The Misdiagnosis

For years, stalled academic careers have been explained away as burnout. If someone feels frustrated, overwhelmed, or stuck, we assume they are doing too much, need better boundaries, or should take a break. Sometimes that is true. Often, it is not.

The faculty I worry about most are not burned out in the classic sense. They are still showing up. Still delivering. Still being relied on. Their departments function better because they are there. They are respected, trusted, and frequently thanked. On paper, they look successful. From the outside, there is no obvious problem to solve.

And yet, when you look closely, their careers are not moving forward in proportion to their effort. Promotion feels distant. Strategic work keeps getting postponed. They feel oddly invisible despite being indispensable. This is not a motivation issue. It is not a resilience issue. It is a misdiagnosis.

What’s Actually Missing

What is actually missing is not skill, productivity, or commitment. It is opportunity selection.

Academic medicine trains us extensively in execution and almost not at all in deciding which opportunities deserve that execution. The system rewards people who say yes early, then quietly relies on them to absorb complexity indefinitely. No one teaches faculty how to evaluate whether a role builds toward promotion, leadership authority, or long-term sustainability. They are simply told they are needed.

Every yes, however, is also a no. Every commitment crowds out something else. When opportunity selection is absent, those tradeoffs are made implicitly instead of deliberately.

Why This Stalls Careers

Academic careers are not accumulation games. They are narrative careers. Promotion committees are not tallying effort. They are evaluating coherence, trajectory, and impact. They want to understand what you are known for, how your work builds over time, and why your contributions matter beyond your institution.

Reliable faculty often arrive at review with impressive CVs that nonetheless tell a scattered story. The work is real. The effort is undeniable. But the strategy is invisible. Time has been consumed by roles that stabilized programs, supported colleagues, and filled institutional gaps, while the work that advances promotion has been repeatedly deferred.

Psychologically, this is reinforced early. Many physicians equate helpfulness with professionalism. Saying yes feels aligned with being a good colleague and a good citizen. Declining opportunities can feel disloyal, especially when requests come from leadership. The system benefits from this instinct but does not protect it.

Strategically, the consequences compound. Writing, grant development, national positioning, and thought leadership all require sustained, protected effort. When those are continually sacrificed for urgent institutional needs, careers plateau quietly. Faculty often assume the problem is efficiency or discipline, when it is actually selection.

Opportunity Selection as a Career Skill

What changes careers is not working harder. It is choosing opportunities that compound.

Opportunity selection is the discipline of evaluating roles based on where they lead, not just how meaningful they feel in the moment. Strategic faculty still contribute. They still serve. But their yeses are intentional. Each role strengthens the next. Each commitment builds depth, visibility, and authority. Over time, the career story becomes clearer.

This is not intuitive, and it is rarely taught. Most faculty learn it only after experiencing stagnation or watching others advance faster with less visible effort. Those who figure it out earlier often appear lucky. They are not. They are deliberate.

A Real Example

I see this most clearly in my work with mid-career faculty. One client came to me after being passed over for a leadership role she had effectively been doing for years. She had built and sustained a program everyone relied on. She mentored trainees, smoothed conflicts, and absorbed administrative complexity so others could focus on their work.

When she applied for formal advancement, she was told she lacked a clear external profile and defined area of impact. Nothing about that feedback reflected her actual contribution. It reflected how her work had been framed and where it led.

Once we redesigned her opportunity selection, things shifted. She stepped away from roles that did not build authority, formalized the leadership work she was already doing, and redirected effort toward a defined scholarly and organizational focus. Within two years, her promotion trajectory changed. Not because she did more, but because she chose differently.

Why Departments Should Care

Departments often underestimate how risky this pattern is. The faculty most likely to leave are not the ones struggling visibly. They are the ones carrying disproportionate institutional weight without commensurate recognition or protection. When they exit, it feels sudden. In reality, it is the predictable end point of years of unstrategic opportunity selection reinforced by a system that confuses reliability with sustainability.

Applying This Now

You cannot wait for the system to solve this for you. Opportunity selection is a skill, and it can be practiced immediately.

A few practical ways to start:

• Before saying yes, ask what this opportunity replaces. Be explicit about what you are giving up.
• Map each major role to promotion criteria. If you cannot articulate how it advances your next step, consider no longer doing it.
• Notice which opportunities build on each other and which ones scatter your effort. Depth compounds. Breadth dilutes.
• Get perspective before committing. Decisions look different when you say them out loud to peers who understand the system.

Every yes is a no to something else. Make sure you know what you are saying no to.

The Shift That Matters

Being helpful builds departments, but it does not automatically build careers. Academic medicine runs on goodwill, but promotions run on strategy. Until opportunity selection becomes explicit, the most reliable faculty will continue to carry work that sustains the institution while their own advancement slows.

For faculty, this means stopping the cycle of silent overcommitment. It means learning how to evaluate opportunities before accepting them, understanding what each yes displaces, and building a career strategy that compounds instead of scatters. These are skills, not instincts, and they develop faster when practiced alongside peers who understand the system.

For department chairs and deans’ offices, this is a systems problem, not an individual one. Departments reduce risk when they invest in intentional onboarding, make promotion criteria interpretable through regular promotion readiness meetings, and provide structured department-level coaching that helps faculty choose roles strategically instead of by default. When opportunity selection becomes part of the culture, reliability stops being a liability and starts becoming a strength again.

If you are a faculty member who wants help learning opportunity selection in real time, group coaching provides structure, shared language, and community with others navigating the same decisions join us in the strategic accelerator group coaching program. 

If you are a department chair or part of a dean’s office looking to reduce burnout and retention risk, the Faculty Excellence & Retention Initiative (FERI) focuses on department coaching, intentional onboarding, and promotion clarity at the systems level.