EVERY FISH NEEDS A DREAM POND

With the health sector getting slowly corporatized in India, the doctors are, for the first time, getting the taste of the corporate world. They now have to make a vital decision early in their career – what do they intend to become – a small fish in a big pond or a big fish in a small pond? Both the situations have their own advantages and disadvantages, but the twin desires of professional satisfaction and hassle free life coupled with the recent epidemic of ‘get rich quick syndrome’ is making this a difficult choice.

The Corporate Hospitals sponsored Clinical Establishment Act, which aims at smothering the life out of small and medium sized hospitals, which remain the backbone of healthcare in non-metropolitan urban India, where public hospitals are either overburdened or understaffed or both, will surely make healthcare expensive for those who have no insurance to fall back upon. It took a lot of courage and talent for a fresh M.D or M.S to arrange for finances, get innumerable permits and permissions, and put all his happiness on hold to start a small hospital but the recent surge of consumer protection adventurism, violence against medical personnel, and now the Clinical Establishment Act will surely dampen the spirits of these would be entrepreneurs. So much about Start Up India and Stand Up India!!

The corporate mentality in large hospitals can be positively stifling. Big corporations tend to become ossified, and with this ossification people get promoted not on the basis of knowledge or skills, but on the basis of their ability to brown-nose and toe the corporate line, or on the basis of an often false perception of their past successes without regard to their actual talent (the Peter Principle). Mediocrity and stupidity reign in such a situation and even though they are poorly run, large hospitals tend to continue to keep the same strategies and the same business culture, as though by following the same failed policies over and over again they will somehow find success. While this is true of many small hospitals as well, at least in a small hospital you have the chance to make a difference and to demonstrate your skills. In large corporate hospitals, knowledgeable and skilled health professionals are often kept deep below the corporate decision making stratosphere where their voices cannot be heard. Since when did hospital management guys start understanding what patients want, only the corporates know!

So here is the easy answer to the fish and pond question: If you have a passion for your work and are seeing others lead your hospital to failure, this situation will be intolerable and you should seek to become a big fish in a small pond, fight the system and set up your own hospital. If, on the other hand, you just want a paycheck but no responsibility, then perhaps being a small fish in a big pond might make more sense. So it depends on what type of work ethic you have and what type of career you would like to see.  When you're a little fish in a big pond, it is extremely difficult for people to see your worth and you'll likely get lost amongst the crowd, especially when lay-offs are a threat as well as when promotions are available. On the other hand when you're a big fish in a small pond, you can show your worth.  You can create more lasting relationships.  Your accomplishments stand out more.  How I wish this was the only answer!

But alas, we doctors are usually not easily satisfied. Once we start growing and accomplishing we start envying the small fishes in the big ponds because they are getting more exposure, meeting newer people, seeing newer things and now we want to be a part of all this. Our small pond starts restricting our growth. Smaller pond was maybe easier at start but we cannot be satisfied as that would mean stagnation. But migration to the big pond comes with a statutory warning: if you want to be in the Big Pond, then you better have perfect skills. Yes, the Big Pond is a great place to swim, but beware of getting left behind. That’s right–if you can’t take the heat, then stay out of the kitchen.

If your ambitions and your worth are in balance with each other and you are really the big fish you think you are, then I feel, you should ask for a bigger pond. If there is none in your environment, it just means you might be at the wrong place. This is simply because you do not know what the newer and more challenging atmosphere has in store for you. When you move up to the top you might be in a position to create the significant contribution, or even be part of changing the world of medicine.  This rocket propulsion is often not available in a small pond. But no matter how big a fish you become you need to have a small fish mindset. The moment you stop challenging yourself, or stop being curious, you are bound to fail. Never rest on your laurels and strive to always take it one step further and swim out of the confines of your safe harbor.

Though this is a very personal decision and I know and appreciate many of my colleagues who regularly create wonders in smaller ponds, I have a feeling that a stage comes in your life when you know you are prepared to take on the best in the world. Being a big fish in a small pond for ever is a bad idea because there would be no close competitor you lose a sense a competition. You start living with a false sense of superiority as you never get to face the tough challenges on a regular basis. You move around with same set of ideas, theories, and philosophy as there are no more intellectual person to guide you and so you never really get an opportunity to explore your real potential. Since you are constantly looked upon as the superior one you lose the thrill of getting appreciated. So a stage comes in a professional’s life when he/she doesn’t want to live in a delusion of superiority but wants to explore his/her real self!

There are advantages to every fish size too. I’ve been both the Small Fish and the Big Fish, and I’ve loved and struggled with both. As a Small Fish, I enjoyed the freedom to be a “freshman” and work on career, at a pace that’s as quick as I could make it. I loved having mentors, being able to ask questions, and absorbing content from dozens of sources. There was no pressure to succeed at everything because I was the Small Fish! On the other hand, the Big Fish is a fun position too. I set the standards, I do the treatment planning; the success or failure of the strategy is on me, and that pressure forces me to get up every day and try to be great. I have to be self-taught. That’s much different from being taught. But one thing is sure…..I could not remain a small fish all my life.

Being a big fish in a small pond is perhaps good for beginners but one hits the ceiling on what one can achieve quickly, and nobody will care. We must optimize at all times for being in the most dynamic and exciting pond we can find. That is where the great opportunities can be found. We doctors understand this challenge, do the corporate running the mega hospitals understand it too? One should try to be the biggest fish in the world and shouldn’t tolerate the confines of even the ocean.