You stayed late to rewrite a colleague's section of the grant proposal. You didn't have to. No one asked. But you couldn't submit it the way it was.
Now ask yourself: why?
Were you driven by a need to get it right? A fear of how the group would look if it fell short? A desire to be seen as indispensable? A belief that no one else would care enough to fix it?
The answer matters more than the behavior. And that's exactly the distinction the Enneagram is designed to surface.
Most personality assessments used in leadership development -- DISC, Myers-Briggs, CliftonStrengths -- focus on what you do. How you communicate. Where your talents lie. Those are useful. I use them regularly in coaching.
The Enneagram goes somewhere else. It focuses on why you do what you do. It maps core motivations, the deep fears and desires that drive your behavior, often without you realizing it. Two physicians can exhibit the exact same leadership behavior for completely different internal reasons, and the Enneagram is the tool that pulls that apart.
The system identifies nine personality types, each defined by a fundamental motivation. It has roots in ancient wisdom traditions but was developed into its modern psychological framework by thinkers like Oscar Ichazo and Claudio Naranjo, and later popularized by authors like Don Richard Riso and Russ Hudson in The Wisdom of the Enneagram. It's not a parlor game. It's a serious framework for understanding what's actually running the show underneath your conscious decisions.
Here's a quick look at how each Enneagram type tends to show up among physician leaders. These are sketches, not boxes. Most people see themselves in several types but have one core type that drives their deepest patterns.
Type 1 -- The Reformer. Motivated by a need to be good and right. In academic medicine, you're the one who rewrites the department policy because the current version is sloppy. You hold yourself and everyone else to high standards. The trap is resentment when others don't share your commitment to doing things correctly.
Type 2 -- The Helper. Motivated by a need to be needed. You're the faculty member everyone comes to -- the unofficial counselor for struggling residents, the person who always says yes. The trap is burnout and a creeping sense that your own needs don't matter.
Type 3 -- The Achiever. Motivated by a need to succeed and be recognized. Academic medicine was practically built for you: publish, present, get promoted, repeat. You're efficient, polished, and productive. The trap is losing track of what you actually want versus what the system rewards.
Type 4 -- The Individualist. Motivated by a need for identity and significance. You're drawn to work that feels meaningful and original. You might be the physician-educator redesigning the curriculum or the researcher pursuing a question no one else cares about. The trap is feeling misunderstood or undervalued in a system that rewards conformity.
Type 5 -- The Investigator. Motivated by a need to understand. You want to master your domain completely before speaking up. In academic medicine, you're thorough, independent, and often brilliant in a narrow area. The trap is withdrawing from the relational side of leadership because it drains your energy.
Type 6 -- The Loyalist. Motivated by a need for security and support. You're the one who anticipates what could go wrong and prepares for it. You build coalitions and think carefully about institutional dynamics. The trap is anxiety that keeps you from making decisions or trusting your own authority.
Type 7 -- The Enthusiast. Motivated by a need for stimulation and freedom. You're the department's idea generator, always excited about the next initiative. You bring energy and optimism to every meeting. The trap is starting more than you finish and avoiding the tedious operational work that keeps things running.
Type 8 -- The Challenger. Motivated by a need for control and self-protection. You're direct, decisive, and willing to fight for what you believe in. In academic medicine, you're often the one who challenges the dean or pushes back against a bad policy. The trap is intimidating people who need to feel safe before they can be honest with you.
Type 9 -- The Peacemaker. Motivated by a need for inner and outer peace. You're the division chief who keeps everyone calm during a merger, the faculty member who mediates between warring colleagues. The trap is going along to get along and losing sight of your own priorities.
Here's a real pattern I see in coaching. A physician leader gets feedback that they're "too controlling." A behavioral assessment confirms they score high on dominance. So they try to back off, delegate more, say less in meetings.
It doesn't stick. Or it works on the surface but something still feels wrong.
That's because the behavior was never the real issue. An Enneagram Type 8 who micromanages does it because they fear being vulnerable or blindsided. A Type 1 who micromanages does it because they fear producing something flawed. A Type 6 who micromanages does it because they fear something going wrong on their watch.
Same behavior. Three different engines underneath. And each one requires a different kind of growth.
This is where the Enneagram earns its keep. It doesn't just tell you to stop micromanaging. It helps you understand what you're actually protecting yourself from, so you can address the root cause instead of hacking at the branches.
The Enneagram is not a self-help quiz you take and forget. It's a framework that unfolds over time, and it unfolds best in conversation with someone who can help you see what you can't see on your own.
In coaching, I use the Enneagram to help physicians recognize their patterns under stress, understand why certain relationships at work feel effortless and others feel impossible, and make leadership decisions that align with their real values rather than their automatic reactions. Ian Morgan Cron and Suzanne Stabile lay this out well in The Road Back to You, which is a practical and accessible entry point for anyone new to the system.
The Enneagram doesn't replace behavioral tools. It sits underneath them. Once you understand your core motivation, every other assessment you've ever taken starts to make more sense.
There are several free and paid Enneagram assessments available online, but I'd recommend being cautious with quick quizzes. The best way to identify your type is through careful self-reflection, reading the type descriptions honestly, and ideally working through it with someone trained in the framework. A mistyped result will send you in the wrong direction, and that happens more often than you'd think.
The point isn't to slap a number on yourself and call it done. The point is to develop the kind of self-awareness that changes how you lead, how you relate to your team, and how you make decisions about your career.
If you're curious how your core motivations are shaping your leadership, that's exactly the kind of work coaching is designed for. Explore our individual coaching options to start making intentional choices about your career.
]]>You are a department chair. One of your most productive faculty members is also the most toxic person on the team. They bring in grants. They publish. And they are slowly destroying the culture you have spent three years trying to build.
You have two options. Keep them and watch the rest of your faculty disengage. Or manage them out and take a hit to your clinical revenue and research portfolio that will take years to recover.
Neither option is good. That is the point.
Ben Horowitz wrote The Hard Thing About Hard Things because he was tired of business books that only told you what to do when things were going well. His book is about what happens when every option is bad, you have to decide anyway, and the weight of that decision is yours alone.
I recommend it to physician leaders more than almost any other book on my list. Not because it makes hard decisions easier. Because it makes you feel less alone when you are in the middle of one.
Most leadership books follow a formula. Here is a framework. Here are the steps. Apply them and succeed. Horowitz has no patience for that. His book is built from his years as CEO of Opsware, a technology company that nearly died multiple times before he sold it to Hewlett-Packard for $1.6 billion. The path was brutal, and he does not clean it up.
He writes about laying off a third of his company. About demoting a friend. About sitting alone at 3 a.m. knowing that a decision he had to make by morning would hurt people no matter which direction he chose.
There are no tidy lessons. Just the honest account of someone who led through sustained uncertainty and came out with hard-won observations. That honesty is what makes it useful for academic medicine, where the leadership literature physicians are usually handed does not acknowledge these realities.
Horowitz has a chapter called "The Struggle" that I have read more times than I can count. He describes the experience of leading when everything is going wrong — when you cannot sleep, when you second-guess every call, when you feel like a fraud for not having the answers.
He writes: "The Struggle is when you wonder why you started the company in the first place."
Replace "company" with "division" or "department," and you have the inner monologue of half the physician leaders I coach.
Academic medicine does not talk about this. There is an unspoken expectation that if you are smart enough to lead, the leading should come naturally. It does not. The emotional toll of making decisions that affect people's careers and livelihoods is enormous. The loneliness of those decisions compounds the toll.
