In the 1992 election, James Carville advanced an idea for President Bill Clinton’s campaign that has had enduring significance, with a statement that has entered the modern lexicon of politics—not to say almost every other realm of human activity. When asked what was on the voters’ mind, Carville said, “It’s the economy, stupid.”
Almost 20 years have passed since that memorable election, but Carville’s statement still pertains to what’s on the mind of people and how they will vote not just for candidates standing for election but for big decisions in life, including a career. “What is it, stupid, that you care about?”
For young people contemplating a career in academic medicine, these decisions are tough and can be as contested and tumultuous as the election of 2000.
The stakes are very high. Should I vote to be a basic investigator, a translational investigator, or clinical educator in the medical center sweepstakes? Or maybe I should punt this election and go into private practice?
Of course, in most elections (except those for popes), the process is ongoing. Depending on the office, ballots can be cast every two, four, or six years, and there are always options for recalls. Just as a regular person can vote in many elections, so, too, can a trainee cast many votes about his or her career, changing directions, philosophies, and leaders (i.e., mentors), and tacking with the wind, which often seems to blow dollars rather than air.
Nevertheless, for a young person thinking about the future, the first vote has powerful significance and looms large. Should I submit an application for a K award or take that job in the clinic?
Career choices can be a very, very complicated business, and few people can really see far into the future and define a rational strategic plan to guide them in the decades to come. In reality, many—if not most—career choices are pretty ad-hoc affairs that reflect decisions that seemingly have little relationship to a vision for a career. I know a young rheumatologist who thought he wanted to be a clinical educator. In an unplanned development, he fell in love with a fellow in another division whose training schedule required an extra year in the medical center. Thus, the rheumatology fellow decided to extend his training and give the lab a try during the year to wait for his beloved and soon-to-be betrothed. The deus ex machina gave him the freedom to take on the challenge of hard science. This is, of course, a source of great happiness for the two divisions. Trust me, in our interviews of applicants for our fellowship program, we do not discuss the opportunities for love and romance in the Bull City.
In reality, many—if not most—career choices are pretty ad-hoc affairs that reflect decisions that seemingly have little relationship to a vision for a career.
It Comes Down to Three Words
Every year, numerous trainees have to vote on their careers, cast a ballot on their lives with a precious piece of paper, that paper likely stained with sweat as they grow anxious confronting a scary junction, stopping in a yellow wood where roads diverge, having to make choices, leaving behind a road not taken.