I have never been the outstanding academic student. Like many doctors I was usually near the top of my class in grade school, rarely at the top. Conventional wisdom when I was an undergrad was that you needed an 85% average to get into medical school, that is exactly what I got no more, no less and I got into medical school. I don't think I am terribly smart, I do and have done a lot of stupid things. It is just that it is almost like the school and university system was designed for me to excel without really trying that hard.
Entering medical school, it occurred to me that I could become an outstanding academic doctor or I could just scrape through. Within the first few weeks of medical school it became quite apparent that a significant number of my classmates were either, smarter than me, prepared to work a lot harder than I was, or smarter than me and prepared to work a lot harder than me. With that in mind, I focused on first passing and secondly learning the minimum I would need to become a good doctor. Some things interested me more than others and I paid more attention to those. I tried to have as normal a life and as much fun as possible and more or less succeeded. I sat in the back of the lecture hall, read the newspaper if the lecture was boring and made fun of the keeners who sat at the front and asked questions. I also drank mass quantities of beer on Friday and Saturday nights and not infrequently on weeknights.
I treated internship like a job and did very little reading, I figured if I hadn't graduated with the basic knowledge, something was wrong. Sailing was more or less smooth. One night when I was woken up to do an EKG on an ICU patient (ICU nurses can't do EKGs go figure), one of the nurses told me, "at least next year when you are a resident you won't have to do this." I told her I had no intention of ever being a resident.
Specialties never interested me. When you are 24, the idea of spending what amounts to 1/6 of what you have already lived in servitude was less than attractive.
For various reasons I only lasted 3 years as a general practitioner. Deciding to go back into a specialty was for me a huge life change, which I didn't undertake lightly without considering other career options like law school. I remember the feeling of "what the hell have I signed up for" on my first day. Fortunately I took to anaesthesia like it was like I was born to do it. I was a little scared about the whole academic aspect of it so I read from day one (actually I bought the textbooks before my residency) as opposed to the residents who weren't scared of the whole academic aspect who didn't feel pressured to read. I had never enjoyed giving presentations but now I had to give them so because I was so scared of being publicly humiliated (which was legal to do to residents them) I actually worked hard on them and came up with some incredibly polished presentations amazing myself.
I was surviving even thriving in academia but I knew it wasn't for me and after finishing my residency my first job was in a community hospital. About 1 and a half years into what I still remember fondly as a pleasant sojourn as a community anaesthesiologist, for reasons I still can't figure out, I answered an ad to work at the Centre of Excellence.
In a perfect world academic teaching hospitals would go out of their way to attract the best and brightest clinicians financially and otherwise. In reality, unless you have gotten onto the Geographic Full Time (GFT) gravy train or have a subspecialty interest which your academic centre supports, they are soul-destroying factories where one puts in time while waiting for a position at another hospital in town to open up. Positions at other hospitals were not forthcoming in the early 1990s; later when jobs were more forthcoming a lot of the bright minds brought to the Centre of Excellence did not even pretend to be interested in working there for the long term and actively sought work elsewhere within months of arriving. Jobs at other hospitals as I mentioned were not available when I arrived at the Centre of Excellence; I settled in and when the opportunity to run the Pain Clinic came up I took it which made me a sub-specialist.
With my appointment at the Centre of Excellence came an academic title. This initially was Clinical Lecturer although the chairman assured me that I would soon be elevated to Clinical Assistant Professor. The title came with no money attached and no real perks beyond a library card, the ability to use the University's gym for a discount and the ability to join the Faculty Club for the usual fees. There is however a certain cachet to an academic title although maybe I am the only person who thinks that way. I am a little reminded of the episode of Cheers where Rebecca gives Sam and Woody titles instead of a raise.
My academic career remained stalled at Clinical Lecturer for about 7 years, (I am sure the chairman just forgot) but I was eventually "promoted" to Clinical Assistant Professor and then Clinical Associate Professor.
Running the Pain Clinic made me the expert on chronic pain in a University Teaching Hospital which lead to requests to give talks and to lecture the medical school which I took on. I even got invited to speak at national meetings and eventually developed a pretty impressive academic CV. I was a little evangelical and ambitious with respect to chronic pain; I always looked on talks as a way to solidify my standing and build my referral base.
After 13 years I finally left the Centre of Excellence. I noticed soon after I had been dropped from list of part-time academic staff on the University Department's website, so I figured I was no long a Clinical Associate Professor and took if off my CV and letters. After about 3 years, I did get a letter from the Dean re-appointing me. About a year ago in the spirit of "glasnost" the new Chairman invited staff at community hospitals with University appointments to apply for promotions, so I thought what the hell and applied. A few months later the assistant Dean, who I play saxophone with, congratulated me. "On what?", I said. "Your promotion," said the assistant Dean and that was how I knew that I was now a Clinical Professor.
The University made up a nice plaque commemorating my new exalted status and the Chairman presented it to me last week over dinner which the Department paid for. Periodically somebody I haven't seen for a while runs into me and congratulates me. "For what?" I say and they say, "For your professorship", so I guess it is a really important thing, even though I tell people a Clinical Professorship and $1.65 will buy me a coffee.
Somebody at a talk I attended pointed out that most doctors are a little insecure and believe that they are frauds and are just waiting to be found. I knew right away he had me down and I am still waiting for somebody to come and tell me I am full of bullshit and puncture my balloon. I still think of myself reading the sports section in the back of the lecture hall and my general distaste for academia. In some ways I feel a little sheepish, in others I am thumbing my nose at every academic doctor who talked down to me. Because hey, I am a Full Professor now and money can't buy that title.