In this episode of the VisionaryMD Podcast, Dr. Onwuemene, physician and executive coach for physicians, explores one of the most challenging transitions in medicine: the shift from trainee to faculty.

Inspired by a recent coaching conversation with an early-career physician, this episode addresses the quiet questions many physicians ask once training ends:

• Why is this so frustrating?
• Why does it feel harder than it should be?
• Why does no one seem to be helping me anymore?

Using The Wizard of Oz as a metaphor, Dr. A outlines seven signs that you are “not in Kansas anymore”—and why recognizing this shift is essential for building a sustainable, fulfilling academic career. This is the first of a two-part series.

Key Insights from the Episode

1. The journey doesn’t start until you choose a direction In training, your success aligned with the institution’s success. As faculty, that alignment fractures. Progress begins only when you define what “winning” means for your career.
2. Trying to please everyone will hold you back The approval-seeking behaviors rewarded during training can undermine faculty success. Not every voice deserves equal priority.
3. You’ll meet quirky companions along the way Once you define your path, you encounter colleagues whose values and goals align with yours. These relationships appear because you’re moving—not before.
4. Your clarity enables others to lead When you articulate where you’re going, others organize themselves around that direction. Leadership begins with leading yourself.
5. You’ll encounter leaders who lack resources to support you Many academic leaders achieved success under very different conditions. Some are unavailable; others unintentionally send physicians on resource-poor missions. This is common—and predictable.
6. You will succeed anyway Most physicians who remain in academic medicine do so not because the system worked, but because they refused to quit. Grit, optimism, and persistence matter.
7. The thing you’re looking for is you Like Dorothy’s red shoes, the capacity to move forward—vision, resourcefulness, leadership—was with you all along. The real work is developing yourself, not waiting to be rescued.

Core Takeaway

The greatest asset in your academic career is not a title, institution, or mentor. The gift is you.

What’s Next

In next week’s episode, Dr. Onwuemene will discuss what to do once you realize you’re not in Kansas anymore—and how to take charge of your career with clarity and intention.

References

• The Wizard of Oz (1939), Metro-Goldwyn-Mayer
• Covey, S. R. (1989). The 7 Habits of Highly Effective People. Free Press