"The essence of strategy is choosing what not to do." – Michael Porter

We often have a singular idea of what we want to do. We all have a reason that we initially went into cardiology; whether that is patient care, research, medical education, administration or something else . As our career progresses, however, we often realize our interests change or we need to adjust them to better fit within the current health care environment. The difficulty lies in paring down our interests, but not becoming so specialized that we lose track of our overall career goals. It is imperative to stop and think about our bigger career arch. What are some potential complementary aspects to the vision of our career? According to Harvard academic, Michael Porter, this is the essence of strategy: choosing what not to do as it relates to reinforcing your key career purpose.

What's Your Why? What's Your Competitive Advantage?

Both questions are equally important. For the first question, you must figure out what you are passionate about. What are your skills? What is simply a title vs. a true calling? Many of these questions are answered by thinking about your higher purpose. What is it that you truly value? What are the moments that make you proud of your achievements? This is your goal; something that has objective measures for you to achieve.

Your competitive advantage is where you excel; where people are willing to pay you a premium. In business, this is often a product, process or customer relationship. As a cardiologist, your competitive advantage is the value you provide. This often means doing different activities (non traditional career paths such as clinician educator, sports cardiology or cardio-obstetrics) or doing similar activities in different ways (being more available, affable and able). It is finding the best trade off with your time to fit your "why." The key is fitting your skills, services and training into your purpose.

Aligning Your Strategy

Strategy is the unifying theme that gives you coherence and direction. Not only is it crucial to align your personal strategy with your higher purpose and competitive advantage, but you also need to ensure that your career goals and ambitions align with the strategy of your organization. If you do not know your organization's strategy and mission, find out what it is. Without understanding your organization's future priorities, you will likely encounter friction, frustration and resentment towards the direction of your career. A better understanding of your organization enables your "asks" to become explicitly aligned with your organization's strategy, and such asks are more likely to become reality.

How Does Culture Fit Into Strategy?

Organizational culture has many definitions. The late Clayton Christensen – famed author and lecturer – stated, "Culture, in compelling but unspoken ways, dictates the proven, acceptable methods by which members of the group address recurrent problems." Culture is learned through social interactions, not within a rule book. It is often defined by the worst behavior tolerated.

A negative culture can quickly derail your career strategy. As author Peter Drucker stated, "Culture eats strategy for breakfast." It is imperative to understand that culture, and the underlying values underpinning it, are only real if it requires time, energy and money . In other words, actions that are congruent with the prevailing value system are deemed credible. It is thus imperative that we understand the credible values within our organization. For example, is paternity leave encouraged or deemed unnecessary ? Are wellness programs simply tactics – annual food cart lunch, outside of work hours voluntary sessions, etc. – or is there a strategy to restructure workflows and create flexibility to improve wellness? Are the wellness programs viewed as an essential investment in the workforce and community? Looking for concrete examples of your organizational culture enables you to evaluate for credibility and potential alignment with your career strategy.

A Purpose-Driven Organization

A higher purpose is not about economic exchanges. It reflects something more aspirational. A leader's most important job is to connect people to their purpose. Many leaders view employees as self-interested agents and have designed organizational practices and incentives, and have set the culture accordingly. Employees subsequently disengage from their work and perform below their potential. Managers respond with more oversight and control, furthering the self-fulfilling prophecy. The current health care environment is no different. By connecting personal strategy and sense of purpose to the organization, individuals' discretionary energy brings more energy, creativity and learning. Here, the essence of your career strategy is choosing not to work at an organization that is not truly purpose driven and does not align with your "why."

References:

1. Porter ME. What is Strategy. Harvard Business Review. November-December 1996. https://hbr.org/1996/11/what-is-strategy.
2. Husaini M, Kline KP, Chukumerije, et al. Sports Cardiology: The Transition of Fellow-in-Training to Early Career Physician. JACC Case Rep. 2022 Sep 7;4(17):1143-1146.
3. Christenson, CM (2016). The Innovators Dilemma. Harvard Business Review Press.
4. Grant, A. 2021, April 20th. Building an Anti-Racist Workplace. WorkLife with Adam Grant. TED Media. https://www.ted.com/podcasts/worklife/building-an-anti-racist-workplace-transcript.
5. Quinn RE, Thakor AV. Creating a Purpose-Driven Organization. Harvard Business Review July-August 2018. https://hbr.org/2018/07/creating-a-purpose-driven-organization.

This article was authored by Mustafa Husaini, MBA, MD, FACC, an assistant professor at Washington University in St. Louis with editorial assistance by Mohamed Esmail, CFP. Husaini graduated from the executive MBA program at Olin Business school within Washington University in St. Louis and is a member of ACC's Sports and Exercise Cardiology and CV Management Section Leadership Councils.

This article is in memory of his daughter, Aliza, who was born at the start of his MBA and died a few months before graduation. Social Media: @husainim.