Latest / The Hidden Load: For the educators and leaders in medicine who hold everyone up. / The Loyalty Tax — Should I Stay or Is It Time to Go?
Transcript
- Santina Wheat: Hello everyone and welcome back to The Hidden Load for the educators and leaders in medicine. I am your host, Dr. Santina or Tina Wheat. Before we dive in today, I want you to take a breath. I know that you have likely been running from one task to the next because we all are. And today I want to invite you to just be here for a moment. I want to invite you to have the time to reflect on your own situation. Because today we are tackling a question that feels like a heavy weight in the pit of your stomach. And that question is, should I stay or is it time for me to go? Welcome to the hidden load for the educators and leaders in medicine who hold everyone up. 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. 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. 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. Now, in medicine, some of us have been raised on a very specific diet of loyalty. For me, this was certainly not an abstract concept. It was something that I learned in my family, and it wasn't just about medicine. My mother, who was a baby boomer, worked for the same organization for her entire professional life. 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. If you are looking for one-on-one coaching support or want to dive deeper into the resources we discussed today, let's connect. When she retired, she had put in over 30 years with one, albeit large, organization. Her philosophy was clear. If you take care of the system, then the system will take care of you. and in her world, in her situation, that was largely true. Every time there was a bump in her career, perhaps it was a departmental restructuring and positions were eliminated, or it was a change in leadership. There was always for her a mentor You can find information on how to reach me in the show notes. don't forget to hit subscribe so that never miss an episode ⁓ and leave me a rating so that others can find too. and take care of yourself because you deserve to be held up too. And I'll see you next time. or a peer who leaned in or stepped in and was able to catch her and send her in the right direction. She landed on her feet just about every time because she was part of an ecosystem that absolutely valued tenure. And because I watched this happen, I grew up. believing that that was the standard operating procedure for a professional life. She may not be in medicine, but it still taught me that loyalty could help you land where you needed to. If you put your head down, if you do the work, then the institution will reward you for your staying power. Now, let's be honest. That is not the reality today. And the House of Medicine in particular has changed. The safety nets that our patients have depended on have been replaced by productivity metrics, administrative turnover, and even for-profit systems. I have watched my peers and even my own husband, who is not in medicine, find success. not by staying put, but instead by being willing to move. I have seen friends and peers grow in salary, in title, and even in their own sense of agency, specifically because they were willing to look outside. And yet, for those of us who have still been holding on to that loyalty script, it can feel like looking at that door feels like it's an act of betrayal, an act of betrayal to the organization or to our patients, to our team, to our learners. But instead, what I want you to think of is if you're only holding on to that loyalty script, and not looking outside, then maybe that loyalty script is an act of betrayal to yourself. So before I really understood the power of career coaching, a close friend told me about her interactions with her leadership coach. And I'm going to be very honest, at the time, I didn't even believe in coaching. I thought it was a little bit hooey, and I was just listening. But as she was talking to me, as I look back at it, this is probably one of the first introductions I had to the true benefit of coaching. And she shared with me that this coach gave her a rule. And this rule that she told me about it sounded like heresy at the time. This coach said, you should be looking at the market every three to five years. and not just looking at the market, but actually interviewing with other organizations every three to five years. The intent of looking outside and even interviewing was not because you always wanted to leave, but because you need to calibrate. When we stay in one place for too long without looking at the landscape, we unfortunately start to lose the sense of our own value. I've seen this play out from the leadership side of the decks. I have watched new graduates come into organizations with starting salaries that were actually higher than folks who had been in the organization for a couple of years. Think about that for a Think about that for a second. Someone is coming in. and you are mentoring them and they're potentially making more money than you are. And when that discrepancy is brought up, the administrative response is rarely, ⁓ we're going to fix that immediately. Instead, it's often we have to figure out how to bring this up over a couple of budget cycles. We have to slowly make these market adjustments. That right there is an example of the loyalty tax. there can be real, true financial and professional costs of staying silent while the world moves on around you. When you do not know what's out there, you are completely unable to advocate for what's in here. And so the external look, it allows you to see if the landscape has changed. It allows you to find out if there are new innovations, if there are new leadership models, and also importantly, if there are new opportunities that potentially align better with the person that you have become. because we certainly change as we're in our working environment. A great mentor of mine has told me that three years is about where the itch happens. It's about when we need to be determining if there needs to be a change. It's not always a change to a different organization, but it might be a change in title or a change in responsibility. In this time, it's important because maybe things have changed at home. Maybe the education that you've had has allowed you to realize that what you thought you wanted is not necessarily what you actually want. And so I challenge you to think about how you will decide. How do you move past this idea of feeling guilty of potentially leaving an organization or leaving a role, leaving your team and your patients into discernment? And I want to give you four