Horowitz does not offer a way out of the struggle. He offers something more valuable. He names it. He normalizes it. And he says plainly that if you are going through it, you are not failing. You are leading.
One of Horowitz's most practical insights is the distinction between peacetime and wartime leadership. A peacetime leader focuses on culture, long-term strategy, and expanding advantages. A wartime leader is fighting for survival, and the rules change.
Academic medicine often requires wartime leadership, but few people recognize it in the moment. Budget cuts that eliminate faculty lines. A key leader departing with half the division's grant funding. A pandemic that reshapes clinical operations overnight.
Horowitz's advice for wartime decisions is direct:
I worked with a division chief who had to close a clinical program that three faculty members had built over a decade. When she finally made the call, she met with each affected faculty member individually and explained the financial picture clearly. It was still painful. But it was clean and honest. That matters.
Horowitz spends significant time on what he calls "managing your own psychology," and I think this is the most underappreciated section of the book. If you do not manage your own mental state, you will make bad decisions, and the whole organization pays for it.
His suggestions are practical:
Peter Drucker made a related argument decades earlier in The Effective Executive — that the first job of a leader is to manage themselves. Horowitz updates that argument with the visceral specificity of someone who has lived it under extreme conditions.
Horowitz's world is venture-backed Silicon Valley. Academic medicine moves more slowly. A department chair cannot "pivot" the way a startup CEO can. Tenure, institutional politics, and shared governance all constrain the speed of change. And not every leadership challenge requires a wartime footing. Sometimes the best move is patience, not urgency.
But the core message — that hard decisions are the job, not a deviation from it — is one every physician leader needs to internalize.
Read The Hard Thing About Hard Things if you are in a leadership position where the decisions feel impossible and the pressure feels isolating. Read it if you have been promoted into a role that no one prepared you for and the standard leadership advice feels hollow.
It pairs well with Radical Candor by Kim Scott, who worked with Horowitz at several companies. Where Scott focuses on the daily practice of honest feedback, Horowitz focuses on the larger existential challenges of leading through crisis.
The Hard Thing About Hard Things will not give you a playbook. It will give you something harder to find — the honest acknowledgment that leadership means choosing between bad options, making the call, and living with the consequences. That is not a failure of leadership. That is leadership. If you have felt the weight of those decisions, this book will make you feel understood in a way that most leadership books never will.
Check out the complete list if you're interested in other book recommendations.
]]>You need protected time for a new research project. You want to shift your clinical schedule. You think the division's hiring priorities are wrong. And the person who controls all of these decisions is your department chair.
Most faculty I coach treat this relationship as something that happens to them. They wait to be noticed. They hope the chair will intuit their needs. Or they avoid the relationship entirely, interacting only when summoned.
That's a mistake. Your relationship with your chair is one of the most consequential professional relationships you have. And like any relationship, it works better when you actively manage it.
Before you walk into your chair's office with a request, take five minutes to think about their world. Department chairs in academic medicine are managing competing pressures that would overwhelm most people: clinical revenue targets, faculty recruitment and retention, accreditation requirements, hospital administration demands, and their own career aspirations. All at once.
John Gabarro and John Kotter wrote about this decades ago in their classic Harvard Business Review article "Managing Your Boss." Their central insight still holds: managing up isn't manipulation. It's recognizing that your leader has constraints, pressures, and a communication style that you need to understand if you want to be effective.
When you understand your chair's priorities, your requests land differently. "I'd like protected time" is easy to ignore. "I have an R01 submission that aligns with the department's strategic plan, and here's what I need to make it competitive" is a conversation your chair actually wants to have.
Lead with their priorities, not yours. Frame every request in terms of what it does for the department, the division, or the mission. This isn't cynical. It's how organizations work. If your goal and the department's goal overlap, say so explicitly. Make the alignment obvious.
Be predictable and low-maintenance. Chairs deal with dozens of faculty, and the ones who get the most latitude are often the ones who require the least crisis management. Meet your deadlines. Respond to emails. Show up prepared for meetings. It sounds basic, but reliability is rare enough that it becomes a competitive advantage.
Bring solutions, not just problems. Anyone can identify what's broken. The faculty member who says "Here's what I've noticed, here's what I think we should do, and here's what I need from you to make it work" is the one who earns trust and influence over time.
There will be times when your chair makes a decision you think is wrong. Maybe it's a resource allocation that shortchanges your group. Maybe it's a policy change that creates more work for no clear reason.
You can push back. But how you do it matters enormously.
Be direct and private. Don't build a coalition of disgruntled colleagues before you've had the conversation yourself. Don't send a frustrated email late at night. Request a meeting. State your concern clearly. Propose an alternative. And if the answer is still no, accept it with professionalism. You can disagree and still maintain the relationship.
This is what executive coach Marshall Goldsmith calls "disagreeing without being disagreeable." In his book What Got You Here Won't Get You There, he points out that the habits that made you successful as an individual contributor—fierce independence, relentless drive, always being right—can actually undermine you when you need to work within a power structure.
Managing up isn't about performing loyalty or playing politics. It's about building a genuine working relationship with someone whose decisions directly affect your career. That takes intentionality, empathy, and the occasional uncomfortable conversation.
The faculty members who thrive in academic medicine aren't just excellent clinicians or prolific researchers. They're people who know how to work within the system—and with the people who run it.
Learn about how coaching for departments can support leadership development across your team.
]]>You did the hard part. You decided to try coaching. You found someone who seems like a good fit. You scheduled the session. And now you are wondering what exactly you are supposed to do when the call starts.
Physicians spend years preparing for exams, presentations, and procedures. But no one teaches you how to prepare for a conversation about yourself.
Here is the good news. You do not need a binder or a polished narrative. You need about twenty minutes of honest thinking before we get on the call.
The first thing I tell every new client is this: you cannot do the first session wrong.
There is no rubric. No evaluation. You are not being graded on self-awareness. If you show up and the most honest thing you can say is "I do not really know why I am here, but something needs to change," that is a perfectly good beginning.
Michael Bungay Stanier writes in The Coaching Habit that great coaching starts with one question: "What is on your mind?" That is genuinely where we begin. Not with a framework. Not with a five-year plan. With whatever is on your mind right now.
You do not need a dossier. But a little reflection goes a long way. Before your first session, spend a few minutes with these three prompts.
What brought you here? Not the professional version. The real one. Maybe it is the promotion you did not get. Maybe it is the Sunday dread that has become a permanent fixture. Maybe you got the leadership role you wanted and now you have no idea what to do with it. Write down the honest answer, even if it is messy.
What would make this worth your time? What would need to be different in three months for you to say, "That was a good investment"? It does not have to be specific. "I want to stop dreading faculty meetings" is just as useful as "I want to become division chief."
What have you already tried? Most physicians who seek coaching have already tried to fix the problem on their own. You have read the books. You have talked to a mentor. You have white-knuckled your way through another semester. Knowing what has not worked helps your coach understand what you need that is different from what you have already gotten.
Your coach will probably ask some version of "Tell me what is going on." They will listen more than they talk. They will ask follow-up questions that might surprise you — not about your CV or your H-index, but about what you actually want and what is getting in the way.
Expect the conversation to go somewhere you did not plan. That is not a sign it is off track. It is a sign it is working. A physician who comes in saying "I need help with time management" often discovers the real problem is an inability to say no to their department chair. That shift happens when someone asks better questions than you have been asking yourself.
