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The Difficulty of Defining Success

Residency is a time of immense learning. You learn from your attendings, your patients, and your colleagues. Of all the “teaching moments” during my residency, one that frequently stands out in my mind now is the day when one of my co-residents told me about the “post-training phenomenon.” He had previously completed a different residency and practiced in that field for a decade prior to switching to our specialty. “Once you finish training, no one cares what you do. You have to define your own goals, your own successes,” he explained. “You may not know what to do with yourself.”

At the time, I did not really appreciate this forewarning. I know now that it was because I did not understand it. How could I not know what to do with myself? I thought. I knew from a young age that I wanted to be a doctor. I knew in medical school that I wanted to complete residency and fellowship, and to build a career as an academic clinician. I was well on my way, and I had a plan. That will never happen to me.

Fast forward three years later, I now wholeheartedly understand what he meant. In school and training, success is very clearly defined. College acceptance, GPA, medical school acceptance, USMLE scores, honors in clinical rotations, residency acceptance, in-training exam scores, research presentations, the list goes on. Someone sets parameters for you, and if you achieve them, you feel successful. It’s easy.

After training, suddenly those parameters disappear and you are faced with innumerable choices. Academics or private practice? Research? Teaching? Partnership track? Should you incorporate yourself? Pursue administration? International medicine? What is the best way to spend your time? It can be overwhelming.

The addition of family further confuses this picture. How do my goals mesh with my spouse’s goals? What about childcare responsibilities? Is time spent on career focus more or less meaningful than time spent with family? If I choose family, does that mean I am less successful? What is most important to me?

These are questions we all ask ourselves at one point or another. There are no easy answers. In the current era of increasing physician burnout and attrition, the increasing opportunities for work outside of clinical medicine blur the lines of success even further. If you leave clinical medicine and it makes you happier, are you more or less successful?

In the end, the answers to these questions are personal and ever-evolving. Your colleague’s definition of success may not fit you, and just as your thirty-year-old self may think your twenty-year-old self’s dreams ridiculous, your personal definition of success at thirty may no longer be acceptable at forty. Certainly, with passing years, few of us retain the idealism we held so dear in medical school and residency. That idealism was absolutely necessary then to get through those grueling years, but with time it becomes necessary to accept that goals change. We change. Medicine changes.

At the end of the day, my colleague was right. After training, “no one cares what you do.” There are no rules. Your definition of success, and your measure of it, is entirely up to you.

Published on KevinMD, 2016

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