Judith G. Hall
LESSONS LEARNED
Over the years, I have reflected on an academic career in medicine and several
times have been asked to talk about the subject to women in pediatrics (i.e., about the
special challenges for women). I will try to condense some thoughts about an academic
career for this column that would apply to everyone and hope that others will add their
insights.
When I started my academic career, having finished pediatric training and
fellowships in both medical genetics and pediatric endocrinology, I realized that the
careers of clinicians fall into decades of experience (see Table I). The first ten years
consist of training and hopefully both preparing oneself for future work and identifying
areas of special interest.
The second ten years involve establishing oneself wherever you have decided to
start—in a community, in a particular institution, and as a generalist or as a specialist.
You may have chosen to establish yourself in an area of research, concentrate on
teaching, engage in your community or some other appropriate area, but it is usual
during that second 10 years that you determine an area of expertise and establish a
network of contacts. What is important during this decade is to keep your options open
since change is inevitable. For women, this may also mean working part-time.
The third ten years are when you begin to feel “your stride”. Basically, this is the
time to engage in your profession, your community, and your institution. It is a time to
serve on committees, network with those who have similar interests, take seriously the
training of others, and use the broad range of your skills.
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The fourth decade is when you take on added responsibilities and show your
brand of leadership. Because of the longer experience gained, you take on mentoring,
more complex situations, administration, and innovations.
The last ten years of your “official” career is when you begin to plan for what you
will do as an “elder”, begin to wind down, and follow your “heart’s desire”. Your
institution may want you to make room for younger professionals coming along and
allow it to engage in “institutional renewal” (bring in new ideas). However, you still have
enormous “human capital” (experience, insights, wisdom) that should be used in new
and creative ways—more about that later.
To my mind, it is important to take time to reflect “on the big picture” on a regular
basis during these five decades. Hopefully, at least once a year, take a day and go off
by yourself and consider how things have gone during the last year, what adjustment
you want to make and begin to plan for the upcoming year(s). It is useful to do this at
least once a year. You can do it at the beginning of the year in January, you can do it on
your birthday, or you can do it at the beginning of the school year in the fall. Part of the
importance of stopping once a year is to set goals for the coming year, and to look back
at how last year’s goals turned out; to think about your family and those you work with
and what new needs they may have; to think about what you enjoy and are good at
versus those things you are doing just because “they are part of the job”. One of the
lovely things about life is that nothing stays the same—so you always have new options
and opportunities, and many things that can be left behind. Undoubtedly, if you make a
list of goals for the next year, you will only accomplish about half of them. However, the
important question at the time of your yearly review is to recognize what other things
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that you accomplished that you didn’t plan on, and why you didn’t accomplish the 50%.
Then for the coming year, to set new goals for your work, for your colleagues, and just
as importantly, for your family and friends (your “work-life” balance).
The ancient scholars invented sabbaticals—that is, a break from routine every
seven years in order to provide a chance for reflection and renewal. Every molecule in
your body turns over every seven years, so it does seem appropriate to take a break
every seven years. Modern academic life makes it hard, but I strongly suggest that you
try to take a sabbatical every seven years (or at least once a decade) so that you have
a chance to really reflect and think about the direction you are headed, learn some new
skills, and expose yourself to things you would never have learned about otherwise.
During a sabbatical, it is essential that you truly leave behind your usual responsibilities.
It is a good opportunity for your young associates to “try out” some of your jobs (e.g.,
you will be investing in succession planning and giving them invaluable learning
experiences) and for you to get away from the stress.
I have some strong advice about committees. You should try to be on three
committees (and only three at a time), one each related to: 1) your professional
organization or specialty, 2) a committee related to your institution, i.e., the hospital or
the health care organization at which you are working, or the department of which you
are a member, and 3) a committee related to your university, medical school, or
community. “My rule” about committees is that you stay on them for 3 years and either
become chair or go onto another committee. The beauty of this process is that you keep
meeting new people, you learn to network, you find out what is going on and how the
system works, but you don’t burn out. Why become the chair of the committee?—only
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because you have a vision of things you think you can accomplish—absolutely NOT
because there is “no one else” to do the job.
My “second rule” for those of you in academics is that you need to publish four
papers a year. No way—you say!! It is actually, much easier than it sounds if you follow
this formula: 1) one paper is with a student – if you are clinical, writing up an usual case
or if you do laboratory work, a new technique or wrinkle in an old technique – it is great
for the student and your job is to supervise, 2) a paper with a resident or fellow
reviewing a subject and a number of a cases – these are real contributions to the
literature, both you and the fellow/resident will learn a lot, 3) one paper on your own
major project (e.g., your major interest), and 4) a project working with someone else,
either a laboratory person or a clinician, somebody who has skills that you don’t have,
but to whom you can supply material that ends up being published by the collaboration.
If you publish four papers a year in reasonable journals, you cannot NOT be
promoted—in other words, you will meet the elusive criteria for promotion in academic
institutions. Part of this process is keeping a series of things/projects “in progress” and a
list of things that you might work on, so they are handy when a student or a resident
come to you looking for a project. And, of course, you are pulling together materials for
your own future major project, grant, or paper all the time. Needless to say, you can
publish more than four papers, but if you are in an academic institution, it is your
responsibility to increase knowledge (whether your appointment is education, clinical,
