#340 What to Ask Yourself Before Taking the Next Job or Promotion ft. Peter Kim, MD
In this episode, Peter shares what he’s been hearing from successful physicians, department chairs and section chiefs among them, who have a bigger role on the table and quietly wonder if it will make them any happier. He walks through why the top of the ladder can feel flat, what a long running Harvard study found about relationships, and the questions he’d ask before saying yes.
If you’re weighing the next job or promotion, this episode gives you a clearer way to decide on purpose. Tune in!
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Episode Highlights
Now, let’s look at what we discussed in this episode:
- The Question Behind the Offer
- When the Climb Becomes Who You Are
- Why the Next Rung May Not Help
- What Was Actually Missing
- The Questions to Ask and the Rocking Chair Test
Here’s a breakdown of how this episode unfolds.
Episode Breakdown
The Question Behind the Offer
Peter opens with a few recent conversations he’s had with physicians who look extremely successful from the outside. These are department chairs, section chiefs, and the names at the top of the org chart, the people the rest of us assumed had it all figured out. In every one of those conversations, some version of the same question came up: is this it, is this what I worked that hard for?
A couple of them even had the next step on the table, a bigger role or a bigger title at a different institution. That would mean uprooting their families, leaving the house and the city, and pulling the kids out of school. What struck Peter is that they weren’t asking whether they should take the job. They knew they could get it. They were asking whether it would be worth it, and whether they’d actually be any happier on the other side. He admits he didn’t have a great answer in the moment, but he’s been thinking about it ever since.
He says this might be one of the most important episodes he’s ever done, and there’s no disclaimer today because it isn’t mostly about money. He’s clear that it isn’t about burnout, since these physicians aren’t necessarily exhausted, and it isn’t about leaving medicine. It’s about what happens after you’ve climbed for so long, because nobody really prepares us for that part.
When the Climb Becomes Who You Are
Peter walks through how most physicians got here. A path was drawn for us, so we got the good grades, got into med school and residency, matched into fellowship, became attendings, made partner, and got promoted. Maybe we ended up running a section or a department. Every rung had a next rung, and at no point did anyone stop and ask, “and then what?” We just kept climbing, and we got really good at it.
Somewhere along the way, he says, climbing stops being something you do and becomes who you are. Then one day you reach the end of the ladder, maybe as the chair or the chief, and there’s no obvious next rung, or the next one looks a lot like the one you’re standing on. It feels really quiet. Peter knows that feeling because he’s felt it himself. Years ago he had what he thought was his dream job, loved the people and the work, and still found that it wasn’t enough by itself, which he says is a hard thing to admit.
He describes the top of the mountain feeling flat when it should feel like the peak. He’s careful to say this isn’t about a lack of gratitude, since you can be deeply grateful and still feel it. It’s what happens when the climb itself was the fun part. Once it’s over, the thing that organized your life and gave you direction is gone, with nothing put in its place. He ties this to the arrival fallacy, the idea that you’ll be happy when you get there, but notes this is different, because it’s about what happens after you’ve arrived.
Why the Next Rung May Not Help
Peter says what these physicians describe sounds a lot like what used to be called a midlife crisis, a phrase that usually brings to mind the guy who buys a red sports car. He thinks it’s treated as a punchline, and he points out it isn’t just about men. In your 40s and 50s, he says, a few things tend to land at the same time. The career goals from your 20s are done, your kids are getting older or about to leave for college, your parents may need you more, and your own body starts sending reminders. To him, the sports car is a bad answer to the real question, which is whether this is how you want to spend the rest of your time.
For physicians, he thinks it hits harder because we’ve already delayed so much. We spent our 20s and a good chunk of our 30s in training, told ourselves we’d live fully later, and then looked up to find that later is now. He then goes back to the chair with the offer on the table. A bigger role often means the same job description with more attached to it, like more meetings, more politics, more nights answering emails, and maybe less time with patients, which is often the part people loved most. It can also cost the family something real, like a new school, a new city for the spouse, and leaving the people who would show up if something went wrong.
Peter explains why the next step may not make people happier with a concept called hedonic adaptation, which simply means we get used to almost everything. A raise or a new title gives you a bump, and a few months later it’s your new normal, at a higher baseline you now have to protect. He says every one of these physicians has already been through that cycle a few times, and there’s no reason to think the next promotion will work differently. He’s not against ambition, and some of them should absolutely take the job, but because it serves the life they actually want, not because it’s the next rung and climbing is the only move they’ve ever been taught.
What Was Actually Missing
Peter then asks what the answer is if more of the same isn’t it. He points to the Harvard study that began in 1938 and has followed the same group of people, and now their children, for more than 80 years. The psychiatrist who runs it, Robert Waldinger, says the clearest finding is that the strongest predictor of who ended up happy and healthy later in life wasn’t income or achievement. It was the quality of their relationships, meaning whether they had people they could call when they needed support.
Peter admits that’s uncomfortable, because relationships are often the first thing we cut when work gets busy. We skip the dinner, miss the game, and tell ourselves we’ll make it up later. When he put that research next to his conversations, it all started to make sense. What was missing for these physicians wasn’t success or competence, since they’re some of the most capable people he knows. It was control over their own time and closeness with the people who matter most, and both had slipped over time without them noticing. A bigger job at a new institution in a new city, he says, would take more of both.
Coming back from a few sponsor breaks, Peter shares what he wishes he’d done in those conversations. They talked about titles, institutions, and compensation, but never got to the only question that matters at the end of the day: what do you actually want your life to look like? Not your career, but your life. That sets up the questions he’d ask now.
The Questions to Ask and the Rocking Chair Test
Peter lays out the questions he’d ask now.
First, if you’re honest, what are the three or four things that matter most to you, not what should matter or what’s expected of you by parents or colleagues.
Second, how much of a normal week actually goes into those things and the people you want more time with. He suggests picking a Tuesday from last month and thinking about where the hours went and who you spent them with. If your parents are in their 70s and you see them twice a year, or your kids are 12 and 15, that’s worth noticing.
Third, what would you do with the next five years if the title didn’t matter to anyone? He adds that money is a tool for the life you want, not the scoreboard, even though many of us treat it like one.
He then explains why timing matters. There’s a stretch where you have the health, energy, money, and people all at the same time, and for most physicians that window is open right now, in their 40s and 50s. It closes faster than you’d think. He mentions a line from Bill Perkins, author of Die with Zero, that experiences have a shelf life, so the trip you take with your kids at 45 or 50 isn’t the same trip at 75.
Every year spent climbing toward a rung you’re not sure about uses up a year of that window, which is why Peter says the real cost isn’t the money, it’s the year. He’s clear this isn’t about quitting to travel the world, it’s about deciding on purpose: take the job if it serves the life you want, turn it down if it doesn’t, and know which one you’re doing and why.
Peter closes with a conversation he had with his father, a surgeon who spent much of his life building a private practice. When Peter asked him what the best time of his life was, he didn’t need to think long. He said it was when the kids were still at home, and he didn’t mention the practice, the publications, or any titles. He admitted he was too busy to notice it was the best time, and he sometimes wishes he had made more of it.
Peter thinks about that whenever he’s tempted to take on one more thing. He leaves listeners with a rocking chair test: picture yourself in your 70s or 80s, and ask when you’ll look back and call it the best time of your life, and whether what you’re building now will produce more of that or less.
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