Life lessons on decision making

Transcript of Bangalore Institute of Dental Sciences Commencement Speech 30th Nov 2022

You are at fork in your career; with many conflicting options. One can continue to further studies and pursue academic or clinical career, start working now, follow some other track or even stop career altogether. Mind you, there are no right or wrong answer; irrespective the options we choose, the life will go on. But one thing for sure, the decision you make will decide your future path career. In our lives we will be facing many such forks- studies, taking up a job, getting married, buying a house etc. what I hope to do is to give some general principles in guiding you to make such decisions; but we shall restrict ourselves to professional decision making.

Rather than advising on what you should do; let me narrate how I made such decisions at such life changing moments. Then using “ retrospectoscope” identify learnings from these instances so that you need not have to repeat my mistakes or can perhaps adopt some of these strategies.

1. Let’s start where you are now.?I had completed dentistry and had to decide on future career, like all of you at this juncture. I was a decent student and truly enjoyed the art of dentistry. I could have taken any dental subspecialties. But I decided to leave clinical dentistry and decided to take up research. I got a job as a research assistant in oral submucous fibrosis project funded by Kerala government Science and technology department and worked at Government Dental College and Regional Cancer Center Trivandrum under two young and dynamic oral pathologists.

I was nudged to make the decision because of the opportunity I received as a dental student to do research on genetic basis of dental caries, for which I received an award by the Indian Dental Association. Second, I had an intense desire and passion to do something impactful and transformative in life, beyond what dentistry could offer. I took the bold decision to leave aside the clinical skills I’ve learnt and the prospect of a decent career; to do something unknown, and untraditional.

We could take such bold steps at your age because we are na?ve, and confident to learn new skills, as well as the willingness to take risk. Putting all these attributes together we can call it “Leap of faith”.?

2. The next career change I made was a year into the research career when I decided to?move to UK to undergo training in Oral and Maxillofacial surgery. That was an easy decision. Although I enjoyed the curiosity driven research. Even after one year, the research grant did not come through to buy reagents or to pay my salary. At the same time, with the affiliation to Regional Cancer Centre, I had opportunity to witness many cancer surgeries and interact with several cancer patients and got interested in cancer care. I received a scholarship to study in UK for a year.

The learning from this decision was that “learn and adapt and course correct when required”

3. The third decision was a very difficult one. I thrived in UK, my mentors, colleagues and patients appreciated my commitment and surgical skills. I passed the fellowship exams with honors. Then, one of my mentors told me that to pursue a career as cancer surgeon you need to do medicine. By that time all my colleagues had completed MDS and started their practice, and here I was advised to start all over again as an undergraduate student. To complicate the matter, I had got recently married and need to take care of family. Although I had a good view on my career trajectory; as you can imagine, it was a tough decision. I would summarize the learnings from this decision as “there is no shortcuts for success” in other words “no pain no gain”

4. The next career decision was the decision to move to New York to pursue head and neck cancer surgery fellowship. It was as difficult a decision as the decision to do medicine. By that time I had finished specialist training in OMF and had multiple offers to become consultant surgeon in UK- with the prospect to settle in life and a steady career. But to get the best training in the specialty that I was pursuing, I felt the need to take up this option. The learnings was the same as last decision “there are no shortcuts for success” or “there is no gain with out pain”

?5. I finished my fellowship from Roswell Park Cancer Institute and got an offer as consultant/attending in head and neck surgery in the dept of ENT of New York University, became chief of head and neck surgery at Bellevue Hospital, the largest public general hospitals of US and in three years I received an NIH research grant of several million dollars, became professor and got tenured. The career and social life was moving on an autopilot mode. Then got a calling to start head and neck surgery at Amrita Hospital Cochin that was starting a cancer center. Leaving a steady, half a million dollar salary position to take up a job paying one hundredth of salary and specialty of head and neck surgery which is very much at rudimentary stage in the country seems to be a risky proposition. But personally it was an easy decision; as the very reason why I left dentistry in the first place was to do something in life which is impactful and transformative. One couldn’t have asked for a better opportunity. With the rigorous surgical training and experience, well rounded research and teaching training; I was well prepared to take up the job. The six years I spent at Amrita was one of the most academically fruitful part of my career. Along with Dr Iyer and Sherry Peter, developed the first comprehensive head and neck service of the country- incorporating, OMF, plastic and ENT. Started the first MCh program of the country. The graduates of this program now leads head and neck services of many major cancer centers of the country from Kashmir to Kochi, Mumbai to Kolkata. This unit had, and continues to have a major impact in the filed of head and neck oncology of the country. The learning from this decision was that “don’t be risk aversive, let the passion drive the decision-making process”. According to Daniel Kahneman, there are two types of thinking- Type I, in which we make decisions on a quick reflex mode, second is Type 2 which is thoughtful decision. The Type I decision is often as effective as type 2.??

?6. My most challenging assignment was as Director of Cochin Cancer Research Center. It was an yet to be established cancer center in the public sector. A very prestigious position, in the town I grew up and the opportunity to impact cancer care of a state. I recall my first day in the office. I arrived at 7:45 AM, as usual; only to find a stray dog and a very sleepy watchman from night shift to welcome me. By 10:00 to 11:00 AM staff started to trickle in. Few patients who turned up had to go through extensive documentation in large ledgers and had to move through several rooms. The issue was not the process but at the end, most patients had to leave with out any meaningful treatment and receiving mostly cancer care counseling. This is somewhat like going through the airport security processes only to find that the flight is canceled or postponed when one reach the gate. The focus was more on the process than the end product.

Over the years, the team could improve the work culture, efficiency and the patient numbers steadily increased as well as their confidence in the institution. We together, with the support of the government, created a distributed cancer care model in Ernakulam district, that is now being implemented as a state-wide initiative. Over the course of the job I realized that there is a significant difference in the expectations of the employer, that is the government and my own vision for the cancer center. And decided to move on. Lessons learned from the decision to join and exit CCRC is that “There are no failures in life, only learnings” make best use of the opportunities. Cut the loses and move on from positions which are frustrating rather than clinging on to it. It’s not going to benefit yourself or the employer.

7. My current position came to my lap when I was contemplating to leave CCRC. A senior executive of Tata Trust had heard about my work in Kerala and asked whether I could join a startup- Karkinos, to create a distributed cancer care program throughout the country using a technology platform. So I joined a Tata supported health Tech startup-Karkinos that aligned well with my life mission of impacting lives of cancer patients. The learning from this decision was that “follow your passion, money and the job satisfaction will follow”

To sum up ladies and gentlemen, when you are at the fork follow these seven guiding principles, you may not go wrong.

1. Trust your instinct and take a “Leap of faith”- how I decided to leave clinical dentistry
2. Learn and adapt and course correct when required- moving from research back to clinical practice
3. There are no shortcuts for success or there is no gain with out pain- decision to undergo medicine and fellowship training.
4. Don’t be risk aversive, let the passion drive the decision making process- Decision to move back to India
5. There are no failures in life, only learnings, and make best use of the opportunities. Cut the loses and move on from frustrating positions rather than clinging on to it. Decision to join and exit CCRC
6. Follow your passion, money and job satisfaction will follow- current position at Karkinos
7. Love what you do; if you don’t find, keep looking, don't settle for less, only deadwood will settle. One day you will find it. Enjoy your career ride as much as the constantly moving professional targets and destinations- then work becomes a joy and you will never have to work.?