Latest / The Hidden Load: For the educators and leaders in medicine who hold everyone up. / The Stagnation Tax: Why Leaders Must Hear No
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. And today I want to talk about a word that makes every high-achieving healthcare professional instantly flinch. It is a simple two-letter word that we are conditioned to avoid at all costs, starting from the moment that we take organic chemistry. the beginning of our pre-medical journey. And that word is no. In medicine, a no feels like a catastrophic failure. A no means that grant wasn't funded. A no means the residency program director did not rank you. A no means that you don't have the opportunity to do that research project. With the lab that you were hoping for. A no means the Institutional Budget Committee has denied your request for more clinical staff. It might be that paper that you submitted was not accepted and you feel like all of your work has been for naught. Because we are a culture of straight A perfectionists, we tend to carry a massive hidden load. The exhausting energy of risk avoidance. We curate our proposals, our ideas, and also our leadership initiatives so perfectly that we only ask for things when we are ninety nine percent certain the answer will be an easy yes. And when we get that no, it feels catastrophic. And today, I want to turn that entire framework on its head. I want to offer you a radical leadership metric. And that is, if you aren't hearing no on a regular basis, then you simply aren't trying hard enough or reaching high enough. When you play the leadership game so safely that your record is flawless, then you aren't being elite. You are just playing small. And so today we are going to talk about why a no is actually a vital diagnostic tool. How to use rejection as an immediate opportunity to grow, and why collecting your share of no's Is the only thing that makes the Hard fought yeses taste so sweet. Now, I want to be completely honest with you about how this showed up for me in my own leadership journey. I never had that magic streak where everything I touched turned to guilt. I always wished I could have. I never had a moment where institutional doors just flew open for me. Like most of you, I had to fight for every inch of my progress. the positions that I was able to obtain. But a few years ago, I sat down to audit my leadership portfolio and think about what impact I'd been able to have. I looked back at the curriculum changes that I had proposed, the small resource requests that I had made, and the initiatives that I had put forward over the preceding few years. And as I looked at the list, I noticed something strange. Every single one of them had been approved. On the surface, you might think, great, that's a hundred percent success rate. You're doing amazing. But as I sat there looking at the clean sheet, Another realization hit me. My record wasn't looking so clean because of institutional genius. My record was clean because I had really moved to playing defense. I was so terrified of the institutional no, of that failure, so afraid that a rejection would be a public indictment of my competence or my standing. Especially after a period of time where every battle was so hard fought that I was actually doing the institutions rejecting for them right inside my own head. I sometimes would have a big, bold, creative idea that really could solve a systemic issue for our learners or our faculty. But before I even touched the keyboard to draft a proposal, the internal editor took over. The leadership is going to say no. They're never going to find the money to do this. This timeline looks too aggressive. Let me scale it back. Let me just ask for part of what we actually need because then that'll be a safe yes. Then it'll look like I had a win. I need to temper down the expectations of my team. Right there that I was doing, it was a self-censorship trap. I was protecting my record at the expense of potential growth. I was carrying the hidden load of constantly watering down my own vision, purely out of fear of hearing a two-letter word. The moment that I realized a clean record actually meant a lack of courage. was the moment that I realized that I should no longer be doing the institution's gatekeeping for them. So in order to move forward, I needed to look at the systemic anatomy of why I carried this fear and why some of you are also carrying it. Medicine breeds us to believe that absolute consensus is the only safe operating environment. In the operating room or in the clinic, you want standardized You don't want a rogue creative idea mid procedure. We're taught that you need to do the same thing that a reasonable person would do. So everyone needs to have their care be similar. But when you step into an educational or institutional leadership role, that exact same safety mechanism actually becomes stagnation. When we avoid the risk of hearing no, we end up paying an invisible tax. And as I mentioned before, I call it the stagnation tax. We spend hours in our offices engineering ambition right out of our proposals. We think Well, the department really needs an entire multidisciplinary health tracking system. But the committee is probably gonna say no to that. So let me just ask for a single software license instead. Does that sound familiar? You do the work, you get the easy yes for that single software license, and you celebrate. But you haven't actually solved the problem. You just took a safe bet. Sure, you might have chipped away a little bit at your problem, but you need to move a lot further. When you shift your perspective to realize that a no is not an identity crisis, but instead it is simply a data point, then everything can change. A no tells you exactly where the institutional boundary is. It tells you where the financial friction lies. It tells you what objections you need to solve for. If your leadership portfolio Doesn't include a folder full of rejected proposals, it means that you are leaving your best ideas on the cutting room floor out of pure comfort. And so this is the place that we have to push ourselves. We