specific questions that you can ask yourself during this three to five year check-in. I want you to grab a pen or open a note on your phone because these are your diagnostic tools. And if you're driving right now, then come back and grab these later. Question number one, do I still have opportunities for growth here? We all know that when we first start within an organization, especially in the first few years of a job, the learning curve is so steep, but eventually it stops being so steep and that curve plateaus. And so you then need ask yourself, am I still being challenged? Am being developed? And specifically, am I being developed as a leader? If the answer is no, have I simply become part of the furniture? if you have hit a ceiling ⁓ where there is no more room for intellectual or professional expansion, then you aren't just staying. You are stagnating. And you might say to me, ⁓ Well, I'm happy to reach this title. And so this question isn't all about a title. Sometimes it's about, I doing projects that are allowing me to grow as a person or as a clinician or as an educator? It's about growth in whatever way is meaningful for you. Okay, on to question number two. Is this organization still aligned with my personal mission. Purpose is not a static thing. It's not a static thing for an individual, and it's not a static thing for an organization. Organizations go through strategic planning about every three to five years. And when they do that, they often reevaluate their missions. I would encourage you ⁓ to do the same. your mission as a new attending may be vastly different than your mission ⁓ as a mid-career faculty member, be vastly different if you are the chief medical officer or chief clinical officer, ⁓ may be vastly different than you are a senior faculty member. And so when you look at your own mission, has it changed a lot? and then look at your institution's mission. Has that changed a lot? And even if the institution mission hasn't changed a lot, does the institution's why still match your why? If the organization's priorities have shifted towards volume while your heart is in education, that friction will eventually burn you out. Are there ways to? See if aspects of your. mission and that of your organization ⁓ are aligned in a meaningful way, ⁓ then might be a time to start looking. On to question number three. Is someone here intentionally investing in me? Loyalty should be a two-way street. Loyalty is not bad, but it is bad if it's one-sided. Look around. Is there a leader who is pouring into you? Or Are you the reliable one who always handles the overflow because they know that you will say yes? Do they know that you are the buffer for everyone else, but no one is actually buffering you, especially if one is buffering you. ⁓ when you're articulating that you need help. In this case, the relationship is extractive. It is certainly not collaborative. And then on to question number four. Am I still finding joy in at least a meaningful part of my work? I'm not saying that you have to find joy in your entire role. I don't actually think that dream jobs exist, but I do think that you can say that I'm finding joy in a large part of my work. Life is too short to feel like your spirit is being slowly eroded. Many of us face that reality, especially during the pandemic. And so you need to ask yourself if you have excitement still in medicine, if you have lost that excitement that brought you to medicine, then it's important to ask yourself if it is the work itself ⁓ or ⁓ if it is the environment where are the work. Sometimes doing the external work makes you realize that you have it great where you are, to realize it's time to leave. Now, I said you should be doing this evaluation every three to five years, the trigger. We have to acknowledge the additional hidden load of our personal lives. Maybe ⁓ you have a new baby. Maybe you are grieving a loss. When I lost my mom was one of the times I went through this self-evaluation. Maybe you have an aging parent who needs you or your spouse's career is pulling you in a new direction. In medicine, we are taught that our professional commitment should be our primary identity. we feel like we have to sacrifice our household's needs to maintain institutional identity. And while I do believe that our professional identity is part of our identity, I don't think it should be ⁓ the key focus. ⁓ But let me tell you, leaving a job because it no longer fits your life is actually an act of high leadership. It means that you are managing your own most important resource, your own capacity, and you're doing it with integrity. Changing your role to be the parent or the child or the partner that you need to be isn't quitting. It's aligning your work and your career. is really important. So my mother's generation stayed for the safety net. Some in my generation stay for the mission. But a mission that requires your total depletion is not a mission. It is a trap. ⁓ looking at what is there isn't cheating. It is actually stewardship. Sometimes you will look out there and realize that you are exactly where you need to be. When you have that realization, you will walk back into your clinic on Monday with a renewed sense of purpose. because you chose to be there rather than just being there by habit. Sometimes when you look out there, it might give you a great idea of something else that you can bring back to your institution that'll allow it to become even better. And then you've had the success of advocacy and making things better for both yourself and your team. And this is important for our team members and our learners as well. If we model continued loyalty without caring for ourselves, then we have taught the next generation that there isn't hope in finding joy in our careers. But when we model that it's appropriate to look out there for fulfillment, to look out there for joy, that there are ways to find sustainability in your career and home. and one of the ways of doing that is by constantly reevaluating your situation, then we've taught them that that's okay too. And so I want to give you an action step. This week, I want you to take 15 minutes and just sit with the four questions that I gave you about growth, alignment, investment, and joy. Be honest. That discomfort that you feel as you ask yourself these four questions, it's not guilt, it's information. And it's a way that you can help others frame this conversation themselves as well. Thank you for joining me for this episode. check the show notes for a reminder of our four questions, and for the free alignment workbook. Take care of yourselves because you deserve to be held up to. I look forward to seeing you next time.