Changing careers in medicine? Ask yourself, not everyone else [PODCAST]

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Deciding on a career change can turn into polling everyone you know until someone says what you want to hear. Lauren Fine, an allergist-immunologist and founder of Permission to Change, felt that pull when she moved from mostly clinical work into medical education and later into coaching. This episode is based on her article “How to stop asking for permission and decide for yourself,” published on KevinMD. You will hear why you, not your family or colleagues, decide the “shoulds” about what a doctor should be, and why she believes you are never truly ready until you do it. She explains how coaching differs from mentoring, and why “what” questions work better than “why” questions, which stir up emotion. She also describes burnout as not getting back what you put in, which sometimes calls for changing how you work rather than what you do. Press play to hear why she starts with a small, reversible change, and why it helps to find someone who asks the right questions instead of granting permission.

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Transcript

Kevin Pho: Hi, and welcome to the show. Subscribe at KevinMD.com/podcast. Today, we welcome Lauren Fine. She’s an allergy immunology physician. Today’s KevinMD article is “How to stop asking for permission and decide for yourself.” Lauren, welcome to the show.

Lauren Fine: Thank you, Kevin. I’m so happy to be here. Thank you again.

Kevin Pho: All right. Let’s start by briefly sharing your story and then explaining why you decided to share this article on KevinMD.

Lauren Fine: Sure. Like you said, I’m an allergist-immunologist, and that’s not all that defines me, or that I feel defines me. I’ve been in allergy immunology for about fifteen years, and in medical education pretty much since I began as an independent attending physician in academics.

As I have transitioned through all of the different phases in my career, I’ve recognized that instead of asking ourselves for permission or asking others for permission, we really need to give ourselves the permission to make a change and to take that leap. I’ve gotten into life coaching. I work with women who are trying to decide what the next career change is, and I also recently gave a talk on the same topic.

Kevin Pho: In your article, you talk about your own story, your transition from clinical medicine. Why don’t you share that story and then talk about the article itself for those who didn’t get a chance to read it?

Lauren Fine: Like I said, I made a couple of transitions. One was in 2017, when I left primarily clinical medicine for medical education. When I went through that change and decided to do it, I had the feeling that I had to ask everybody around me what they thought: “Should I do this? Should I not? What’s your opinion?”

I had a friend I had worked with for a long time who never really asked me for permission or advice to do anything. She was just like, “I’m going to do this. This is my decision. This is how I’m going to work.” I really admired her for that. But when she contacted me and asked for my advice on whether she should make a leap, when she was deciding whether to take a new position that was open for her to potentially take, I realized, “Gosh, I can’t give her the advice. I can’t give her permission. I really need to ask her questions, take a coaching approach, and figure out the right questions to help her make that decision herself.”

We keep asking people for their advice because we’re hoping they will tell us what we want to hear. If we don’t hear it from the first person, we go to the next one, and then the next one, and then the next one. It becomes a game of who will tell me what I want to hear, and then I’m going to use that person: “Oh, this person told me I should do it. OK, I finally got that.”

I think we also cue up, or tee up, the conversation depending on who we’re talking to or what we’re asking permission for. We give them a little bit of background. We give them some biases before we ask the question, and then we hope they buy into what we want them to say.

Kevin Pho: Now, was there a light bulb moment where you realized that you didn’t have to ask for permission before making any transition?

Lauren Fine: Yes. I will say that when I made that leap, I recognized that you’re never truly ready to do anything until you do it. That is the hardest thing, I think, for physicians, and especially high-achieving individuals, to recognize. We study, and we study, and we plan, and we say, “This is my life, and this is what I’m going to do.” There are certain check boxes we have to achieve to get there. But when we decide to make a change, I think it’s really hard to leap into something new.

That light bulb moment was that I’m doing this for myself. There are all the shoulds I’ve been living by: “I should do this. This is what my career should look like. This is what a doctor should do, and this is where a doctor should be.” It changed when I realized that I’m the one who decides the shoulds: not other people, not my community, not my family, not the other physicians around me. When I recognized that, I was like, “OK, I’m ready,” because I’m going to make the leap, not because I’m truly ready.

Kevin Pho: A lot of physicians tell me similar stories, of feeling like they have to ask for permission. When you were in that position, tell us about some of the forces, some of the pressures, that made you feel you had to keep asking for permission. Were they explicit? Were they implicit pressures? Tell us why you felt you had to keep asking for permission before making that leap.

