Is Expertise Just Elitism?
It sure feels like it.
This was first published on LinkedIn
"Expertise" in radiation oncology fascinates me.
When we were students and applying for residency, there was an instruction to rotate at a "big name" center and get a LOR from a "big name" doctor, especially if your medical school did not have a residency. When I rotated through, I found that it was often the more junior attendings or mid/late career who weren't "big names" were doing much of the teaching and seeing higher volumes of patients. Yet, when we'd have a VIP patient, they would seek out the chairman or other senior physicians who didn't seem to treat many patients. When I became a resident, I noted we had some "big names" speak to us and often gave great talks, but many seemed to phone it in and were more interested in meeting the department leadership.
As my career progressed, I would often email "big names" for advice on challenging cases and often times, their responses would stupefy me - did they have any idea what kind of setting most of us practice in? Their suggestions simply did not reflect the level of what was possible in our community and it was often quite frustrating. Years late, I found that I gained more wisdom from high volume community docs about realistic management of these cases. Now, I have an email chain with mostly community docs, a text thread from very practical junior faculty at the local AMC, one from residency and one from new friends that's a mix of community and academic docs. They all have different expertise.
When I log on to theMednet, we now see the equivalent of a Blue Check that is called "Invited Lecturer". These are uniformly physicians at academic centers whose names you definitely know. I started doing my best to avoid looking at the name of the person and just read the answer. There was nearly zero correlation between a Blue Check doc and a quality answer. In fact, the most worthless answers came from Blue Checks ("Yes". "Probably not" "That doesn't matter"). Non-Blue Check answers typically were written better and referenced well, but their answers get buried under the Blue Checks. Go see for yourself!
When I go to ASTRO's annual meeting, a similar theme emerges - often times the talk you are waiting for because the topic interests you and the name is familiar - often appears to be a regurgitated talk that's been given over an over, while when I stumble upon an unknown name that's giving their first talk, I am astounded at how much I learn.
In the past, the "trust" we had in a source was credential based, as the friction to contact people was so onerous. Now, we can email or DM or text basically anyone and likely get a response. We are more connected than ever before. I recommend for optimizing learning from others, do your best to focus on the content, rather the person themselves. Some will prove to be excellent, but if you limit yourself to the "big names" you will likely miss out on many chances to improve your knowledge.
Love you all,
Sim