research, or administration) and your papers will increase knowledge.
The next question for each person is who will be their “model(s)”. Today they are
called mentors. I personally have found that there is not one, but many. There are
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different models for different parts of your life and for different stages in your life and
career. You should be on the look out for good models for the various aspects of your
life (work, recreation, family, reading, etc). Ideally you try to get the chance to talk to the
(these) individual(s) about how they manage things and what advice they would have
for you. You don’t always have to follow their advice, but they will be flattered that you
have asked and they will therefore be interested in what happens to you there after.
An extension of the area of mentors is your networks. The more networks you
have, the more work it is to keep them up, but also the more opportunities you have to
learn about new and different things on which you may want to work or that will have an
effect on your career long term. My daughters calls them “irons in the fire”, you pick up
an “iron” when you go to a particular meeting or at a particular time of year, and then
you may just keep it at the back of the fire the rest of the year. Networking is essential in
academics and in community practice. Part of the function a network of contacts is to
learn new skills and ideas, and part is that you learn on which people you can call upon.
It doesn’t take much to see people at meetings and find out what they are thinking about
and/or working on.
How is it different for women? When I was a medical student (there were only 5
of us in the class), we had a wonderful senior female pathologist who talked to us about
the “five goods” and those five goods have held me in good stead over many years! The
first is good health (that you are fortunate enough to have good health—cherish it and
take care of it); the second is good organization (you must be organized when you are
multitasking all the time—you have lists, and lists, and lists to keep you organized); the
third is good help and this may be help at home or in your office (and if you have good
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help, you are blessed, so treat them well); the fourth good is a supportive partner (you
may have to analyze whether your partner is really supportive or wishes you were doing
something else, but you need support; and therefore, open discussions with your
partner on a very regular basis); and the fifth is good luck. This fifth “good” requires
having an attitude of turning things around to look like they are good luck and finding the
silver lining to almost any situation. You do make your own good fortune!!
Women in academics or practice are often pulled by family, partner, children,
care of the elders in their family, and just too many things to do. Women are good multitaskers. They are also often interested in different sorts of research questions and
different sorts of patients than their male colleagues. There is a long list of things that
are described as being of interest or unique to women in academics—from caring about
the environment in which they work and setting social standards, to interdisciplinary
work, being peacemakers, and working on subjective topics. See Table II.
These interests leads women into different kinds of research questions, not
infrequently, their interests have to do with gender issues and children. It follows that
there are large numbers of women in pediatrics, medical genetics,
obstetrics/gyencology, and gerontology. It is not a surprise that these are areas that
relate to the other aspects of women’s lives. Be sure that you network in the areas that
are of interest to you, that you find good friends to work with, and most important for
women—No whining allowed.
Flexibility in one’s career and life is essential for all physicians and researchers.
This also means that if you are interested in a variety of things, you may find yourself in
situations where you are able to shift gears when the need arises. Nevertheless, it pays
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not only to be interested in many things, but to also have the ability to focus in depth on
one particular issue and question. The best research and innovation comes from asking
the most penetrating questions.
Even at an early stage in one’s career, it is important to give some thought to the
later stages, to “retirement”. The reason is that those 10 year intervals will pass very
rapidly and you will find yourself at 50 years of age thinking “Oh my goodness, I’m going
to be retiring in 10-20 years”. Looking ahead and thinking about what you want to do in
your senior years makes that transition easier (see Table III). While you are still
working, develop a hobby, get involved in publishing, in your professional organization,
or in international work—there is still time to “try out” possibilities for your future. You
should begin to think about what you would/might like to do in “retirement” at about age
50 years of age. Personally, I collected cases of a rare congenital anomaly so that when
I retired, I could spend time reviewing them, identifying unusual features and publishing
important observations. It is never too early to start to plan, both financially and
experimenting with possibilities. During those sabbaticals, you may want to “try out”
some of the things that you think you might like to do at a later stage in your career. If
you think you want to work in a developing country, go for two months rather than
signing up for two years.
Last but not least, have fun. Enjoy what you are doing, find ways to eliminate
stress and disagreements. You have only life (as far as we know)--so enjoy it. All of the
research on aging well and happiness suggest that social contacts, exercise (both mind
and body) and giving (of yourself and your resources) to others is where real happiness
comes from.
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Since we are all living longer than our parents, thinking about how to use our
hard earned life experiences is worth some specific thought and planning. Nobody
should have to work past 65 years of age unless they want to. It does require some
planning: saving sufficient funds, helping to find a replacement for your position, and
determining what appeals to you. Certainly, nobody should have to take night calls after
60 years of age (unless they are crazy enough to love it!). What you plan to do will be
totally unique. However, some exploration of options and preparation is required.
On the other hand, academic institutions, and leaders in Pediatrics should be
considering ways to use the knowledge and skills of their senior personnel in new and
creative ways: a senior person on every committee (for institutional memory and
wisdom), small grants to finish up a lifetime of work, awards for outstanding academic
contributions by faculty/emeriti over 70 years of age, and addressing the small things
(shared office space, library access, yearly senior gatherings, etc.) which are needed to
keep senior faculty/emeriti engaged in productive work.
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Table I – TRAJECTORY OF 50 YEAR CAREER IN PEDIATRICS