The first session usually runs forty-five to sixty minutes. You will not solve everything. But you should leave feeling like someone actually heard you — possibly for the first time in a while.
Do not over-prepare. I have had clients show up with color-coded career timelines and spreadsheets of prioritized goals. That energy is understandable. It is also a way of staying in control — the opposite of what coaching requires.
Do not perform. You are not interviewing for a position. The most productive first sessions I have had were with physicians who said, "I honestly have no idea where to start."
Do not expect advice. A coach is not a consultant. I am not going to tell you whether to take the associate dean role or stay in the lab. I am going to help you figure out what you actually want so you can decide with clarity instead of anxiety. A 2009 study in Consulting Psychology Journal found that coaching effectiveness is most strongly linked to the client's openness and willingness to reflect — not the coach's ability to prescribe solutions.
Show up willing to be honest. That is it.
Not vulnerably-sharing-your-deepest-fears honest. Just honest enough to say the thing that is actually bothering you instead of the version you have rehearsed for your annual review.
Coaching works when you bring the real stuff. The first session is where that starts.
If you'd like to explore what coaching could do for your career, contact us to schedule a conversation.
]]>Halfway through Up in the Air, Ryan Bingham learns that his company is replacing him. Not with another person. With a laptop screen. A young hire named Natalie has designed a system that lets them terminate employees over video chat. No travel required. No Ryan required.
He has spent his entire career being the person who walks into a room and tells someone their services are no longer needed. Now it is happening to him.
If you have spent years in academic medicine building a reputation around a specific role, that scene should land hard.
Ryan does not just do his job well. He is his job. His expertise at firing people is the one thing that makes him irreplaceable. When that disappears, he has no backup plan. No relationships deep enough to catch him. No sense of self that exists outside the work.
I talk to physicians who are closer to this than they want to admit. The surgeon whose identity lives entirely in the OR. The division chief who cannot imagine a version of themselves that is not running the show. The researcher whose entire sense of worth hangs on the next grant cycle.
These are not character flaws. Academic medicine trains you to merge with your role. The institution rewards it. But it creates a terrifying vulnerability. When the institution shifts direction, or the role changes, or someone younger and cheaper can do the thing you built your life around, what is left?
Ryan's mistake is not that he cares about his work. It is that he never developed anything outside of it. The film makes this painfully clear. He has no real friendships. His family barely knows him. His apartment looks like a hotel room.
Organizational psychologist Benjamin Dattner, in his book The Blame Game, makes the point that professionals who over-identify with a single role become fragile in exactly this way. When the role is threatened, they experience it as an existential crisis rather than a career transition.
That distinction matters. Losing a role does not mean you have lost your value. But it can feel that way if the role is the only container you have ever put your value in.
The time to think about who you are beyond your title is not when the title changes. It is now. That does not mean you need a five-year plan. It means asking yourself whether your sense of professional identity could survive a restructuring, a leadership change, or even a promotion that moves you away from what you currently do.
Ryan never asks that question until it is too late. You do not have to make the same mistake.
Check out our individual coaching options if you're navigating a career crossroads.
]]>Somewhere in the first weeks of medical school, you absorbed a rule no one explicitly taught you: figure it out yourself. That rule got reinforced in residency, rewarded in fellowship, and by the time you made faculty, it was baked into your identity.
So when something in your career or your life starts to crack, your instinct isn't to reach out. It's to push harder.
I'm not here to tell you that self-reliance is a bad thing. It's kept you alive in call rooms and code blues. But the version of it that served you at 2 a.m. during intern year is not the version that will serve you as a division chief, a program director, or a mid-career faculty member trying to figure out what comes next.
At a certain point, going it alone stops being strength. It becomes a bottleneck.
In Dare to Lead, Brene Brown makes a point that lands hard in academic medicine: "Leaders must either invest a reasonable amount of time attending to fears and feelings, or squander an unreasonable amount of time trying to manage ineffective and unproductive behavior." Asking for help is part of that investment. It is not a concession. It is a leadership decision.
The best physician leaders I've coached all share one trait. They got comfortable saying three sentences that most of their peers avoid: "I need help with this." "I don't have that figured out yet." "Can I get your perspective?"
Those sentences didn't make them look weak. They made them easier to trust, easier to follow, and far more effective.
You don't need to overhaul your entire approach. Pick one thing you've been carrying alone -- a conflict with a colleague, a career decision you keep circling, a sense that something isn't working -- and bring it to someone. A mentor. A peer. A coach. Say what's actually going on instead of the polished version.
That's not vulnerability for its own sake. That's the same pattern recognition you use every day in clinical work: identify what you can't solve alone, and consult.
Asking for help is not a sign of weakness. It is a sign that you take your work and your growth seriously enough to stop pretending you have it all figured out.
If this resonates, check out our individual coaching options.
]]>Academic medicine has no shortage of ways to evaluate you. Citation indices, teaching evaluations, clinical productivity, grant funding. Every one of those measures what you do. None of them measures who you are.
That distinction matters more than most people realize. I've coached physicians who were hitting every metric their institution cared about and still felt hollow. Not burned out, exactly. Disconnected. Like they were performing a version of themselves that looked right on paper but didn't feel right.
The VIA Character Strengths Survey is one of the best tools I know for closing that gap.
The Values in Action (VIA) Survey was developed by psychologists Martin Seligman and Christopher Peterson as part of a massive research project to create a common language for human strengths. Their book Character Strengths and Virtues is essentially the positive psychology counterpart to the DSM -- instead of cataloging what goes wrong with people, it catalogs what's right.
The survey identifies your rank ordering of 24 character strengths, grouped under six broad virtues: wisdom, courage, humanity, justice, temperance, and transcendence. Your top five to seven are considered your "signature strengths" -- the ones that feel most essentially you.
Here's what makes the VIA different from something like CliftonStrengths or DISC. Those tools measure talents and behavioral tendencies. The VIA measures character. It's asking a fundamentally different question. Not "What are you good at?" but "What kind of person are you at your core?"
That's a question most physicians have never been formally asked.
Knowing your signature strengths gives you a framework for making decisions that goes deeper than career strategy. It reaches into identity.
Consider a few examples.
The VIA doesn't tell you what to do with these insights. But it gives you a vocabulary for understanding why certain roles energize you and others drain you, even when the external metrics suggest both should feel the same.
This is worth emphasizing. The VIA is not a performance tool. It doesn't rank you against your peers. It doesn't generate a score your department chair will see. It's not diagnostic.
What it does is hold up a mirror. And for people in academic medicine, who are accustomed to being evaluated by others against external standards, that mirror can be disorienting in a productive way. The survey asks you to consider what feels authentic, not what feels expected. For many of the physicians I work with, that's a genuinely new experience.
Research published by Seligman and his colleagues in American Psychologist found that people who use their signature strengths regularly report higher levels of well-being and lower levels of depression. Niemiec's book Character Strengths Interventions lays out practical ways to apply these findings. The evidence base is solid, and it's growing.
The VIA Survey is free. You can take the full assessment at viacharacter.org in about 15 minutes and get your complete ranking of all 24 strengths at no cost. There are paid reports with more detail, but the free version gives you plenty to work with.
I recommend taking it when you have a few quiet minutes. Don't overthink the questions. Your first instinct is usually the most accurate.