Lauren Fine: I think it was because it was such a huge change, to go from being a full-time clinician who was doing a little bit of medical education to being basically a full-time medical educator with a little bit of clinical practice. When I had worked so hard to get there, it felt like giving something up.

Then I realized I wasn’t truly giving something up. I was going to carry with me all of the things I had learned and be able to apply them to teaching my students, and I would still be in it. It would just be a flip-flop of my fraction, or my ratio, of what I was doing. That’s when I realized I’m not truly letting go of it. I kept that clinical practice for that reason. I wanted each of them to feed into the other, because now everything I’m learning with teaching, I bring back to my patients at the same time. I love that each one actually helps the other grow.

Kevin Pho: Eventually, you made another transition, to do more coaching. Tell us about the next part of your story.

Lauren Fine: I actually got involved in coaching, or interested in it, through the American Medical Association. They had a workshop over the summer a couple of years ago. I went to it, learned some of the skills, and thought, “Gosh, this is something I really love. I want to do more of this.”

I think we all coach others in different ways. We are mentors, coaches, advisors, and sponsors for other people. I wanted to really learn how not to be a mentor, and how to help others find the next steps in their path by asking the right questions rather than telling them what to do. As a mentor, you tend to give people connections and ideas and share your experience. As a coach, you don’t do that. I didn’t know how to do that; I just knew I wanted to. So now I’m coaching women physicians and other physicians, anybody who is high-achieving and really just wants to know how to ask themselves the right questions rather than asking others for permission.

Kevin Pho: I love that distinction between mentorship and coaching. When you say that in coaching you have to ask the right questions, what exactly does that mean? What are the right questions?

Lauren Fine: The right questions are the questions that help that individual walk alongside you. If I am asking a question because I’m just truly curious about something, that’s for me; that’s not for them. When I ask the right questions, it’s more of a series of “what” questions: “What would you be giving up if you were to do this? What do you think the consequences would be? What are you most afraid of?” A lot of “what” questions, because if you ask questions that start with “why,” it brings out a lot of emotion. When you bring out emotion, you end up blurring your logic, and you’re making decisions based on how you feel rather than on what makes the most sense.

So I really focus on “what” questions and try to help people slow down their thoughts. I think one of the best things about coaching is that it allows people to stop. Instead of running through things a million miles an hour, which we do when we’re thinking about something on our own, skipping over things that are logical, worrying about the future, and thinking, “Well, what if, what if?” we stop, and we ask a lot of these questions: “What are your values, and how does this fit into your values?” These are questions that really get someone to slow down and think a little more deeply and slowly.

A lot of the time, I would say, when somebody is being coached, they come to a revelation, or a light bulb moment, as you said earlier. They realize it’s the right thing to do because they said it themselves. I think the best feeling for me as a coach is when somebody comes to that moment where they recognize that no one else is telling them something. They just said it themselves, and that’s when they believe in it and actually want to make a change.

Kevin Pho: When you made these transitions, from clinical medicine to medical education to coaching now, I’m sure a lot of people asked you about your aspirations, or you asked your colleagues what they thought in general. What was the spectrum of reactions you received when you were making the change to medical education and when you were making the change to coaching?

Lauren Fine: I think with medical education, some of the reactions were, “Why are you doing this? You’re successful. Why make a change? You’re in a great place. You’ve got great benefits. You’ve got patients who love you and colleagues who love you. You just spent all this time building this up, and now you’re going to let it go?”

Kevin Pho: That seems to come from a place of judgment. Just like you said, asking that “why” question evokes all this emotion, right?

Lauren Fine: Exactly. And I definitely did have emotion, because I was like, “Well, this is something I want, so don’t worry about the why.” [laughter] I shouldn’t have to defend myself and explain that. And I really didn’t know what I was getting myself into, so it’s really hard to defend yourself when you don’t have anything concrete, right? It’s just an idea of what you want for yourself, and you go after it.

And why? Well, because I can. Because I’m excited about it, because it gives me a lot of opportunities, and because I’m not necessarily giving up all the things I’ve already done. I am still in communication and work with a lot of the people I used to work with. It’s just in a different way.

