Academic Success breeds Mediocrity

Annoyed

As I was reading “Zero to One” by Peter Thiel this morning, I was abruptly and uncomfortably caught by one particular sentence:

“All Rhodes Scholars had a great future in their past”.

No matter how many times I attempted to continue reading past that line, I was stopped in my tracks and re-read it again and again. I then reflected on some of the things written in the paragraphs before:

“Elite students climb confidently until they reach a level of competition sufficiently intense to beat their dreams out of them.”

“Higher education is the place where people who had big plans in high school get stuck in fierce rivalries with equally smart peers over conventional careers like management consulting and investment banking.”

“For the privilege of being turned into conformists, students (or their families) pay hundreds of thousands of dollars in skyrocketing tuition that continues to outpace inflation. Why are we doing this to ourselves?”

A Linear Path

These thoughts felt like a personal attack as I’ve pursued and continue to pursue traditional academic accolades in an effort to define progress towards my professional goals. To Peter’s comment, I both agree and disagree.

Let me explain.

My path was quite linear for all intents and purposes. In pharmacy school, we’re taught that we can only pursue a career in either community or hospital. However, if we decided hospital pharmacy was our calling, additional post-graduate training via a PGY-1 or PGY-2 was required. With increasing competition every year and droves of professionally dressed, ambitious 4th year students at Midyear, obtaining a residency was competitive with match rates of 60%, on average. Concluding that this was the path towards success, this was the path I chose as I completed my PGY-1 Pharmacy Practice Residency at Sarasota Memorial Hospital and my PGY-2 in Pharmacy Informatics at the University of Utah Healthcare.

It can be difficult to agree with Peter as my first, post-PGY-2 position was an informatics pharmacist at the Mayo Clinic. As a 4th year student, this was the dream job for me and I felt as though I finally made it. I was part of a 500-person team to implement the single, most complex Epic implementation in both Epic and Mayo’s history. In the seven years I was there, I had the most amazing opportunities to learn and grow. More importantly, I was able to build a secure financial foundation for myself despite taking out $135,000 in pharmacy school loans along with another $60,000 for my MPH that came later. Debt-free and a great career, how exactly is that being mediocre or conforming?

Well, Peter, I disagree vehemently with you because it was this linear, pre-defined path that gave me the opportunity to take risks and explore new areas of interest and ideas.

Adopting the contrarian view

My first venture into something “risky” or non-traditional was YouTube. A simple search on Google will yield a litany of journal articles, blogs, or commentary that skewed towards being more conservative on social media as a healthcare professional. Though, I never felt as though I really fit in anyways and began creating YouTube videos on the topic of pharmacy and informatics. Besides, it was fun and I felt compelled to create the content that I wish I had when I was a pharmacy student. More importantly, the financial security that I was establishing (I was negative net worth for most of my time at Mayo mind you) allowed me to invest more into my YouTube hobby as I bought new cameras, lenses, and equipment. Though, I can’t say that it was all positive experiences either as the vast majority of family, friends, and outsiders were unsupportive of what I was doing. The only exception was Angela, my girlfriend at the time, that motivated me to press on. This is where Peter’s thoughts about adopting a contrarian view resonated with me. Had I listened to what others were saying, I probably would have never continued making videos.

My second venture was probably the formation of Pharmacy Informatics Academy (PhIA) with David, Tony, and Beju. Although I don’t think this opportunity would have surfaced if it wasn’t for taking the linear path, this is probably where Peter’s original comments rings more true to me. Ironically, the original conception of PhIA involved how pharmacy students can take alternative paths from the ones that were prescribed to us in pharmacy school. Albeit, noting that there was still merit in traditional paths. What we had started in late 2018, morphed into something quite unexpected and quite different as we forged our own thoughts on how individuals could pursue pharmacy informatics.

Embracing the uncomfortable

My curiosity later led me towards pursuing an MPH in 2018 from the Johns Hopkins Bloomberg School of Public Health. Despite Peter’s criticism of higher education, I attribute a lot of my pivots in the last few years to my MPH experience. It didn’t come naturally though and I felt extremely uncomfortable in a foreign topic that I wasn’t trained in. In fact, in many of my initial introductions to professors and classmates I’d give the disclaimer that I didn’t know anything about public health to temper their expectations. I was also being honest. However, given some of the risks I’ve already taken and what my good friend Ryan used to say, “You learn the most when you’re uncomfortable”, I leaned in 100%.

In many ways, my time at Hopkins could be described as tumultuous. We had 80 credits to complete with 40 of them being electives. Despite my excitement in exploring areas in public policy, business, and epidemiology, I was confused and had an identity crisis during those 2.5 years. Oddly, there was something addictive and attractive in dabbling in subjects that were in sometimes in complete opposite areas of the spectrum and so I continued to lean in. One of those new territories I explored was healthcare policy. Many hospital and health system initiatives related to health information technology is driven by regulation. For example, the rapid adoption of electronic health records (EHR) in the US was largely due to the Health Information Technology for Economic and Clinical Health (HITECH) Act in 2009. Waves of value-based programs like Value-Based Purchasing (VBP), Hospital Readmission Reduction Program (HRRP), and more recently, the Interoperability Rules from the Centers of Medicaid and Medicare Services (CMS) and the Office of the National Coordinator (ONC) for Health IT as part of the 21st Century Cures Act have dictated the direction of where health IT is going. As an informatics pharmacist configuring EHRs that were dictated by these regulations for our providers made me question why I was conforming when I saw clinician burnout everywhere. Long story short, I ended completing my practicum and capstone at the ONC over a year-long internship and it has completely changed my thinking. Following a linear path is no longer my cup of tea. Radical change and disruption, or rather as Peter Thiel would describe it, going from 0 to 1 as opposed to 1 to n can only happen when you seek to create something new instead of copying or incrementally improving what someone else has already done.

Forcing a New Path

After 7 years of stability, I decided to take a chance and leave my pharmacy informatics job at the Mayo Clinic and forge a new path for myself as a health data architect at Verily. The difference this time is tackling a problem that doesn’t have a well-defined, linear path: global healthcare interoperability. The irony in both this statement along with this entire article is that I also firmly believe that more formal education is required to proceed. I applied to Stanford’s Biomedical Informatics Certificate program last year and have been continuously evaluating Harvard’s Biomedical Informatics Masters or PhD program in the last 2 years. While I agree to Peter’s criticism of higher education, I disagree that I’ll conform to what I learn. I think that the lessons and environment will allow me to extrapolate new ideas, and perhaps new paths, that will lead me towards my goal.

Parting Thoughts

After being annoyed at what I read from Peter earlier this morning, I have some parting thoughts. Take calculated risks that deviate from the norm. Don’t follow in the footsteps of those you admire, but rather use them as examples of the type of person you aspire to be and become someone uniquely and authentically yourself. Which, in my opinion, will yield the results of 0 to 1.