Like every assessment I use in coaching, the VIA is a beginning. The report will tell you your signature strengths. It won't tell you what they mean for your career, your leadership, or the specific tensions you're navigating in your department right now. That takes a conversation.
The physicians who get the most from this tool are the ones who sit with the results and ask hard follow-up questions. Am I using my top strengths regularly, or have I drifted away from them? Are my signature strengths visible to the people I lead? Where is there a mismatch between what my role demands and what my character naturally provides?
Those are the questions that lead somewhere.
Knowing your character strengths is valuable on your own. It's even more powerful when your whole team does it together. Learn about how coaching for departments can help your team grow together.
]]>A department chair retires. The search committee meets, reviews a short list of internal candidates, and picks the faculty member with the most impressive CV. Great researcher. Respected clinician. Published extensively. Seems like the obvious choice.
Six months later, that physician is drowning. They have never managed a budget. They have never navigated a conflict between two faculty members who refuse to speak to each other. They have never had to tell a colleague that their performance is not meeting expectations. The institution handed them a leadership role and assumed the rest would follow.
This is not an occasional failure. It is the default model in academic medicine. And it is broken.
Most industries learned decades ago that leadership is a distinct skill set that requires deliberate development. Companies like GE, Google, and McKinsey invest heavily in identifying and growing leaders long before they need them. The military builds leadership development into every stage of a career.
Academic medicine has done almost none of this. What passes for a leadership pipeline in most medical centers is informal and reactive. Someone retires or steps down, and the institution scrambles to find a replacement from a pool of people who were never developed for the role. Ram Charan, Stephen Drotter, and James Noel describe this problem precisely in The Leadership Pipeline: organizations fail when they promote people without helping them understand that each leadership level requires fundamentally different skills, time applications, and work values.
A 2024 survey by the AAMC found that while 85 percent of medical school deans agreed that leadership development was critical to institutional success, fewer than half reported having a structured succession planning process. The gap between knowing it matters and actually building it is enormous.
This is the part that academic medicine still struggles to accept. The qualities that produce an outstanding clinician or researcher, deep technical expertise, individual excellence, relentless attention to detail, are necessary but nowhere near sufficient for leadership.
Leading a division or department requires a completely different set of capabilities:
None of these skills appear on a CV. None of them are developed through clinical training or research mentorship. And when we skip straight from "excellent faculty member" to "division chief" without any development in between, we are hoping that raw talent will compensate for a total lack of preparation.
Sometimes it does. More often it does not.
The downstream effects are measurable and expensive. A 2022 study in Mayo Clinic Proceedings found a direct relationship between leadership behaviors and the burnout and satisfaction levels of physicians they supervise. Bad leadership is contagious.
When a new division chief flames out after eighteen months, the institution loses the recruitment investment, the search costs, and the disruption to the team. Worst of all, the people watching learn the wrong lesson. They see what happened to the last person who took a leadership role, and they decide it is not worth the risk. The pipeline does not just break. It empties.
I work with physicians at exactly this inflection point. They have been offered a leadership role, or they are a year into one, and they are realizing that nobody prepared them for what the job actually requires. Not the clinical or academic parts. The human parts. Managing people, navigating politics, making decisions without perfect information.
Coaching does not replace institutional investment in succession planning. Academic medical centers still need structured programs and mentorship pathways. But coaching addresses the gap that exists right now, for the physician who got the title last month and needs a thinking partner who understands the landscape. It is ongoing, specific, and meets the physician where they are with their actual challenges in real time.
The institutions that take this seriously will have an enormous advantage. That means identifying leadership potential early, not waiting until someone retires to ask who is next. It means investing in development at the mid-career level, where the gap is widest. And it means normalizing coaching as a standard part of leadership transitions, not a signal that something has gone wrong.
This is fixable. But it requires treating leadership development as infrastructure, not an afterthought.
If you're ready to invest in your leadership, contact us to schedule a conversation.
]]>There is a scene in The Queen's Gambit where Beth Harmon lies in bed staring at the ceiling. She is not looking at plaster. She is seeing chess pieces. Entire games playing out move by move above her head. The world disappears. There is only the board.
If you have ever lost hours inside a research question or a grant revision and looked up to realize it was midnight, you know what that feels like.
Beth's obsessive focus is what makes her extraordinary. She does not dabble in chess. She consumes it. Every waking hour devoted to studying games, memorizing openings, and visualizing positions no one else can see.
In academic medicine, this kind of focus produces breakthroughs. The researcher who spends three years on a single mechanism. The surgeon who practices a new approach until their hands know it better than their conscious mind does. Cal Newport calls this "deep work" in Deep Work: Rules for Focused Success in a Distracted World — the ability to concentrate without distraction on a cognitively demanding task. It is rare and enormously valuable.
Beth has it in abundance. So do many of the physicians I coach.
But watch what else happens to Beth. She alienates the people who care about her. She self-medicates. She treats every relationship as secondary to the board. By the middle of the series, she is winning tournaments and falling apart simultaneously.
That pattern shows up in academic medicine more than people admit. The physician who is exceptional in the lab but has no idea what is happening in their own division. The faculty member who publishes relentlessly but has never invested in a leadership skill. The researcher so locked into one question that they miss the career pivot their department needs from them.
Obsessive focus without self-awareness is not a strategy. It is a slow burn toward isolation.
What finally changes for Beth is not more focus. It is connection. In the final episode, she calls her friends. She accepts help. She lets other people into the process she had kept entirely private.
She still plays the game alone. But she stops preparing alone.
That is the lesson. Deep focus is your edge. But the people around you — colleagues, mentors, a coach — are what keep the edge from cutting you.
If you have built your career on the ability to go deep, that is worth protecting. But take an honest look at what you might be neglecting while you stare at the ceiling. Relationships. Leadership development. The broader view of where your career is heading.
Beth Harmon won the match when she finally let people in. You might be surprised what opens up when you do the same.
Learn about how coaching for departments can support your leadership pipeline.
]]>Here is something I keep hearing from department chairs: "We made a great offer and they still went to private practice." Or they took a position at a competing institution. Or they left academic medicine entirely.
This is not a hiring problem. It is a competition problem. Academic medical centers are losing the talent war, and most of them have not fully reckoned with why.
The physicians who have the most options are exactly the ones academic medicine can least afford to lose. They are the clinician-educators who build training programs, the translational researchers who land major grants, the leaders who hold departments together. And increasingly, they are choosing to go somewhere else.
Let us get the obvious part out of the way. A 2024 AAMC faculty salary survey confirmed what everyone already knows: academic physicians earn less than their counterparts in private practice, often significantly so. In some specialties the gap is 30 to 40 percent.
But when I ask physicians who left academic positions whether money was the primary driver, most say no. It was a factor. It was not the reason. The reason was almost always something less tangible and harder to fix.
They felt invisible. They were grinding through clinical work with no time for the scholarship or teaching that drew them to academic medicine in the first place. Nobody asked about their career goals. Nobody helped them build a path.
For decades, academic medical centers could attract talent by offering something the private sector could not: intellectual community, teaching opportunities, research infrastructure, and the prestige of a university appointment.
That value proposition is fraying. Research time gets eaten by clinical demands. Teaching is praised in mission statements and ignored in promotion decisions. And prestige does not pay the mortgage or make up for a system that treats you like a billing unit.