Kevin Pho: Do you feel that medicine has evolved? We’ve always talked about medicine being a linear path, and a lot of physicians are defined by being a doctor. Now, of course, we talk to so many physicians who are more than their degrees and who do so many things outside of clinical medicine. Has that mindset evolved since you first started your journey?

Lauren Fine: My mindset for sure has.

Kevin Pho: How about the mindset of medicine in general? How about the mindset of your colleagues? If you were transitioning outside of clinical medicine today, what do you think their responses would be? And would they be different from their responses all those years ago, fifteen years ago?

Lauren Fine: I think so. Honestly, I don’t know that it was COVID, but I think with COVID a lot of people really took a second look at life and their careers. I do see a lot more people willing to do, or interested in doing, whether it’s a side gig or a complete shift to something else. Or maybe testing the waters with a side gig and then deciding to completely make that change once they feel like, “OK, this is feasible and doable and not totally crazy.”

So yes, I think there is. I also could be more open to it, and it could be a bias I have, that I’m around more of those people. I’m involved in more of those communities, so I see more of it, and I may not have seen as much of it if I were still where I was when I made that change.

Kevin Pho: What about physicians who may be a little bit burned out and want to see if there is anything else within medicine they could do outside of the clinical spectrum? You talk about the questions they need to ask. What are some examples of the questions they need to ask if they want to do something similar to what you did and perhaps make a transition outside of clinical medicine? How do they know that path is right for them?

Lauren Fine: I think burnout is such a hot word, and it’s a really difficult word. For me, burnout is really not feeling connected, and not getting back from something what you’re putting into it. It’s not about working hard. I know there are many people listening to this podcast who have passions and hobbies they could do all day, every day, if they could actually get paid for it, and they would not get burned out from it, because they’d be getting something back.

I think that’s a question we need to ask ourselves: “What am I getting out of my job? What am I not getting out of my job? And what would I do differently to be able to get something out of my job?” So it’s not necessarily about changing your job. You don’t have to change what you do. Sometimes it’s about changing how you do it, or who you’re doing it with, or setting different boundaries with others who may be taking those things away from you.

And sometimes we have to give some things up to get, right? We can’t necessarily set boundaries and expect everything to work out and everybody to listen to us. But what are the things I’m willing to exchange to be able to set those boundaries and to get back what I’m putting into this?

Kevin Pho: Now, when you coach physicians who are perhaps considering a transition out of clinical medicine, it’s a transition from a place of relative comfort into something that’s unknown and relatively more uncomfortable. How do you advise these physicians to be comfortable with the uncomfortable, to be comfortable with the unknown? What are some pieces of advice you could share with us today?

Lauren Fine: That’s a great question. Again, you’re not truly ready until you’ve done it. But that doesn’t mean you need to take a huge leap, completely throw away everything, and feel like you’re throwing away everything. First of all, you’re never throwing away everything. You’re always bringing everything you’ve done with you, and there are a lot of skills and a lot of wisdom you bring with you.

At the same time, we sometimes make small changes in order to make a big change. If you can make an irreversible change reversible by changing something about it, maybe how big a change it is or how fast you make it, we’re often more comfortable with it. So my advice is to make a small change that you feel is reversible. You can pull back out of it if you don’t feel like it’s right or it’s not going in the right direction. Then make it irreversible when you’re ready to move a little further, and then make another reversible change.

It’s kind of like walking into a cold ocean, right? [laughter] Sometimes you have to do it slowly, because it’s such a shock to jump in without doing it step by step. So for those who are risk-averse, who really don’t like to make a huge change and say, “I’m just going to figure it out when I do it,” I think that’s the best advice I can give.

Kevin Pho: We’re talking to Lauren Fine. She’s an allergy immunology physician. Today’s KevinMD article is “How to stop asking for permission and decide for yourself.” Lauren, as always, let’s end with your take-home messages for the KevinMD audience.

Lauren Fine: Kevin, I think the best thing any of our audience members could do, if they are trying to decide on a change, is to find someone they can talk with who is not necessarily going to give them permission but is going to ask them the right questions. Whether it’s a coach, a trusted friend, or somebody who knows how to take that right approach, they can really slow down your thoughts. And take that reversible change first; don’t necessarily leap into things headfirst.

Kevin Pho: Lauren, thank you so much for sharing your perspective and insight, and thanks again for coming on the show.

Lauren Fine: Thank you, Kevin.

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