10 years training

10 years establishing self

10 years engaging in profession, community institutions

10 years taking on additional issues/roles, mentoring, complex situations,
administrative innovation, intention

10 years winding down, shifting gears, pursuing heart’s desire
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Table II – ISSUES OF IMPORTANCE TO WOMEN IN MEDICINE AND SCIENCE

Holistic approaches

Peacemaking

Mentoring, nurturing

Good of the whole

Socialization to the norms and

Caring about the environment
ethics of a field

Subjects and topics of study

Processing, networking

Multidisciplinary, teamwork

The language that is used

Collaboration

Regular communication

Subjective approach
which are important to women
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Table III – OPPORTUNITIES TO “GIVE BACK”: IDEAS FOR USING THE SKILLS
DEVELOPED DURING ONE’S CAREER THAT CAN BE USED IN OTHER WAYS
AFTER “RETIREMENT”
A. Professional organization/society - officer, advisory capacity, work on projects
B. Historian – advice (institutional memory), writing, record your field
C. Ethical issues related to your field
D. Fundraising and other developmental activities
E. “Fill-in” locum teaching, sessional teaching, clinical teaching and
locums/coverage for others who are sick, on sabbatical, etc.
F. Mentoring (both young and “older” colleagues)
G. Editor and/or reviewing manuscripts
H. Lectures on cruises and other travel
I. International health or education work, and/or advisor and preparing others
J. Consultant to business or governmental agencies
a. Medical issues
b. Legal cases
K. Reflective, analytic, and policy writing for professional group, institutions, and
governments
L. Foundation work for hospitals and organizations you support
M. Parent support groups – support, advice, being on boards
N. Inner city - working with the poor and disadvantaged
O. Help orient immigrants in your area of expertise, orient them to language and
local requirements
P. Mediation and counseling in official capacity
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Q. Volunteer
a. Holding premature babies in hospital
b. Docent in museums
c. Local senior centre
d. Church, synagogue, or temple
R. Travel to help
a. Missionary work
b. Building houses
c. Educational institutions
S. Speaking – Toastmasters, emeriti college, alumni travel and continuing education
T. Continuing in an area of research
a. Space usually comes with grants, therefore, being “allowed” to apply is at
the Chair and Dean level
b. If you want grad students to help, you need to get approval from your
university’s graduate studies program
c. Research networks/collaborations
d. Reviewing grants for researchers for your university or for agencies
e. Long-term follow-up of previous projects research
SIDE CONSIDERATIONS:
1) Must decide whether you want/need to be paid
2) Identify “going” rates and model contracts ($6000/course, $250 review
paper/book, $500/day legal expertise, $100 thesis review
3) Expect to be indemnified, so you are not liable to a suit
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4) Expenses should be reimbursed
Source: UBC Association of Professors Emeriti. 2009. Report of Preparation for
Retirement Committee. http://www.ubcemeriti.org/Preparation.html. Accessed
December 10, 2013.
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