Meanwhile, private groups and health systems have gotten smarter. They are offering physicians flexible schedules, leadership development, and professional autonomy. Some are even building research programs and teaching opportunities that used to be the exclusive domain of academic centers.
The competitive landscape has shifted, and academic medicine has been slow to notice.
Throwing money at the problem is a start, but it is not a strategy. The institutions that are holding onto their best people tend to do a few things differently.
They invest in professional development before people are halfway out the door. Coaching, leadership training, and career planning should not be reserved for faculty in crisis. They should be part of what the institution offers from day one. As Marshall Goldsmith argues in What Got You Here Won't Get You There, the skills that made someone a great clinician or researcher are not the same skills they need to lead, manage, and sustain a career. Institutions that recognize this and invest accordingly have a real retention advantage.
They protect what makes academic medicine different. If a faculty member's entire week is consumed by clinical RVUs, they are doing the same work they could do in private practice for more money. Protected time for research, teaching, and scholarship is not a perk. It is the point. When institutions let that erode, they destroy the only reason talented people chose academic medicine in the first place.
They listen and respond. Not through annual engagement surveys that vanish into committee. Through real conversations with faculty about what is working and what is not, followed by visible changes. When physicians feel heard, they are far more likely to stay and invest.
They develop leaders, not just recruit them. Too many institutions hire a promising physician, hand them a division chief title, and offer no support for the transition. Then they are surprised when the new leader burns out or underperforms. Coaching and structured leadership development are not luxuries. They are how you protect a seven-figure recruitment investment.
The talent war is not going to be won by any single intervention. It requires a genuine shift in how academic medical centers think about faculty as assets to be developed, not resources to be consumed.
The institutions that figure this out will attract the best people and keep them. The ones that keep doing what they have always done will keep losing them, and they will keep blaming the market instead of looking in the mirror.
If you are a physician evaluating whether academic medicine is still the right place for you, or a leader trying to figure out why your department keeps losing people, the answer usually starts with one honest conversation about what is actually going on.
Check out our individual coaching options to start building your leadership toolkit.
]]>Let me paint a picture. You are a successful physician in academic medicine. You run a lab, teach residents, see patients, and sit on three committees. Someone suggests you work with a coach. Your first thought is probably not "great idea." It is more like: why would I need that?
That reaction is completely normal. And it is worth understanding where it comes from, because the resistance itself often tells you more about your situation than you realize.
Medical training builds a specific kind of person. Someone who solves problems independently, tolerates enormous pressure, and rarely asks for outside input on their own performance. Those traits save lives.
But they also create a deep association: needing help equals falling short. That equation gets baked in during residency and reinforced for years after. By mid-career, it is not even a conscious thought. It is just how you operate.
The resistance to coaching usually comes from one of three places.
The self-reliance reflex. You have solved every hard problem in your career by bearing down and working through it. Why would this be any different? The issue is that career challenges, leadership dynamics, and interpersonal friction do not respond to the same approach as a clinical puzzle. They require a different kind of thinking -- the kind that is genuinely hard to do alone.
Fear of exposure. Coaching means letting someone see behind the curtain. For physicians who have spent years managing how they are perceived, that feels dangerous. What if the coach sees something I have been hiding from myself? What if I am not as capable as everyone thinks? These fears are rarely spoken aloud, but I hear them underneath almost every initial conversation.
The remediation stigma. In many medical institutions, coaching has historically been offered to people who are struggling. If the only physicians you have seen get coaching were on performance improvement plans, of course you would resist it. But that framing is outdated. A 2023 study in Academic Medicine found that professional coaching is increasingly being used as a development tool for high-performing faculty, not a corrective one.
Skepticism about coaching is fine. Healthy, even. I do not want to work with someone who blindly agrees to everything. Critical thinking is what makes physicians good at what they do.
But there is a line between healthy skepticism and reflexive avoidance. You cross it when you find yourself dismissing the idea without ever seriously considering it. When you notice that the same career frustrations keep showing up year after year. When your inner voice says "I should be able to handle this" about something you clearly have not been able to handle.
That is the moment resistance stops protecting you and starts costing you.
You do not have to defeat the resistance all at once. That is not how it works. In my experience, the shift happens in small, honest moves.
Jerry Colonna, executive coach and author of Reboot, puts it well: "The things we are most afraid to look at are usually the things most in need of our attention." That applies to careers just as much as it applies to anything else.
Here is what I have learned after years of coaching physicians: the resistance is not the enemy. It is information. It tells you where the edges are -- where growth is waiting if you are willing to step toward it.
You do not have to be ready. You just have to be honest enough to ask whether the resistance is protecting you or holding you back.
If you'd like to learn more, contact us to schedule a time to chat.
]]>In The Pursuit of Happyness, Chris Gardner lands the job. Standing on a San Francisco sidewalk, tears streaming down his face, clapping for himself because nobody else is there to do it. It is one of the most celebrated scenes in modern film.
But here is what I keep coming back to. By the time he gets that job, he has lost nearly everything. His wife left. He was evicted. He slept in a subway bathroom with his five-year-old son. The dream did not come free. It came at a price most people would not survive paying.
Academic medicine asks you to pay in three currencies at once.
Adam Grant writes in Give and Take about the toll of sustained sacrifice without reciprocity. The givers who burn out are not the ones who give the most. They are the ones who give without a support structure. Gardner had no structure. He had will.
I admire Chris Gardner's story. But I do not think it should be the model. The narrative of the lone hero grinding through impossible odds makes for a great movie. It makes for a terrible career strategy.
You should not have to sleep on a bathroom floor to prove you deserve your career. And if the path you are on is costing you your health, your relationships, or your sense of self, that is not a character test. That is a signal.
Gardner did not have a coach. He did not have a colleague who could sit with him and say, "Let's look at what this is actually costing you and whether there is a smarter way through." He had grit. But grit without perspective is just suffering with good branding.
The physicians I work with are not short on determination. They are short on someone who will help them see the full picture honestly, without judgment, before the costs stack too high.
If that resonates, it is worth a conversation. Learn about how coaching for departments can help your team communicate more effectively.
]]>You walk out of a faculty meeting thinking the plan is clear. Within a day, one colleague has already launched the project without waiting for approval. Another is quietly building a spreadsheet to track every possible risk. A third is checking in with everyone to make sure the team feels good about the direction. And the fourth hasn't responded at all because they wanted more time to think.
Same message. Four different responses. That's not dysfunction. That's four communication styles doing exactly what they do.
DISC is one of the simplest, most practical tools I use with physicians to make sense of these differences. Not to label anyone. To translate.
DISC is a behavioral model rooted in the work of psychologist William Moulton Marston, dating back to the 1920s. It doesn't measure intelligence, values, or clinical skill. It measures how you tend to behave and communicate, under normal conditions and under stress.
The model breaks behavior into four dimensions:
Everyone has all four. But most people lead with one or two. That's your default gear. In academic medicine, where you're constantly switching between clinical teams, committee work, mentoring, and administrative meetings, knowing your default matters more than you think.
For a solid introduction to the framework, Robert Rohm's Positive Personality Profiles breaks down the four styles in accessible, non-academic language.
Let me make this concrete. Here's what I see in the academic medicine settings where I coach.
High-D in a faculty meeting. They want the bottom line. They got impatient two slides ago. They'll push for a decision before everyone is ready, not because they don't respect the process, but because they genuinely believe speed solves problems. If you need their buy-in, lead with the outcome, not the backstory.
