Finding a Niche or Digging a Rut?

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One of the most common pieces of advice medical trainees receive is to "find your niche." This advice often comes from well-meaning advisors, often with more than a few white hairs, who are passing down the same advice they received as trainees. In the past, success in academic medicine was best achieved by finding a particular sub-subfield of clinical expertise within one's specialty that had not yet been developed or studied and publishing as many papers as one could, therefore attaching one's name indelibly to the area. This was expected to lead to speaking invitations and opportunities to teach about one's focus area, and ultimately the chance to become a leader in the field–the definition of success.

However, there are downsides to the dogged pursuit of a single focus area, especially when trainees are asked to define a niche essentially by finding "what is left that hasn't been studied." With the explosion of technology available to the millennial learner (1) and an ever-growing quantity of scientific publications (over 24 million total citations in MEDLINE as of 2017), (2) the amount of information one can access is at times overwhelming. Finding an area that has not yet been explored in a meaningful fashion has become more and more difficult, forcing those looking for a niche to either reinvent the wheel by studying subjects that have already been investigated (and therefore not making a significant new contribution to the field) or to develop a focus area so small that the potential downstream impact becomes almost miniscule. Too often, I see the latter–trainees feeling the need to take on projects (and later on grants and career paths) that they do not have an innate interest in and have little chance of making a current or future impact on medical care simply because it is the only niche they perceive is left or the only one available to them given other life circumstances.

Burnout is an immense issue for today's medical students and physicians with rates of over 50 percent, well above that in the general United States population. (3) While burnout rates differ by age, sex, specialty and many other areas, one common theme is that those physicians who spend little (less than 20 percent) of their work effort on activities they find most personally meaningful have burnout rates almost three times as high as those who spend at least 20 percent of their time on activities that they find meaningful. (4, 5) I would argue that by telling trainees to "find your niche"–and in so doing place the emphasis not on what they are passionate about but what presents the best opportunity for publication and grants in a tiny sub-area of a field they may or may not have an interest in–puts them at risk for future burnout (especially if they select an area that is "available" but not personally meaningful. We are essentially advising our trainees to dig themselves into a rut.

Times have changed. We should no longer tell our trainees and medical mentees simply to "find your niche," but to instead focus on finding what has true meaning for them. Learning to live and develop one's career authentically in a world that still places an undue and antiquated emphasis on number of publications and impact factors can be incredibly challenging, but I believe that it is the right decision in the end and will lead to significantly higher career satisfaction and sense of personal accomplishment.

My advice to trainees is ultimately this: Find your passion and pursue it; once you do, your "niche" will develop on its own. It may be a clinical, research, educational, or leadership niche–or any number of other potential types of niches–but the most important thing is that it is a representation of what you truly care about. The best niche is an authentic one.

References

  1. Desy JR, Reed DA, Wolanskyj AP. Milestones and Millennials: A Perfect Pairing. Competency-Based Medical Education and the Learning Preferences of Generation Y. Mayo Clin Proc 2017; 92(2): 243-50.
  2. NIH U.S. National Library of Medicine. "Detailed indexing statistics: 1965-2017." Available at: https://www.nlm.nih.gov/bsd/index_stats_comp.html Accessed 11/19/2018.
  3. Dyrbye LN, West CP, Satele D et al. Burnout among US medical students, residents, and early career physicians relative to the general US population. Acad Med 2014; 89(3): 443-51.
  4. Shanafelt TD, West CP, Sloan JA et al. Career fit and burnout among academic faculty. Arch Intern Med 2009; 169: 990-95.
  5. West CP, Dyrbye LN, Shanafelt TD. Physician burnout: contributors, consequences and solutions. J Intern Med 2018; 283(6): 516-29.

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