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Musings of a Cancer Doctor
Wide-ranging views and perspective from George W. Sledge, Jr., MD
Monday, February 20, 2012
On Recommending Someone

I probably write two or three letters of recommendation a month, and each takes an hour or so to compose. Add them all up and I spend three or four working days per year evaluating the talents of others and communicating my thoughts to distant deans or chairs of promotion committees.

These reviews are an important part of the academic favor bank. They lubricate academia's gears. One day I will be called by an old friend who will say something along the lines of "Jordan is still a bit wet behind the ears, but he's going to be really good in a few years. Would you mind writing a letter?" And a year or two or three later I will call him back and say "Melinda is quite strong. I know the two of you haven't met, but would you mind..."

 

Whether the reviews themselves are valuable I cannot say. The medical education literature raises some doubts: positive reviews far outweigh negative ones, and they can’t all be above average, unless my memory of basic statistics is seriously flawed.

 

A negative review certainly makes a statement, and can be a career-killer, but they are exceptionally rare. No one ever writes: “Dr. Smith is an obnoxious turd. I wouldn’t let him treat my dog.  His research is derivative, his personal ethics dishonest, and his breath smells. His wife is divorcing him because he is an abusive philanderer. No wonder he works at your institution.”

 

And yet such comments abound when academics congregate in bars. We try and see the best in others in letters of recommendation, perhaps because we know how tough the academic life can be, perhaps because we prefer mercy to justice.

 

Given all this, could I be spending my time more productively? Maybe, but I do not regret the time lost to these letters. In reading the curriculum vitae of an assistant professor in Texas or New York I get to see a new career unfolding, and to learn something interesting about science and the personality of the candidate.

 

CV's are often loaded with personal information. Though not required and not obviously relevant to one's academic prowess, they abound with mentions of marital status, children's names, extracurricular activities, and even hobbies. If you are proud of something you have done, it tends to end up on your CV. I won an award for a freshman English essay at the University of Wisconsin, which netted me $25, and nearly 40 years later it is still on my CV. And will be there when I retire: it was a pretty good essay.

 

When you don't know the person you are reviewing, the CV is pretty much all you have to go on, along with two or three publications the institution sends you. I learned how to read CV's from my mentor, Bill McGuire, 30 years ago, and still pass on his thoughts to junior colleagues. With no claim to originality, let me share his wisdom.

 

The first thing you do is to weigh the CV. Promotion committees do this, and it is a reasonable starting point. Someone who hasn't published a word in the past five years is unlikely to do so in the next five. There is an old basketball saying: "You can't teach height." The academic equivalent is "You can't teach energy." You either have energy or you don't, and it tends to manifest itself fairly early in a career.

 

The next thing you do when reviewing the publications is to look at the number of first-author publications. Someone with no first-author publications probably has never had an original thought in his life, and is being carried by his colleagues. That is pretty obvious, said Bill, but what is less obvious is the meaning of a publication list where the candidate has only first-author publications: "Selfish and unwilling to share. I would never ever hire someone like that."

 

So you want a mix, said Bill. And you want consistency over time. This is something I have noticed in reviewing over the years. If someone had a bunch of articles published as a fellow and during the first year or two of a faculty position, and nothing since, that suggests that their career has hit some sort of roadblock.

 

That roadblock might be personal (cannot get a grant, can't write up research without being pushed to do so by a mentor) or institutional (no protected time at a new institution), but it is a warning sign. Sometimes I can figure the roadblocks out by reading other parts of the CV, where a measure of other responsibilities (clinics, committees) explains the lack of time needed for academic accomplishment, or where a lack of grant money leaves an ominous hole. But there are also times when a CV has an eerie emptiness about it, and I wonder "What has this person been doing these last six or seven years?"

 

McGuire also taught me to look at the titles of the papers.  There were, he opined, two types of researchers: pole fishers and fly fishers.  Pole fishers sat on the banks of a particular pond, never moving, until the pond was fished out. Fly fishers stood in the middle of the river, flicking their rod up and down the stream, never touching the same place twice. “And George,” he said, “You are a fly fisher.”

 

He was right, both about me and about the research careers one sees on CV’s. Some researchers are steadfast in their research and career plan: it’s all there in a straight line, an embryonic differentiation path laid down by the investigator’s genetic make-up. Others are more eclectic in their research tastes, following whatever interests them wherever it might lead.  Depending on which camp you belong to, you view others as either rigid and conservative or as unfocused dilettantes.

 

Bill McGuire was an outdoorsman, hence the fishing metaphor.  Years later I came upon Isaiah Berlin’s masterful essay The Hedgehog and the Fox. The essay is based on a fragment from the ancient Greek poet Archilochus: “The fox knows many things, but the hedgehog knows one big thing.” Both types of thinkers are valuable to the intellectual enterprise, but they operate very differently, and I suspect that both study sections and promotion committees prefer hedgehogs. Or pole fishers: take your pick.

 

In judging we judge more than the candidates. We judge institutions as well. Research environments matter. There are academic Death Valleys where no flowers bloom. There are centers where the senior leaders are so terrified of being forgotten that they refuse to let others take credit for their work.

 

And, increasingly, academia is populated by South Africa-like apartheid regimes that rigorously separate "clinicians" and "researchers,” to the detriment of both “tracks.” Remember, I’m a fly fisher: I hate tracks on principle. They don’t let me wander, they often head in the wrong direction, and the countryside they pass through can be astonishingly boring. But academic administrators seem to like them.

 

Institutions, like individuals, develop reputations over time. When I read the CV of an institutional victim I always have the urge to devote a portion of my letter to explaining to the academic dean how they might better use their center's most precious commodity, the minds and time of junior faculty. And I occasionally have the urge to write a note to the young faculty member: run for your life! Do not stay there another minute! Find something else to do with your life before it is too late! But I don't. Unsolicited advice is unwelcome advice.

 

We also judge ourselves in writing letters of recommendation. We bring our biases about what represents a perfect world: the right number of papers per year, the right number of grants received, the correct journals to publish in, the appropriate colleagues to work with, and what represents a high quality institution. Like most biases, these are frequently ill informed.

 

We often judge people by where they trained or work, which is one of the most persistent forms of bias. Long after racism, sexism, and ageism have vanished, placeism will still rule. Your institution’s endowment should not be a determinant of your personal worth, but it all too often stamps you. 

 

And that CV can arrive on my desk at the wrong time. I had a friend whose promotion was on the bubble. At the very last moment, after years of failure, he scored a large NIH grant, and he is now a distinguished senior professor. Today the average age for a first RO1 is 43. Mozart and Alexander the Great died in their 30’s, as does many a career awaiting that imprimatur of academic success. I fear for the current generation of assistant professors, whose chances of promotion will be dashed by decisions made by graying old men uninterested in the future of America’s scientists.

 

What we don’t see on the CV is often what matters the most: the hardships endured in pursuit of one’s training, the dedication to difficult tasks, the love of one’s profession, the skill and care provided to patients, the meticulous crafting of scientific experiments, the long hours spent pouring over data in search of a clue to one of nature’s mysteries, the largely ignored hours spent mentoring students, and the thrill of sharing one’s results with colleagues.  These are assumed by promotion committees, and by writers of letters of recommendation, but they are what make medical science a special, even joyous, pursuit.

 

About the Author

George W. Sledge, Jr., MD
GEORGE W. SLEDGE, JR., MD, is Chief of Oncology at Stanford University. His OT writing was recognized with an APEX Award for Publication Excellence in the category of “Regular Departments & Columns.”