High-I on a clinical team. They're the ones building relationships across silos. They remember names, check in on people, and generate enthusiasm for new initiatives. They also tend to say yes before they've checked their calendar. If you're working with a high-I colleague, help them prioritize. They'll appreciate it more than you expect.
High-S during a leadership transition. They're the steady hand. They won't be the loudest voice in the room, but they're the reason the team didn't fall apart when the last division chief left. They need time to process change and they need to know their input counts. Rushing them signals you don't value what they bring.
High-C in a quality improvement initiative. They're in their element. Data, process maps, root cause analysis -- this is where they thrive. They'll catch the flaw in your logic that everyone else missed. But they may hesitate to share it if they think the culture penalizes dissent. Create space for their precision. It will save you from expensive mistakes.
Here's the pattern I see most often. A physician leader communicates in their own style and assumes it landed. When it doesn't, they interpret the disconnect as a people problem. That colleague is difficult. That team doesn't get it. That committee is dysfunctional.
DISC reframes the disconnect as a style gap, not a character flaw. And style gaps are fixable.
When I debrief DISC results with physician teams, the most common reaction is relief. People finally have language for something they felt but couldn't articulate. The high-C researcher understands why the high-D chair's terse emails feel dismissive -- and the chair understands why the researcher's follow-up questions aren't obstruction. They're thoroughness.
That mutual understanding doesn't require anyone to change who they are. It just requires a small adjustment in delivery. And those small adjustments compound. Over months, teams that understand each other's styles spend less energy on friction and more on the work that actually matters.
The honest place to begin is not by typing your colleagues. It's by understanding your own defaults. Where does your style serve you well? Where does it create predictable friction? What happens to your communication under stress?
Most people shift under pressure. A normally steady leader might become more dominant when the stakes go up. A conscientious researcher might withdraw when they feel rushed. Knowing your stress pattern gives you an early warning system -- and a choice about whether to follow your default or adapt.
The assessment takes about fifteen minutes. But the report is the beginning of the conversation, not the end of it.
If you want to understand how your communication style shapes your leadership and work more effectively with the people around you, that's exactly what coaching is for. Explore our individual coaching options to find the right fit for where you are.
]]>A physician I coach recently told me she spent three months building the courage to ask her department chair about coaching funds. When she finally did, the chair said, "We have had money for that all along. Nobody ever asks."
That story is more common than you would think. Many academic medical centers have faculty development budgets that can cover coaching. The problem is not usually the money. It is that nobody tells you it exists.
If your institution has a faculty development office, start there. Many departments have discretionary funds for professional development that go underused every fiscal year. Coaching fits neatly into that category, especially if you can tie it to a concrete goal.
Framing matters. A request that says "I want to work with a coach to strengthen my leadership skills as I prepare for a division chief role" lands differently than "I think I need coaching." Be specific. Connect it to something the institution cares about -- retention, leadership pipeline, promotion readiness.
The Harvard Business Review has reported that executive coaching yields a return of nearly six times its cost when tied to clear organizational goals. That kind of data helps when you are making the case.
Institutional funding sometimes comes with institutional expectations. Your department may want to know what you are working on. They may want progress reports. They may steer you toward an approved vendor list.
None of that is inherently bad. But it can limit the conversation. If the thing you most need to explore is whether you want to stay at this institution, having them fund the exploration creates an awkward dynamic.
This is worth thinking about honestly before you ask.
Some of the most productive coaching relationships I have seen are ones where the physician chose to invest personally. Not because the institution would not pay. But because they wanted the conversation to belong entirely to them.
When you are the client -- not your department, not your dean -- the scope of the work is yours to define. That freedom matters.
Ask if the money is there. It often is, and there is no reason to leave it on the table. But if institutional funding comes with strings that would limit what you can actually talk about, consider whether the investment is worth making on your own terms.
Either way, do not let the funding question be the reason you never start.
If you're exploring what coaching could look like for you, contact us to schedule a conversation.
]]>You know the one. The new clinical pathway, the resident wellness curriculum, the interdisciplinary research initiative. You have been meeting about it. Building the proposal. Refining the budget. Waiting for the perfect moment to launch.
And it still has not launched.
I see this pattern constantly in academic medicine. Smart, capable physician leaders who are so committed to getting something right that they never get it out the door. Eric Ries wrote The Lean Startup for tech entrepreneurs, but its core message lands just as hard for anyone trying to build something new inside a medical institution: stop perfecting the plan and start testing it in the real world.
The Lean Startup was published in 2011 and became one of the most influential business books of the last two decades. Ries built his framework around a simple observation: most new ventures fail not because they could not build their product, but because they built something nobody wanted. The solution is not more planning. It is faster learning.
The core loop is build-measure-learn. Build a minimum viable product. Measure how real users respond. Learn from the data. Then decide whether to persevere on your current path or pivot to a new one. Repeat this loop as quickly as possible. The faster you cycle through it, the less time and money you waste on ideas that do not work.
Ries draws heavily on lean manufacturing principles — particularly the Toyota Production System — and applies them to innovation under conditions of extreme uncertainty. If you have read about continuous improvement or kaizen in healthcare quality work, you are already in adjacent territory. Ries takes those ideas and points them at the problem of building new things rather than optimizing existing ones.
The concept from The Lean Startup that I find most useful for physician leaders is the minimum viable product, or MVP. Ries defines it as the version of a new product that allows you to collect the maximum amount of validated learning with the least effort.
In academic medicine, we are terrible at this. Our training teaches thoroughness, completeness, and rigor. Those are virtues in clinical care. They are liabilities when you are trying to innovate. I watch faculty spend a year designing the perfect new elective — mapping every learning objective, writing every assessment rubric, securing every approval — before a single student has experienced it. By the time it launches, the landscape has shifted, the champions have moved on, or the funding has dried up.
The MVP approach says: run a pilot. Offer the elective to eight students next quarter with a bare-bones syllabus. See what works. See what does not. Iterate. You will learn more from that imperfect pilot than from another six months of committee meetings.
This is not about being sloppy. It is about recognizing that your assumptions — about what learners need, what patients value, what clinicians will adopt — are just hypotheses until you test them. Ries is explicit about this. An MVP is not a half-finished product. It is a learning tool.
Let me walk through what Ries's framework looks like in a few academic medicine scenarios.
Say you want to start a multidisciplinary clinic for a complex patient population. The traditional approach is to spend a year on the business plan, negotiate space, hire staff, and launch at full scale. The lean approach is different. Start with a half-day clinic once a month using existing staff and borrowed space. See five patients. Track outcomes. Survey the referring providers. Find out what is actually working before you invest in the full build-out.
I worked with a physician leader who did exactly this with a transitions-of-care program. The pilot was modest — one nurse coordinator, a shared conference room, a simple tracking spreadsheet. Within three months, she had enough data to show reduced readmission rates for her pilot cohort. That data got her the institutional support for a full launch. If she had waited for the full program to be approved before seeing a single patient, she would still be waiting.
Ries's framework also maps well onto medical education. If you want to redesign a lecture series or introduce simulation-based training, you do not need to overhaul the entire curriculum at once. Pick one session. Redesign it. Measure learner engagement and performance. Compare it to the traditional format. Use that data to decide what to scale.
David Irby and Molly Cooke wrote about this kind of iterative educational improvement in their work on the Carnegie Foundation's study of medical education, Educating Physicians (Jossey-Bass, 2010). Their argument — that medical education needs to move faster and learn from doing — aligns closely with what Ries is saying about startups.
