Just Say No: Saving Your Sanity While Working in Academic Medicine

David Norris, Jr, MD

David Norris, Jr, MD

Congratulations! You’ve received your appointment as a new faculty. Faculty evaluations and promotion and tenure reviews will arrive before you know it.

One way to shine in your first year, and to build your CV, is by serving on committees, engaging in research, publishing journal articles, and directing educational experiences. When you start, administrative time is likely spent completing your charts and twiddling your thumbs. You will want to fill that time and will be tempted to take the dozens of opportunities that comes your way. And why shouldn’t you be involved? You have the time—right?

Be careful about always saying yes. Beyond settling into your role as a faculty member, you have to protect your mental health. Getting involved in too much, too quickly, will emotionally, psychologically, and physically burn you out. Plus, you’ll miss great opportunities later on if you’re too busy with projects early on that are only of modest interest to you.

However, knowing when to say no—and then actually saying it—can be a challenge.

When to Say No

Decide what you want your future to look like. Do you want to focus on patient care, or are you interested in curriculum development, research, or administration? Identify your short- and long-term goals.

Once you’ve identified your career focus, knowing when to say no becomes obvious. Opportunities that help achieve your goals are best. Those that compliment your goals—or give you exposure to the “higher ups” at your institution are second best. Say no to those that do not fit your interests or goals.

If you can easily say no, you don’t need to read further. Yet, if like me, you are a pleaser and struggle with refusing someone, then read on. I can’t claim credit for these techniques. I learned some from my mentors and others I picked up from colleagues at STFM.

Say It Directly

In general, the best option is a direct, but courteous “no.” This is easier if you practice before it is needed. Avoid adding “maybe next time” unless you mean it.

Shoot Me an Email

You’re approached by a colleague in another department who wants you to serve on a committee. You have the time but have been working on a project you need to finish. If you cannot manage a direct “no,” ask him to send details in an email. In many instances, the issue dies right there. You never receive the email—and you don’t need to say no!

Musical (Department) Chairs

If you do receive the email, your department chair may say no for you. My chair is more protective of my time than I am (a fact for which I will be eternally grateful). If I am unsure, I run opportunities past her. She confirms my instincts and gives me the perfect guiltless refusal—an email saying my department chair has asked that I not participate at this time due to needs in the department.

Call a Time Out

Sometimes a project will interest you, but you do not have time. Ask for a clarification on time commitment, or set your own boundaries. What you anticipate to be a weekly meeting may turn out to be a once a quarter lunch discussion. When setting a time boundary, follow this example: “I’d be happy to review that paper. Unfortunately I’m overloaded at the moment. I can give you a 10-minute review. If that’s enough then great! If not, sorry I can’t help more.”

Of the last three, I prefer the Time Out method. What method do you prefer or recommend to new faculty? Let me know in the comments below.

5 responses to “Just Say No: Saving Your Sanity While Working in Academic Medicine

  1. Agree entirely about the need to say no (and about the importance of recognizing when you need to decline). Hopefully along the way you’ll have supportive Director and Chair who will allow you to be able to determine when you’re in need of saying “No” for personal mental health. This is an important post for new faculty! (as well as for some not-necessarily new faculty).

  2. Sarina Schrager

    I think saying no directly can be difficult for some people, especially women. Another method of saying no does it in 3 parts and includes a way to get more information about the request. For instance, “thanks for asking me. Before I agree to anything I need to know how much time this request will take and whether it will come with any administrative support, ec.” Then, really think about whether the request will benefit you in the long run (or short run) for any reason. For instance, if it is not on a topic that you are interested in, but it is a request from a senior faculty who you would like to work with in the future, if the request doesn’t seem like it will take too much time, you may consider saying yes.

    Many of our faculty will talk to their mentor committees about larger requests to see if they will benefit their long term career.

    Thanks for a great post, we should talk about this more. Sarina Schrager

  3. Heather Paladine

    Love these comments!
    One simple but very useful piece of advice I received as a new faculty was to consider for 24 hours before taking on a new project or committee. My initial response is to be enthusiastic and say yes to everything, and even 24 hours gives helpful time for reflection.

  4. Mistakes made by new faculty include thinking that other faculty are not very busy. This can be particularly true if you come from a rural or busy primary care practice. Academic family medicine has many, many pieces. A study of department faculty revealed many more pieces than I ever considered.

    As noted, find your place. Consider a faculty development fellowship. STFM is a great place to find out about these opportunities. This can give you the needed time to consider direction.

    You may need special funding to be able to reach your goals. This funding could come from state, federal, foundation, or internal sources.

    Mistakes made by all faculty include not moving on for a better fit, better family situation, or better salary. Too many times people stay despite less than the best treatment. It is a sad fact that the financial design does not work well for family medicine. Budget considerations often result in insufficient salary increases and opportunities.

    Not all who move on do better; however, as cost of living, retirement fund contributions, commute times, housing costs, and opportunities vary.

    Don’t make a move until you get it in writing. Promised jobs and positions can disappear without notice. Rescue work involving clinical duties often begin with promises but may not end with additional payments for the extra time or travel. Secretarial support can disappear or there can be little left after senior faculty have taken their cut. These were all seen in just the first 8 years of academic family medicine.

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