My 4 year-old, Rogue Two, is the king of pre-school.

He makes the same jokes with the administrator every morning as he walks by her office on the way to his class.  Other children literally come to him for help with tasks and activities before asking the teacher.

He knows the routines, he knows where everything is and what to do, and all the teachers know his name.

Yes, he is enjoying himself.  But he wants to be bigger.

He can’t wait for Kindergarten, riding the bus, participating in big kid sports, and doing the same things that Rogue One, his 9 year-old brother does.

He doesn’t realize that in elementary school he won’t be the ruling the roost, and that the same jokes will play differently to a new audience.

Almost everyone will be bigger than him, there will be numerous things he’s not allowed to do, and there will be a whole new group of people he has to impress.  He will have to earn everyone’s trust and they will have to learn his loud, brash style.

There will be someone smarter, or more talented, or cooler, or someone who gets to do things he doesn’t, or someone who can get away with things he can’t.  Eventually he will near the end of elementary and realize the strides he’s taken to again be king of the hill.

Then the process will start over in middle school.  Then high school.  Then college.

If he goes into medicine, he will have to do this again in medical school.  Then again during residency/fellowship, and even as a faculty member in the Ivory Tower.

It turns out that everything he needs to know about life as a faculty member in The Ivory Tower, he will learn in kindergarten.

Last week we discussed how money plays a role in academic medicine, and prior to that, Vagabond MD discussed why academic medicine was a poor fit for him, partially because the Tower did not make a spot for him.

This week, we discuss politics.

All entries in this series will be able to be found here.

Every Flight Begins With a Fall

One of the truest axioms in academics is that the best way to advance your career is to leave.  Want a promotion, a higher salary, or to explore new opportunities?  Leaving, or almost leaving, is the best way to receive it.

I say this as someone who has been at the same institution for 9 years, but has watched many others leave.

It turns out the grass is often greener in another Tower’s yard.  Not just for the individual, but for the Maesters who run the Tower.  Physicians at other institutions are often valued more highly than those within the institution.

Those from outside Towers carry a certain je ne sais quoi that makes them more desirable than those within the tower.

Two weeks ago, Vagabond MD shared how he was not offered a faculty position at his local Tower despite having a stellar academic record.  It is certainly possible that he would have been offered a job had he applied for a position coming from another highly regarded university.

People often prefer the devil they know.  In the Tower, it is sometimes the opposite.

Everyone Is Mine To Torment

I had my first taste of Ivory Tower politics during residency.

I was applying for fellowship in a competitive field, and was in residency at one of the best known programs in the country.

I was unofficially told by one of the faculty members in this speciality that I was unlikely to obtain a fellowship spot at my home program.  For those outside of medicine not familiar with The Match, read this to understand how we obtain spots in residency and fellowship.

There were five total spots.  In addition to myself there were two other internal applicants, and numerous external applicants.

I was told the directors of the fellowship program did not want to keep all three of us — they wanted 3 of the 5 spots to go to external applicants.

This was not three specific people they were targeting.  They just wanted three of the five spots to go to people from somewhere else

Apparently I was the odd man out — I was the one least likely to be ranked high enough to obtain a spot and stay at my local Tower for training.

The informant did not specify why I was the odd man out, though I was given hints.

One internal candidate just meshed well with everyone.   The other person was well-liked, and had some additional training I did not have.

Nothing was said to me about it, but I knew I did not come across as the warm and fuzzy type, so my relationship with the program directors was not strong.

The lack of personal connection to the program directors may not have harmed me, but when there is competition for a spot, the presence of a strong relationship absolutely helps.

I wasn’t sure how to use the information.  It was not something I could discuss with the head of the program, and the way the match system works, it almost didn’t matter.  I needed to figure out where I wanted to go, make a list, and prepare myself for the possibility of leaving.

So I ignored the information and went through the process.

When Match Day came — the day we’re told by a computer where we go for our training — it turned out my informant was right.  I was moving on to greener pastures.

You know nothing, Jon Snow

So I moved on to the next Tower for more training.  I completed a fellowship, and during it a post-doctoral program and a Master’s degree.

I was fortunate — while not nearly as accomplished as Vagabond, a faculty job was waiting for me at my home Tower at the end of my training.

I chose not to interview at many institutions.  I was happy at my home Tower and was happy in the town.  Staying was the right decision, and I’ve not second-guessed that decision.

However, by the time I became a faculty member at the Ivory Tower, I had forgotten my lessons from Kindergarten.  I have subsequently relearned them.

I’ve embarked on a research career at a university renowned for its research, but without necessarily being the stereotypical fit for research.

I’m surrounded by people more talented than me, smarter than me, and more accomplished than me.  That includes individuals both younger and older than, and personalities of various types.

Some of those that wield the most influence can be the most capricious, and some of those who have the most bestowed upon them are the most difficult to interact with on a routine basis.

I’ve been in favor and out of favor.  I’ve ticked off heads of divisions and had to learn better how to take a tenuous professional relationship and slowly work on it to make it a source of professional strength.

I’ve lost opportunities because I was not the chosen one, had opportunities I’ve earned taken away by those who did not support my goals, and had those same opportunities restored by people who did support them.

I’ve also participated in the selection process of evaluating individuals applying to fellowship at my Tower.   I’ve learned that evaluating a person goes well beyond what is on paper.

We’re judging someone’s character, work ethic, and future potential.  These things are determined not solely by the persons résumé, but also by perception, which is influenced by our own character.

This is not an insult — this is how it should be.  Individuals are not test scores or résumés, and the most important and valuable parts of a person often cannot be quantified.  Where judgment falls short is when we fail to recognize the films over our eyes that color our perceptions.

We are often judging people against ourselves, and finding they come up short, when it is the person doing the judging who has failed.

This failure to understand when we judge someone incorrectly is one of the more difficult problems in the Tower system, and one of the hardest to solve.

Junior League

I am 37 (almost 38).  I’m married with 3 kids, a mortgage, and a minivan.  I’ve been faculty for a few years, obtained advanced training and certifications, have publications and grants, and am working on more.

I’m also often called “junior faculty” because of both the expectations of where I should be in the future, and the reality of where I am not compared to those around me. In any non-Tower setting no such label would be applied, but I am being judged only partially against myself, as well as against the past and the future of the Tower.

Working in the Ivory Tower doesn’t make us more pure, but I’ve learned it often makes us more righteous, because of that past and future.  Righteousness combined with judgment is another form of politics, as we try to decide other’s futures based on what we believe to be important.

Despite the politics, I’ve decided to stay in my room at the Tower.  I not only have a nice view of the park, but perhaps if I stay long enough, eventually I’ll get to be a Maester as well.

“You may never have proof of your importance but you are more important than you think. There are always those who couldn’t do without you. The rub is that you don’t always know who.” 

― Robert Fulghum, All I Really Need to Know I Learned in Kindergarten