At the start of a new career there are a myriad of opportunities, responsibilities, and expectations - all of which require you to make decisions. This is especially true as you transition from being a learner who is frequently told what to do into an attending who is expected to know the answer. And, it is TOTALLY NORMAL to feel overwhelmed. It is also normal to feel that even a “little” decision takes a lot of energy. How do you want to schedule new and returning patients, who need a longer visit, how do you want to drape the patient in the operating room, when do you want the clinic to end… 

My goal today is to provide you with practical guidance on how to make these decisions. Based on Simon Sinek's work, I would like to discuss the art of saying "yes" or "no" to opportunities. Or as I like to call it based on the classic books of my childhood, Choose your own adventure.

Regardless of the following advice, I recommend that you learn to make a decision later. That your initial response will not be yes or no based on guilt or obligation or your current feelings of being overwhelmed,, but “I will consider this” or “I will look over your proposal” or “I will think about this and get back to you”. Give yourself some breathing room so that you can consider the yes and the no and not have to take back a commitment or a refusal in the future when you have more clearly vetted the opportunity. 

When evaluating whether to say yes or no to an opportunity, there are a few key points to consider:

1. Start with Your Why: 

The core philosophy espoused by Sinek is that people and organizations should always start with their "why" or ultimate motivation before considering the "how" or "what." When faced with a decision, ask yourself why you are considering saying yes or no. What is the underlying purpose or motivation FOR YOU? 

Understanding your "why" will guide you in making choices that align with your values and goals. 

If you have not figured out your primary motivation, this step should take you to a place where that is your primary goal. If you have not spent any time thinking about what motivates you and your aims in life and work, I recommend that you start there. I talk about this in my blog regarding strategic career planning but there are plenty of great resources including Simon Sinek’s book “Start with Why” and many Youtube videos and Ted Videos. 

I have also found that talking to the people you are closest to can be revealing. Just as the people close to you can see (but may not tell you) when your personal relationships are good or bad for you, they can also see what lights your fire, even if you are not clear.  I often tell residents who are grappling with selecting a possible subspeciality to check and see when they came home happy but exhausted from a rotation versus just exhausted or frustrated. You may not be able to see that you were always happiest during your endocrine rotation, but your closet friends and family may be able to reflect this back to you. 

2. Does it Align with Your Vision: 

Ensure that your decision is not just about immediate gains but is in line with your broader purpose and vision. If you are not sure about how to differentiate between your mission and your vision, know that a clear vision is like having a roadmap for your career and life to attain your mission. My example is my plan to create a coaching business and course for early career faculty members (vision) in order to help early and mid career academic physicians more quickly and efficiently attain success and promotion in their work and professional lives (my mission).

It provides direction and helps in filtering out distractions by allowing you to:

1. Define Success: Be clear about what success looks like for you. This could be professional achievements, personal growth, or a combination of both - ideally both. But this allows you to have a clear yardstick to manage your accomplishments against.
2. Evaluating Opportunities: Assess whether saying yes to an opportunity brings you closer to your vision. If it doesn't, it might be wise to decline. This might sound too simplistic, but it really is the key. If it does not bring you closer to your mission and vision, say NO.
3. Setting Boundaries: A clear vision helps in setting boundaries. It makes it easier to say NO to things that do not contribute to your goals, preventing burnout and maintaining focus. But also allows you to see when an opportunity fits with your vision of your future 

3. Understand That Saying No is Also Saying Yes to Things that Matter

The key concept to understand is that saying YES to something is saying NO to something else. So make sure that your “yes” does not mean that your “no” is to those times that you value, like time to exercise, time with your community, or time to write that paper you care about.  The ability to say No is also a crucial skill for effective time and energy management as it allows you to preserve your resources for the things that truly matter and contribute to your purpose. And this understanding does not always mean that the decision will be easy. 

For me, there was a time in my life where being on editorial boards was a resounding yes - it helped me meet great people, impact the literature being published and improved the quality of my studies and manuscripts. But as  my mission shifted to leadership roles that were more about community building and impacting the broader speciality, these were no longer the right roles for me. And they became an opportunity for me to sponsor someone else to take over these roles. 

By saying No to things that don't align with your mission and vision you:

1. Prevent Overcommitment: By saying no, you avoid spreading yourself too thin, ensuring you can give your best to the commitments you do take on.
2. Focus on Priorities: This allows you to eliminate tasks that are distractions to your primary goals and It allows you to focus on high-priority tasks that will have the most significant impact for you.
3. Respect Your Limits: While this is not the strong suit of most physicians I know (or the one that I see in the mirror everyday), acknowledging and respecting your own limits is essential for maintaining productivity and well-being. It’s okay to protect your time and resources. It is also okay to say no because you really do not want to do something.  

4. Focus on Balanced Decision-Making:

When deciding whether to say yes or no, consider both the immediate and long-term impacts. Look at decisions from multiple perspectives to ensure that they align with both your short-term needs and long-term goals.

These include assessing the:

1. Short-term vs. Long-term: Weigh the immediate benefits against long-term goals. Oftentimes, a short-term sacrifice is necessary for long-term gain, and vice versa. This is where understanding where you ultimately WHY  is important.
2. Risk (or Requirements) and Reward: Evaluate the potential risks (or commitments of time, energy, resources) and rewards of each decision. Consider both tangible outcomes and intangible benefits such as skills, experience, and relationships. 
3. Holistic Perspective: Look at the decision from multiple angles. How does it affect your professional growth, personal life, and overall well-being? This may also be a great point to talk to mentors, coaches, spouses, colleagues, siblings… who can give you additional perspective. 

As you look at the opportunities and adventures that await, here are some questions that I find particularly useful to assess a situation. 

• Does this opportunity align with my Why (core purpose)?
• If I had to do this tomorrow, would I be excited or filled with dread?
• What will I have to give up to say yes to this? Is it worth it?
• Will I regret not taking this opportunity - now or in 5, 10, or 20 years?

Summary:

Say YES when:

1. The opportunity aligns with your long-term career goals
2. It resonates with your personal values and passions
3. It offers unique learning or networking possibilities
4. You have the capacity to fully commit

 Say NO when:

1. The opportunity conflicts with your core priorities
2. It doesn't contribute to your professional growth
3. You lack the necessary time or resources to do it justice
4. Your gut feeling tells you it's not right, even if you can't articulate why