Even research strategy can benefit from lean thinking. Before committing to a multi-year, multi-site trial with a new collaborator, run a small feasibility study together. Write a letter to the editor or a brief report as a team. See how the collaboration actually functions before you are three years into an R01 and discover that your working styles are incompatible.
One of the more underappreciated sections of The Lean Startup is what Ries calls innovation accounting. This is the practice of defining clear metrics before you launch, so you can actually measure whether your intervention is working.
Academic medicine is surprisingly bad at this for new initiatives. We launch programs and then evaluate them with vague satisfaction surveys or anecdotal impressions. Ries argues that you need to define your leap-of-faith assumptions up front. What has to be true for this program to succeed? Then design your MVP specifically to test those assumptions.
For a new clinical pathway, your assumption might be that referring providers will actually use it. For a wellness program, your assumption might be that residents will attend voluntarily. Identify the riskiest assumption. Test it first. If it is wrong, you have saved yourself an enormous amount of effort.
I want to be honest about the limits. The Lean Startup was written for people building software products in venture-funded companies. Academic medicine operates under different constraints.
These are real constraints. But I have found that the lean mindset is still valuable even when you cannot execute the full framework at startup speed. The question is not whether you can iterate as fast as a tech company. It is whether you can iterate at all, instead of planning endlessly and launching once at full scale with your fingers crossed.
If you are a physician leader who is building something new — a program, a curriculum, a research initiative, a quality improvement project — The Lean Startup will challenge you to move faster and learn sooner. It is especially valuable if you tend toward over-planning, which is most of us in academic medicine.
Pair it with The Innovator's Prescription by Clayton Christensen, Jerome Grossman, and Jason Hwang if you want a deeper look at disruptive innovation specifically in healthcare. Ries gives you the method. Christensen gives you the strategic context for why healthcare institutions struggle to innovate in the first place.
The Lean Startup is not a healthcare book. But its central insight — that the biggest risk is not failure, but building the wrong thing — is one that physician leaders need to hear. Your next program does not need to be perfect at launch. It needs to be good enough to learn from. Build the smallest version that tests your riskiest assumption. Measure what happens. Adjust. That loop is how real innovation works, in Silicon Valley and in academic medicine.
Check out the complete list if you're interested in other book recommendations.
]]>For nineteen years, Andy Dufresne chipped at a concrete wall with a rock hammer small enough to hide in a Bible. Every morning, that wall looked exactly the same. No visible progress.
But something was changing. He just couldn't see it yet.
I think about that wall a lot when I talk to faculty members who are three years into a five-year plan and can't see the progress. You submitted the grants. You said yes to the committee work, the mentoring, the teaching obligations that nobody seems to count toward promotion. And from where you're standing, nothing has moved.
It has. You just can't see through the poster yet.
Here is what strikes me most about Andy's escape. It was not impulsive. It was a plan that unfolded across two decades in complete silence. Not even Red had any idea until it was done.
That kind of quiet commitment is what the biggest achievements in academic medicine demand.
These are rock-hammer projects. The people who achieve them are willing to work when nobody else can see the plan.
Andy writes one letter a week to the state legislature requesting library funding. Two years. No response. When they finally send a small check and some used books just to shut him up, Andy starts writing two letters a week.
That is not stubbornness. That is strategy. The system is designed to wait you out. It assumes you will give up. When you don't, the calculus changes.
If you have ever pushed a curriculum proposal through three levels of committee review, you have lived this subplot. Angela Duckworth's research confirms what Andy demonstrated -- sustained effort toward a long-term goal, maintained through setbacks, predicts achievement more reliably than talent. Her book Grit: The Power of Passion and Perseverance is worth a read.
It is. Keep writing the letters.
Patience is not passivity. That distinction matters.
Andy didn't sit in his cell for nineteen years staring at the wall. He did the warden's taxes. He taught inmates to read. He built the best prison library in New England. He played Mozart over the loudspeakers and did two weeks in solitary without regret. He kept developing skills that would matter on the other side.
I see faculty members make one of two mistakes. Some grind away at a single goal so relentlessly that they burn out before it arrives. Others drift, filling time with obligations that don't compound into anything. Andy did neither. He was patient about the wall and intentional about everything else.
The faculty members who arrive at tenure in the best shape used the waiting years to build capabilities they didn't strictly need yet. They learned to manage budgets before they had one. They built relationships across departments before they needed a collaborator on a grant.
Andy's escape route was a sewer pipe. Five hundred yards of it. The most iconic scene in the film is a man crawling through filth because that was the only path to freedom.
Every long-term plan in academic medicine has a sewer pipe. A year when everything converges -- the grant deadline, the tenure review, the clinical load that somehow doubled. You do not get to skip that part. But you get to decide whether you enter it with a plan or without one. Andy knew where the pipe led. That made all the difference.
Red asks Andy how he can stand the slow game. Andy's answer is five words: "Get busy living, or get busy dying."
The faculty members I work with who build the most meaningful careers are not the ones who found shortcuts. They are the ones who committed to a plan and kept working when the progress was invisible.
If you are in the middle of a long-term plan right now -- chipping away at something nobody else can see -- that is not a sign the plan isn't working. That is exactly what the early years of a good plan look like.
Learn about how coaching for departments can help foster a culture of accountability.
]]>Here is the tension nobody resolves for you: your department hired a physician-scientist. They want the grants and the papers and the clinical revenue and the teaching evaluations. They want all of it. And they gave you the same number of hours in a week as everyone else.
You finish a clinic day feeling guilty about the grant you did not write. You spend a week in the lab and come back to an inbox full of patient messages. You sit in a faculty meeting where the clinical faculty talk about RVUs and the basic scientists talk about R01s, and you belong to both conversations and neither.
This is the fundamental challenge of the physician-scientist career. Not the science. Not the medicine. The constant pull in two directions at once.
The most common mistake I see physician-scientists make is treating research time as flexible. Clinic is on the schedule. Patients show up. Research time has no waiting room, so it gets borrowed. A half-day here, a week there for clinical coverage. Small concessions that compound until you realize you have not had a protected research block in a month.
Timothy Ley, who studied physician-scientist workforce trends at Washington University, warned about this in the Journal of Clinical Investigation. The pipeline loses physician-scientists not because they lack talent but because the systems around them erode the conditions they need to do science.
You have to fight for your research time. Not politely. Structurally. That means:
You need to decide which identity leads your career narrative. Not which one you care about more. Which one you lead with when you are up for promotion, when you are introducing yourself at a conference, when you are writing your biosketch.
The physician-scientists I coach who struggle most are the ones trying to be equally visible in both worlds at all times. That is not a strategy. That is exhaustion.
Cal Newport argues in So Good They Can't Ignore You that career capital accumulates when you go deep, not wide. For physician-scientists, that means choosing a primary lane for your scholarship — your research program — and letting your clinical work inform it rather than compete with it. You are still a physician. But your career trajectory is built on what you discover, not on how many patients you see.
Department chairs in clinical departments think in clinical terms. They track patient volumes, referral patterns, and revenue. Your research matters to them in the abstract, but when they are staring at a staffing gap, your K award does not fill it.
You need to translate your research into language your chair understands. Talk about grant funding as revenue. Talk about publications as national visibility for the department. Frame your trainees as workforce development.
When your chair asks you to take on more clinical work, do not just say no. Come with a counterproposal. Show them what you will deliver with protected time. Make the case in terms they value.
