation issue? Let's look at the difference. If your current clinical schedule is constantly running an hour behind because the medical assistance are understaffed or the front desk workflow is broken, that is a resource and logistics issue. It is incredibly frustrating, yes, and can happen anywhere. But it is a systems problem that can be theoretically optimized through iterative design. Advocacy and better budgeting. But ask yourself this instead. When you identify that staffing crisis and you step up as a leader to present a highly detailed data-driven operational strategy to fix the workflow, how does the leadership respond? Do they pull up a chair, treat you as a strategic partner, and evaluate the data? Or do they dismiss your voice out of hand, pat you on the head? And tell you just to go see more patients because they still view you as the compliant junior attending. In that example, it's not a resource issue. That is a valuation issue. Resource constraints change with a fiscal year. An institutional mirror that refuses to value your mind will almost never change. Okay, checkpoint number two. Am I mourning the current reality or the past equity? Now this requires brutal internal honesty. When you look at your schedule, Your department, and your upcoming initiatives. Are you choosing to stay because you are genuinely energized by the five-year strategic vision of your current chair? Or are you staying simply because you are emotionally attached to the sweat equity you built three, four, or five years ago? High performing leaders fall into the sunk cost trap constantly. We stay because we remember how hard we fought to build a specific residency track. or stable clinical lane. And we hate the idea of walking away from something that we poured our blood, sweat, and tears into. But true strategic leadership requires you to invest entirely in the future value of a space, not in its historical costs. If the future trajectory of your current department is flat or declining, staying to guard your past equity is losing is a losing clinical Okay, now checkpoint number three. Does the new table offer a clean mirror? When you interview at an external organization, your primary directive isn't to evaluate the parking situation or the baseline salary scale, though those might be important to you. Instead, your primary directive is to audit the mirror of the new room. The external institution does not know the 30-year-old or 32-year-old version of you. They don't care about your early training mistakes or your rookie administrative blunders. They only know the high capacity, articulate, seasoned leader who is standing in front of them in the interview room today. They are buying your current genius at absolute full market value, entirely unclouded by historical typecasting. They are looking to bring you in specifically for that authority and perspective that your current institution treats as background noise, potentially. If you run your current role through these three checkpoints and realize that you are paying a heavy stagnation tax simply to protect an unvalued history, you have your diagnostic answer. The grass will not be perfectly green anywhere in modern medicine. But a clean mirror gives you the exact sunlight that you need to finally grow to your full potential. So why is this evaluation so vital for educators and leaders? Well, because our trainees are watching how we treat our own worth. In medicine, we inadvertently teach our learners a culture of martyrdom-driven loyalty. We model the behavior of staying in broken systems, ticking the abuse, and complaining in the hallway, while never actually exerting our own professional autonomy. We teach them that once you clip a badge to your coat, you belong to an institution forever, regardless of how it erodes your well-being or limits your growth. When you have the courage to conduct a transparent, dignified values driven exit from an organization, when you look a department in the eye and say, Thank you for the years of training, but my capacity has outgrown the current structure. And I am stepping into a space that aligns with my next phase of leadership. You are performing a profound act of education. You are showing residents and junior faculty that physicians are not institutional property. You're showing them that a medical degree is a license for autonomy, not a sentence for stagnation. You teach them how to value their own minds by refusing to let your own mind be marginalized by an outdated institutional perception. And you might go through this process and decide that you actually love your institution, that you are being valued. and that your advocacy matters. If that case is true, then staying at your institution teaches them something as well. Finding the place that values and staying there is an important lesson as well. So we have covered a lot of territory today. We looked at the heavy weight of the inertia tax, the distinct reality of the stagnant mirror, the strategy for avoiding the greener grass mirage, and why modeling professional autonomy is a core responsibility for medical educators and leaders. So your Monday morning challenge for this week. Before you start your first clinical block or step into your first faculty meeting, I want you to take 60 seconds to look at your reflection in the hospital mirror. Ask yourself, who does this institution see when they look at me today? Do they see the leader who is capable of driving this department forward? Or are they still looking at a ghost for my arrival date? If the mirror is stagnant and you've spent years trying to clean the glass to no avail, it might be time to accept that the friction of moving is a small price to pay for the freedom to grow. Stop doing the mental gymnastics required to stay small in a room that refuses to let you expand. Thank you for joining me for this episode of the Hidden Load. if this breakdown helped you navigate your own professional crosswords today, I hope you'll share it with a colleague or junior faculty member who might be currently staring at their own steering wheel, trying to decide if it's time to turn the key. Let's protect the person so we can protect the mission. I'm Dr. Santina Ortinawheat. And I will see you next week. Thank you for listening to The Hidden Load. If today's conversation spoke to you, I would love for you to share it with a colleague who might need to hear it too. It's one of the simplest ways we can start shifting the culture of medicine together. And remember, your time spent reflecting here matters. You can earn free CME or CE credits for listening to today's episode through the Pinnacle app. You'll find that link in the show notes. If you are looking for one-on-one coaching support or want to dive deeper into the resources we discussed today, let's connect. You can find information on how to reach me in the show notes. don't forget to hit subscribe so that you never miss an episode and leave me a rating so that others can find me too. and take care of yourself because you deserve to be held up to. And I'll see you next time. Thank you for listening to The Hidden Load. If today's conversation spoke to you, I would love for you to share it with a colleague who might need to hear it too. It's one of the simplest ways we can start shifting the culture of medicine together. And remember, your time spent reflecting here matters. You can earn free CME or CE credits for listening to today's episode through the Pinnacle app. You'll find that link in the show notes. If you are looking for one-on-one coaching support or want to dive deeper into the resources we discussed today, let's connect. You can find information on how to reach me in the show notes. don't forget to hit subscribe so that you never miss an episode and leave me a rating so that others can find me too. and take care of yourself because you deserve to be held up to. And I'll see you next time.