need to lean into that opportunity for discomfort. So what happens when you actually step out on a limb? When you send that bid proposal and you get the email that says, Thank you for your initiative, but we can't support this project at this time. Well, a lot of us we feel that on the inside. We feel like we did something wrong, that because our idea wasn't accepted, that we're not good enough. But how do we avoid that? How do we handle that without spiraling into imposter syndrome? In order to not spiral, we need to use the post rejected diagnostic pivot. We can treat the no exactly like a complicated clinical case that didn't go the way that we expected or hoped. When this happens clinically, we don't yell at the chart. Well, maybe some of us do, but really we audit the data. So the first step is to isolate the rational from the emotional. When the leadership no drops, your brain will immediately try to turn it into drama. It will say, they don't value my department, or they don't respect my leadership, or I'm just stuck. Those are drama and thought distortions. And I want you to strip them away. And instead, I want you to find the structural reason why you received a no. Was it actually a timing issue? Was it a capital constraint? Was it an alignment failure with the hospital's current fiscal or strategic plan? When you treat a no as a diagnostic riddle rather than a personal insult, it becomes an immediate opportunity to grow. Once you've done that, the second step is to conduct the no debrief. Never let a no hang in the air without an autopsy. Walk back into the office of the person who gave you the rejection. Do not go in defensively or angrily. Go in again as the clinician conducting a case review. Say this exact phrase: I completely accept the decision on this project. For my own growth as a leader, Can you help me understand the primary variable that made this a no for the institution right now? I'm telling you to think about it first and then go and ask the question so that you have the opportunity to determine if you evaluated the situation correctly. And when you go and ask the question, most of the time They will lay out the exact roadmap for how you can turn this into a yes at a time that is more appropriate, maybe six months from now. By doing that, you learn the institutional landscape through the rejection. You figure out what process you could follow to get maybe this change or another one through the process. The third thing I want you to consider is that a no is frequently a not yet. In academic medicine, institutional memory is quite long. And often these are big bureaucratic systems, and moving the ship takes time. A no is often not a completely closed door. It is often just a checkpoint. It means that your argument hasn't fully accounted for the current pressures yet. And when you understand that, it forces you to really sharpen your data, to build better alliances across departments, and to come back with a clinical argument that is bulletproof. And here's the ultimate truth of this leadership dance. The no's are the only things that make the yeses so incredibly sweet. If every project you propose goes through without a fight, then you never actually feel the triumph of true systemic change. The yeses that stick with you, the ones that change the trajectory of a residency program, the ones that secure the funding for a community health initiative, the ones that protect your faculty's well-being. Are almost always the ones that started as a definitive doors slammed shut no. When you fight for a concept, when you take the rejection, when you use it to iterate, to learn, to grow, and to understand your institution on a deeper level, you build leadership muscle. And when that final yes lands, it isn't just an administrative victory. It is proof of your resilience. It is proof that you didn't just ask for what was easy. You pulled the institution forward into what was necessary. I want you to think about how sweet that victory feels. You cannot have the high of those victories without being willing to risk the low of the initial rejection. So, why does this matter for those of us who are educators and leaders? Well, because our trainees and our teammates are watching how we handle the closed doors. If your residents see you get defensive, angry, or completely defeated every time an institutional request gets denied, then they learn to never stick their necks out. You are teaching them to be cynical, safe administrators rather than the Fold clinical leaders that we need. When they see you take a no, dust yourself off, pull the data apart, and say, All right, team, they said no to option A, which means we just learned what they won't accept. Let's build option B. Then you are modeling real institutional stamina. You are also modeling for them, but it's okay to receive a note. Oftentimes, people look to their leaders and think they've never had a door shut in their face because they only see the positives. It's important for them to know that happiness and success in our career is not a straight line. There are bumps along the road. And modeling this to our learners, to our teammates, gives them the knowledge that it's okay when it happens to them too. Okay, let's talk about your Monday morning challenge. This week, I want you to look at your dream project list, the big, audacious, hairy ideas that you've been sitting on because you are convinced the higher ups will shoot it down. I want you to draft a proposal. And I want you to hit send. Go into next week with the explicit goal of pushing the envelope far enough to actually hear the word no. Stop paying the stagnation tax. Treat that rejection as an invitation to sharpen your blade. Because if you aren't hearing no, you aren't leading. You are just waiting. Thank you for joining me today on the Hidden Load. If this episode gave you the courage to risk a no this week, I hope you will share it with a colleague who is currently playing it a little too safe in their own career or department. Let's help lighten their load together, 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.