The loneliest spot in academic medicine is being the only physician-scientist in a clinical department. Your clinical colleagues do not understand why you would give up a full practice. Your basic science collaborators do not understand why you still see patients.
Seek out other physician-scientists. Join the American Physician Scientists Association. Attend the ASCI or AAP meetings. Build a peer network of people who get the dual identity without needing it explained. These relationships are not just social. They are strategic — for collaborations, letters of support, and career advice that only someone in your shoes can give.
The physician-scientist path is not efficient. It takes longer to get promoted, longer to get funded, and longer to feel settled. But the physicians I work with who stay on this path and thrive share something in common. They stopped apologizing for being both. They built systems to protect the research. They learned to manage up. And they found a community that understood.
If you'd like to learn more, contact us to schedule a time to chat.
]]>Someone gives you feedback after a lecture, a case review, a committee meeting. Before they finish their second sentence, your brain is already drafting a response. Not a response to what they said. A rebuttal.
You are not unusual. You are a physician.
Your training taught you that being wrong has consequences. Real ones. So your nervous system learned to treat any suggestion that you fell short as a threat to be neutralized. Fast.
The problem is that this reflex does not distinguish between a life-threatening mistake in the ICU and a colleague telling you that your presentation could have been more concise. It fires the same way every time.
Sheila Heen and Douglas Stone describe this in Thanks for the Feedback as an "identity trigger." When your self-concept is built on competence -- and whose isn't, after a decade of medical training -- feedback can feel less like information and more like an attack on who you are.
There are really only two ways to receive feedback. You can protect yourself, or you can learn something.
The defensive posture sounds like:
The learning posture sounds like:
You do not have to accept every piece of feedback as gospel. Most of it is imperfect. But if you never get past the defensive posture, you never find out which parts were worth hearing.
Here is the simplest shift I teach in coaching. When feedback lands and your chest tightens, say this: "Thank you. Let me think about that."
That is it. You do not agree. You do not argue. You buy yourself enough time for your prefrontal cortex to catch up to your amygdala.
I have watched this one sentence change how physician leaders relate to their chairs, their peers, and their trainees. It turns a moment of friction into a moment of credibility. People trust leaders who can hear hard things without flinching.
In academic medicine, the physicians who advance are not always the smartest in the room. They are often the ones who can take input without breaking. The ones peers actually want to give honest feedback to, because they know it will be received.
That is a superpower. And it is entirely learnable.
You do not need to love feedback. You just need to stop losing valuable information to a reflex you never chose.
Explore our individual coaching options to see how coaching can support your growth.
]]>Keating reads that Thoreau line to a room of boys who have never been asked to think for themselves. Their entire education has been about memorizing the right answers. He is asking them to do something terrifying: form their own.
I see a version of this every time I work with a department that has stopped learning. Not stopped producing -- they publish, they present, they hit their metrics. But the curiosity is gone. People are executing, not exploring. And nobody talks about it because the numbers look fine.
Early in Dead Poets Society, Keating tells his students to rip out the introduction to their poetry textbook. Dr. J. Evans Pritchard's introduction reduces poetry to a formula. Plot importance on one axis, technical perfection on the other, calculate the area, and you have its greatness.
The boys are stunned. You do not rip out pages at Welton.
But Keating's point is precise. When you reduce something alive to a formula, you kill the thing you are trying to measure. Carol Dweck's research in Mindset: The New Psychology of Success makes a parallel argument. When institutions reward fixed demonstrations of talent over the messy process of learning, people stop taking risks. They optimize for looking smart instead of getting smarter.
Academic medicine has its own Pritchard Scale. H-index. RVUs. Grant dollars. These metrics matter. But when they become the only language a department speaks, faculty learn to play it safe. Nobody proposes the unconventional study design. Nobody admits they are struggling with a new technique. Nobody asks the dumb question in grand rounds.
Keating's real gift is not rebellion. It is permission. He gives those boys permission to think independently, to test ideas that might be wrong, to find what matters to them rather than performing what matters to someone else.
Physician leaders can offer the same thing. Not by throwing out the metrics, but by creating space alongside them where learning is expected and struggle is not a sign of weakness.
That looks like:
You do not need to stand on your desk. But you might need to make it safe for other people to stand on theirs. A learning culture does not happen by accident. It is built by leaders who demonstrate that growth matters as much as performance.
Learn about how coaching for departments can support your leadership team.
]]>You know you need help with something. Maybe it is a career that feels stalled. Maybe it is a leadership role that is stretching you in ways you did not expect. Maybe you just feel stuck and cannot explain why.
So you start looking. And almost immediately, you run into a confusing landscape. Therapy. Mentoring. Consulting. Coaching. They all involve a professional helping you think through hard things. But they are not the same. Not even close.
I have this conversation with physicians almost every week. So let me lay it out plainly.
Therapy is a clinical practice delivered by a licensed professional. It is designed to diagnose and treat mental health conditions — anxiety, depression, burnout that has crossed from exhaustion into something deeper.
Therapy tends to look backward. It asks: What happened to you, and how is it shaping your experience now? That work is essential, and no coach should ever try to replace it.
If you are struggling to get through your day, if something feels fundamentally wrong and not just professionally frustrating — therapy is the right call. I have referred physicians to therapists more than once. That is not a failure of coaching. It is getting the right help at the right time.
A mentor is someone further along in a path you are walking. In academic medicine, this is usually a senior faculty member who shares advice, makes introductions, and helps you avoid the mistakes they made.
Good mentoring is enormously valuable. But it has limits. A mentor's advice is filtered through their own experience, and the power dynamics — especially within your own department — can make it hard to be completely candid. Mentoring is advice-driven by design. It is not a space built for you to figure out your own answer.
Consulting is the most transactional of the four. You hire a consultant because they have specific expertise you lack. They diagnose the problem, propose a solution, and often help you implement it.
In academic medicine, a consultant might help you restructure a division, design a faculty development program, or build a compensation model. Peter Block describes this well in Flawless Consulting — the consultant brings specialized knowledge and delivers recommendations that the client would not arrive at on their own.
The relationship ends when the project ends. A consultant does not care whether you grow as a person. They care whether the deliverable is right.
Coaching sits in a distinct space. A coach does not treat a clinical condition. A coach does not share war stories from their own career. A coach does not hand you a solution.
Instead, a coach helps you develop your own clarity. The International Coaching Federation defines coaching as "partnering with clients in a thought-provoking and creative process that inspires them to maximize their personal and professional potential." In practice, that means asking questions that cut through the noise, holding you accountable to your own commitments, and helping you see the patterns you are too close to notice.
Coaching is forward-looking. It asks: Where do you want to go, and what is in the way?
For a physician in academic medicine, that might mean figuring out whether you actually want the division chief role or just feel like you should. It might mean learning how to say no to committee work that is diluting your research focus. It might mean preparing for a conversation with your chair that you have been avoiding for months.
These four are not competing options. They are different tools. I have worked with physicians who see a therapist every other week, have a mentor they meet for coffee once a month, hired a consultant for a departmental restructuring, and work with me as their coach. Each relationship does something the others cannot.
The key question is not "Which one is best?" It is "Which one do I need most right now?"
If the answer is coaching — if you are generally healthy, professionally capable, but stuck or underperforming relative to your own standards — that is exactly where this work lives.
Check out our individual coaching options to start working with a coach.
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