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The Saga.

8 February 2013

I know a lot of my readers have been science-nomads for decades, moving between cities every few years for college, graduate school, post-doc, post-doc, assistant professorship, and fall-back gig after being denied tenure. That hasn’t been my experience. After growing up in Seattle, I moved to St. Louis a few weeks after my 18th birthday. I’ve been here ever since. I went to the same university (Washington University in St. Louis) for college and graduate school. I was hired by a local medical center as a health care engineer and then as a PI. When I got the job, I felt reasonably secure that I might be in St. Louis forever.

Then, I had a good contact with Saint Louis University, and it looked like I would get an assistant professorship there. I was approved by the faculty. And in the meantime, after winning a grant and an innovation award, I thought that I would be safely ensconced at my medical center, with a joint appointment between the hospital and SLU, and that would be my career. I would research health care delivery systems. I’m good at that. I would be happy doing that. I had a plan.

Red tape held up my faculty appointment. My follow-up grants weren’t funded. I started to run out of money. My hospital administration held firm to a “Zero Cost Policy” for research: they would invest nothing at all. And they had no interest in using my skills to support the quality improvement department, despite manifest – published! – success there. They would let me work on those projects, but they would not pay my salary to do so. Without new grants, and without my appointment at SLU, I was suddenly looking at unemployment. It looked scary.

So I started applying to universities, schools of public health, for assistant professorships. My resume is thin for that. What I have going for me is a small history of funded grants. A big name university behind my education. But my bibliography is thin at best. I got two interviews, on the phone. Both went well. One led to a campus interview, the other to an enthusiastic request to resubmit my application when the position was upgraded from non-tenure-track to tenure-track.

But the idea of being a professor terrified me. I don’t know if I could teach classes and do research. I don’t have the constitution of an assistant professor, I don’t think. But it is the position I’d sort of been groomed for over the past four years, writing papers and grants. It was the next place to go. But a professorship wasn’t what I truly wanted.

I’m an engineer. I want to do work that has direct impact in the world, right away. Science takes decades, sometimes, before the impact of new research is felt. In my field, systems science in health care, results sort of gradually move the zeitgeist until policy makers end up trying to make basic changes to policy intended to influence the behavior of the complex system of public health and healthcare delivery. It’s agonizingly slow and often doesn’t have the effect it’s intended to. And even when it does, it comes with side effects. I want to improve people’s lives right away.

So I talked to a friend at a software company. I was thinking that they might have consulting work for me because they do health care software work. Instead, they put me in contact with PECMC (Prestigious East Coast Medical Center). They were looking for an engineer like me. Someone who can do health care delivery engineering, with experience guiding projects from conceptualization to completion. They don’t care much about the research aspect of it. Even though PECMC is a major research institution, the Quality department doesn’t normally do that kind of thing.

I interviewed, and I told them that I wanted to go there. But that I wanted to publish as well, framing the work as research so that we can simultaneously improve quality at PECMC and disseminate results in the literature. They were very receptive. They flew me out. I gave a talk. People were impressed. I was offered a job. I accepted it. I start next month.

I began the long slow process of separating from my current position. Getting another PI to take over my project. Negotiating the incredibly complex obstacle course of renting out my house, moving, getting a place in ECC (East Coast City). Utilities. Inspections. Leases. Credit checks. Thousands and thousands of dollars spent. And now I am almost at the finish line of my time in St. Louis. The movers come Tuesday. The gas company comes out to blow out the pilot lights. I sweep up, and I get in the car, and I drive east.

To pick up the keys to my new apartment, on the eleventh floor of a glass tower in downtown ECC. For a new life. I’m nervous. I’ve had a headache for two straight weeks. I ruminate in the early morning, instead of sleeping. My heart has that lurching feeling of lightness and terror that accompanies the plunge from a cliff into deep water.

But that’s ok. I’m a strong swimmer.

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