Don’t Hate The Player or The Game

A few years ago, I did some alumni interviews for my alma mater. If you have not had the pleasure, I highly recommend the experience. You get the opportunity to meet some of the best and brightest high school students in your area applying for college. In addition, as a parent of kids that I hope are soon college bound, it gives you some insight into what makes a compelling applicant.

But, of course, there is a dark side to this process. By reviewing the CVs and personal statements beforehand, I could see who had been coached to be able to check off all the boxes that a computer algorithm would approve of and those kids who lacked this additional support. I guess that is why many of these colleges still go through the trouble of actually interviewing applicants because while a system can be gamed, a human being may identify the massaging of the CV more readily.

I’m not saying that human beings can’t be fooled (think Russian hacking of the election) but someone like me with a bit of healthy skepticism and a comfort with asking lots of questions stands a better chance of separating the wheat from the chaff.

I chose to meet at a local coffee shop for most of my interviews because I hoped the neutral environment would put the students at ease and the parents, if they wanted to, could be present at a safe distance. I recall interviewing a young man from a good school in town with a tremendous CV. Good grades, good scores, two varsity sports, volunteer activity, and membership/leadership in at least 8 different clubs and associations. While impressive on the surface, it seemed too good to be true.

I started off easy. The grades and standardized test scores are hard to fudge (although not impossible as the college scandals have taught us). Of course, there was tutoring and paid test prep involved. Then I moved on to sports. The swimming was real- it was clear that he cared about it but his other sport was clearly for off season purposes and he was a bench warmer at best. I then went in for the final strike and randomly picked the finance club where the facade started to break down. At first he put up a good show- he was Vice President of the club after all. Turns out the club had three people, had met once a year ago, and had really done nothing except register for official recognition from the school. I gave him a chance to recover by asking him to pick an extra curricular that he was more passionate about and the rest of the house of cards crumbled.

I thanked him for his time and as he was leaving the store, I got snippets of their conversation- he felt positive. Clearly lack of insight.

I had set up two interviews that day and my next person was a quite young lady who came by herself from one of the public schools in town. Her grades were also good as well as her test scores. Her personal statement was solid but her CV was very different. Instead of pages of many clubs and volunteer experience, she had 4 things. First, she worked at her parents restaurant every Friday and Saturday night. She went to church every Sunday and volunteered for Meals on Wheels after church. She played flute in the orchestra which had been to All State every year she was on it. And while she did not participate in a sport at school, she had completed two marathons and continued to train 4 times per week. She talked about everything in such detail that I knew this was not trying to game the system.

As you might suspect, I gave my second interview a very high recommendation for admission while the first interview I was very neutral. Both would be successful at my alma mater but I felt the second applicant was much more genuine and would take advantage of the opportunities the school had to offer over just being able to put the name of the school on their CV.

I promise, here comes the punchline. Whether it is getting into college, medical or graduate school, landing the next big position, or any number of competitive endeavors we participate in as humans, there is a game involved where we try to gain an advantage over others in the process. We can talk as much as we want about how things should be fair and based on merit but that is what people say when they have lost the game. But that does not mean that we have to accept this system as the status quo. In fact, the more we accept this state of affairs, the more ineffective we become as a culture at actually solving problems or getting anything done.

But just like AA, admitting that there is a game that must be played is the first step. I was offering some career advice to a mentee recently. We were at a meeting surrounded by senior experts in the field and I asked him to tell me what each one was known for. This is in no way a criticism of any of these people because I am in the same boat ( although clearly less successful). These folks are Chairs of Department’s, Division Chief’s, full tenured professor’s at their institution, national/international thought leaders. Most folks, however, are built off one or two themes. However, if you dig deeper, most of these leaders in the field have 100s of publications of which only a tiny percentage have any impact on the way we practice or how patients are cared for. But that doesn’t stop people from leveraging these publications in the game for academic promotion, national prominence, speaking engagements, grants, or any number aspects of the game.

My advice to my mentee was not that this was bad, but that this was the model to emulate to be successful in this game. In general, most people create a story around their work that may or may not be impactful and leverage this for grants, career advancement, etc… However, I also encouraged him to remember what was part of the game and what really matters.

The interesting part of academic medicine is that what gets you recognized and promoted is not necessarily what is meaningful about our work. I acknowledge that some of our ranks do some very meaningful research that does impact the way we practice and the patients we care for. But impactful research often spans years or decades and is sometimes not finished in one person’s lifetime. Meaningful discovery and innovation often build on sometimes disparate elements of many peoples’ work. It is rare that there is a discovery that one person alone can take the credit for. People who truly aim to make an impact in the area of discovery must toil for years and deal with setbacks and frustrations and continue to persevere.

We can’t equate that kind of work with 100 or even a 1000 publications and while an individual publication might have some influence on practice, its impact is often fleeting. Again, it does not mean that it is not of value but the value has to be put into context.

The real meaning of our work comes from the daily care we provide patients and the learners we educate who go on to care for others. This type of work is compensated but not valued in the same way by an academic institution. Sure, there are some of us who make their career on new surgical innovation and technology. But this is an arms race and unless you constantly adapt to the newest technology, you can be quickly left behind in that game. And, honestly, this matters very little to patients. At the end of the day, they care little about the size of their incision or the number of ports used and more about the safety, outcomes, and competence of their surgeon. I’m a minimally invasive surgeon and believe in what I do but the surgeon and judgement matters much more than the tools used.

What I worry about is that either we don’t acknowledge there is a game or that we have come to equate the game as meaningful in its own right. This leads to the elevation of people to positions of leadership that are good at spin but lack the fundamental skills and integrity to meet the obligations of that role. Worse still, is those who have been part of the game for so long are constantly looking for the next move rather than committing to the work that must be done in their current position.

This disconnect between the gamesmanship required to achieve elevation and the actual skills and integrity required to serve as a leader are eroding not only academic medicine but other civil institutions in our society. We have equated fame and notoriety with capability. We have come to equate capability with Twitter, Instagram, or YouTube followers. Again the game has always been there but the danger is that it has elevated people into positions of authority that lack the skills to be effective and that impacts everyone. The best way to judge how capable someone will be in a future role is to look at their past performance, not at the number of publications or likes on social media.

That is the reason why I picked a part the CV of my first applicant. If he had stuck to what was real, he would have been just as successful as he was without the padding of his CV. The game is starting earlier and earlier and it is everyone’s job to teach our kids to recognize the game for what it is and help them understand that real worth and meaning is not equal to how well someone plays the game but rather how well we execute on what is expected of us and how we meaningfully contribute to the world around us. I don’t usually bring my religion into these blogs but there is a concept in Judaism that sums up what I am trying to say better than anything I can write: Tikun Olam. Simply put, our obligation as individuals is to try and leave the world a better place than when we arrived. Let’s not fool ourselves that the game benefits anyone else but our own selves. We can do better and I hope we teach those around us to separate the game from true meaning. Thanks for reading.

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