his 2016 book The Road to Character, New York Times columnist David Brooks updates the concept of Adam I and Adam II: the extrinsic and intrinsic self. Adam I is outward, résumé-obsessed, and laser-focused on ambitious career achievements, while Adam II is inward, morally virtuous, and concerned with social responsibility and creative enrichment.
In the academic world, we are obsessed with Adam I. Even worse, we are estranged from Adam II, as physician Jonathan Stock says in his assessment of the “arms race” afflicting modern medicine. Career advancement comes from the accumulation of bullet points on our CV, misaligning the incentives for scholarship. So how can physicians move toward an alternative mode of scholarship—one that’s still scientifically rigorous and peer reviewed but communicated in a more accessible manner?
Cardiothoracic surgeon Tom Varghese is building this kind of non-traditional path, placing equal emphasis on the responsibility to his patients and the deliberate cultivation of scholarship that fits his passion. As Jonathan Stock says, “This is the way to fuel the flame that brings meaning to our work and to our lives.” Here, Tom Varghese shares his three-fold advice for physicians thinking about unconventional careers:
1. Your work has to be tied in to your passion
I had 21 grant rejections before I ever got my first grant. If you're not passionate about your work, it's very difficult to overcome those setbacks. All the programs I’ve built, including Strong For Surgery, are directly aligned with what I'm passionate about: how do we make a difference one patient at a time, one family at a time, one community at a time, one region at a time, one state at a time, and one country at a time.
The power of one drives everything I’m doing. That extends to training residents and reflecting on my work. I'm constantly thinking about how to move things forward. It has to be something you're passionate about.
2. Be open-minded about your scholarship
When you're building an unconventional career path, certain things go without saying. Surgeon Amalia Cochran says, “It's not surgeon-scientist, surgeon-educator, or surgeon-clinician—the key to building a career in academia is surgeon-scholar.” Thoughtful scholarship builds academic currency.
It’s not just about traditional academic articles or book chapters anymore. How do you communicate? Is there an opportunity for high-quality blog posts or podcasts? How about public health campaigns? It's important to have diversity of thought and action across systems.
More people know about me through my interactions on social media than through my academic publications. I believe that, in the years ahead, digital scholarship for social media will take on a life of its own. The important thing is that we retain the ideals of scholarship: is it peer reviewed, is it scientifically thought out, is there a hypothesis, and is there statistical significance?
3. Value improvement as a path to scholarship
We make a common mistake in health care: when we recognize there's a problem, everybody wants to move lightning quick toward a solution. We’re solution generators. We want to implement a million things right away, but what we don't do is pause, take a moment, and say, “Let's define the problem.” What exactly are we trying to change?
Value work shifts that paradigm. Instead of generating solutions, we’re engaged in process-driven problem solving with methodology and rigor. But we don’t do a very good job communicating our value work, partly because this field is in its infancy. There’s a stigma that also exists whenever we talk about cost and quality. Peers will push back and say, “They're only doing this work to make money. This is not a real academic project.”
That's wrong—there is a deliberation to it. The problem is that we're not informing people of the importance of this work. We have to conduct these alternative methods of scholarship with the proper scientific method.