This past year included another household move for us, the impact of which I described in a recent column (11/25/10issue). It was our ninth move since I finished my training. It occurred to me that each environment had had a major influence on my career (duh!). But in further recalling each job and location, the collective influence of chance and timing on the trajectory of my career gave me a jolt, so I dug deeper.
Each location has differed, of course, in geography, institutional and community culture, values and mores, personal relationships and personalities. And they also differed in a difficult to define characteristic that I shall call essence or soul, a feature that uniquely identifies that environment at that particular time. I believe that many physicians and professionals of all types have similar experiences. Examples from my own career follow.
My first job after training was at St. Jude Children's Research Hospital. My colleague at the University of Illinois, Dr. Charley Abildgaard, had visited there and was asked to consider a position, but he became determined to return to his home state of California. He told me that St. Jude was an interesting new place and suggested I look at the job.
I had never heard of St. Jude. My wife and I had three small children and had lived our whole lives in Chicago. I had no job-hunting experience and no one gave me any advice on what to say or ask for. I was naive to say the least. But I went to Memphis and met Donald Pinkel, the director, and half a dozen other faculty members. It was Christmas time so I joined a party at Pinkel's house (St. Jude was small enough to gather all faculty and some staff in his house).
By the end of the second day I was enthralled. Pinkel's vision, the compact size and youth of the institution (less than five years old at that moment), and the opportunity to test myself as an independent investigator were more than I had hoped for. At my exit interview Pinkel said, "I can offer a salary between seventeen and eighteen thousand. Well what do you think?" I said, "I'll take the job." He said, "No, you can't do that, you need to talk to your wife." Talk about naive!
I called my wife and told her how excited I was and that we would discuss it when I got home. I told my boss, Dr. Irv Schulman, chair of pediatrics and a distinguished hematologist (co-discoverer of coagulation Factor IX), that I was considering a job in Memphis. He had made me an offer to join the faculty and stay in his lab. Schulman said something like, "Are you nuts? There is nothing down there in Memphis, no one to work with. St. Jude is new and may not survive; you are doing well here," etc. Needless to say, we moved to Memphis, the best professional move I could have made, especially considering how inexperienced I was.
So if Charley hadn't visited St. Jude and concluded that he really wanted to return to California, I would never have gone to Memphis, I would have had a traditional academic career in Chicago, and never would have had the opportunity to lead a large leukemia program and its clinical research.
My focus in Chicago would have been non-malignant hematology. I would not have become director of St. Jude or physician-in-chief of Memorial Sloan-Kettering. I would not have become so active in ASCO and have started its Quality Oncology Practice Initiative. In other words, my career would have been dramatically different.
Among several other fateful incidents, another stands out for me. In the early 1990s Dr. John Mendelsohn, currently president of MD Anderson, and I were in Madison, Wisconsin, for a meeting of external advisors of Dr. Paul Carbone's University of Wisconsin Cancer Center. We shared a cab going to the airport when, out of the blue, John asked if I would consider being a candidate for the physician-in-chief job at Memorial Sloan-Kettering. John was the chair of medicine there at that time, and I had heard that Dr. Vince DeVita had stepped down from that position after a relatively short tenure because of some differences of opinion. I said I wasn't sure.
About a month later I received a call from Dr. Paul Marks, president of MSK, asking me the same question. I said I would be willing to look. I had been at St. Jude for 24 years and the director for nine years. I was happy and reasonably successful at St. Jude. But my plans for growth, development, and reshaping the faculty were nearly complete. Also, I had come to believe that 10 years, plus or minus a couple, were about as long as a leader should head a creative organization like a medical school, academic department, or institute. In my experience most leaders who stayed longer became stagnant, overly conservative, dictatorial, or had expended their political capital. There were exceptions, but very few.
I visited MSK and found it to be an attractive opportunity professionally and personally. After a subsequent visit with my wife, I called friends and colleagues and former physicians-in-chiefs for their advice; the universal response was, "Don't do it!!" I heard a variety of reasons: Paul Marks was supposedly difficult to work with; some of the chairs are [horizontal ellipsis](fill in the blank); it is a large complex organization that is difficult to change; living in New York is a challenge.
I had a gut feeling it was the right job at the right time in my career, and my wife agreed. I took the job and we moved to The City in an apartment that was within walking distance to MSK. Marks didn't scare me one bit, so we actually got along pretty well. The chairs were largely cooperative and helpful. The medical staff was first rate up and down the line. The administrative and nursing staffs were outstanding. It was a privilege to be head of the medical staff and the hospital. My wife and I thoroughly enjoyed New York. Our kids were grown and gone, so most of the time the rich culture made it feel like living in an adult Disneyland.
So a chance cab ride with John Mendelsohn and the specific timing in my tenure at St. Jude made it possible to take on a great job and learn a lot about adult oncology and the greater cancer world, which has served me well later.
What Did I Learn?
So what did these (and other) experiences teach me that I would be willing to pass on?
1. You may plan all you want, but chance and timing will play a role in professional development much more than you tend to believe.
2. Listen to advice from friends and colleagues, but listen even more to your own gut feeling. (The one job I took that nearly every trusted advisor strongly recommended turned out to be a failure.)
3. At all times, know where you are on your professional growth curve; is your growth slowing or coming to an end?
4. Know whether you are a risk-taker. I learned early in my professional life that I am-I enjoy new, and sometimes risky, challenges and I believe that most good opportunities knock only once. If you are risk-averse, then you may be much more cautious and prefer the comfort of the tried and true, even if your professional growth has slowed.
Socrates said it best: His guiding rule in life's journey is "Know thyself." He might have added, "Be open-minded," or "Understand that chance and timing ("Fate") will influence your direction."