Setting clear boundaries in your career is critical to maintaining a good work-life balance, positive professional relationships, and your own mental sanity. And setting boundaries is especially important when you’re a doctor, where you not only experience a lot of stress and pressure, but your own well-being can affect your ability to take care of the people depending on you for care.

On episode 95 of the Career Relaunch® podcast, Ali Jawa, a practicing endocrinologist turned medical director shares his thoughts on setting boundaries, acknowledging career stagnation, and making a non-traditional move within one’s industry.  I also share some thoughts on defining your walkaway points in your career during the Mental Fuel® segment.

Key Career Takeaways

1. At some point, you have to make a choice about the boundaries you’re going to set between your personal and professional life.
   
2. The intellectual challenge in one’s career is crucial for personal and professional growth, as it encourages continuous learning and the development of new skills and perspectives.
   
3. Having your feet on two different boats moving in different directions is extremely challenging. While you can bounce back and forth for a while, at some point, you have to leap and commit to one or the other.
   
4. You need to get clear with yourself about “why” you want to pursue a specific career path.
   
5. You can’t keep planning forever. You have to take action to honor those things you value most in your career and life.
   

Resources Mentioned

• Ali mentioned Rich Dad Poor Dad, which was a pivotal book that helped me redefine how he thought about his own career.
  
• He also mentioned Marshall Goldsmith’s description of our different identities (programmed vs. created).
  

Listener Challenge

During this episode’s Mental Fuel® segment, I talked about the importance of defining what your action threshold or tipping point will be before you take action.

Think about which milestone you want to cross, what amount of time should pass, what state a relationship should reach, or how badly you’ll let your well-being suffer. What will it take, how far will you allow yourself to go before you can no longer NOT act?

About Ali Jawa, Medical Director at Wilcare

Ali Jawa is a doctor from Pakistan who moved to the US 27 years ago for advanced medical training in Internal Medicine, Endocrinology, & clinical research. He eventually returned to Pakistan to become a professor at a top public-sector medical university there. Over the next decade, he built his clinical practice, set up a medical center called WilCare, served as President of the Pakistan Endocrine Society, & trained several doctors to become endocrinologists like himself. Since 2015, he’s been the Medical Director of WilCare on a full-time basis.

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Interview Segment Music Credits

• Bio Unit – Ground Effect
  
• Bio Unit – Flying Saucer
  
• Mochas – City Sun
  
• Podington Bear – Puppy
  
• AMBIENTALISM – Presence
  
• Poddington Bear- Pives And Flarinet
  

Episode Interview Transcript

Joseph: Okay. Ali, welcome to the Career Relaunch Podcast. It is great to have you on the show. Salam Alaikum.

Ali: [03:08] Wa Alaikum Salam, and the pleasure is mine. Thank you for having me, Joseph.

Joseph: Thank you so much for having me. I appreciate you tolerating my attempt at Urdu at the start here. But I got to try to use a little bit of what I learned last month in Pakistan when I visited you guys out there. The last time you and I spoke face to face was sitting at a sushi restaurant in Lahore over dinner after a workshop I hosted out there. I know you’re a very busy guy. I was wondering if you could just start us off by telling me what you’ve been focused on recently, both personally and also professionally in your life.

Ali: [03:41] Lately, I have been focusing on my business. My primary business is running a medical center based in Lahore. Other than that, I enjoy interacting with my peers and friends in Entrepreneurs’ Organization. I belong to the Lahore chapter, and I actively engaged with them for the past five years.

Joseph: That’s actually where you and I first met. It was nice to have you in the audience there and to be able to speak with you afterward. One of the things you just mentioned is that you’re a medical director. Your organization is called Wilcare. Can you just give me a snapshot of what Wilcare does and the patient population that you serve?

Ali: [04:24] Wilcare is an outpatient medical facility. We have been in existence since 2008. It has been an amazing experience in the sense that initially started with a smaller place. As we developed our clientele and the patient population grew, we expanded. We developed a structure. We primarily deal with patients and clients referred by other businesses for medical check-ups. That is been the bread and butter of Wilcare for the past almost 15 years.

Joseph: Can you also just explain briefly how health care works there in Pakistan? I heard a little bit about this from you when I was there. Can you explain the general setup private versus public and how patients typically access care there?

Ali: [05:17] Patients tend to have a choice. They choose who they want to see, and that is essentially because they are self-pay. They’re paying out of their own pocket. There is a small group of people who have insurance and they have a structure in place in which they go to preferred providers, but it’s not as well-developed as in the West such as in America. It’s basically the patient chooses who they want to go and see; a specialist, a generalist, a family doctor. It’s up to them. Majority of the care is being provided by the private sector. But in all over Pakistan, the government sector exists and does provide coverage to primarily lower social economic classes.

Joseph: Before we go back in time and talk about how you got to where you are today, Ali, I know that you’re also a busy family man and you are a father. Can you give me a snapshot of your family structure, kids? How that looks for you right now?

Ali: [06:18] I have a big family. My children are all grown up. When you have to deal with your family life as well as your business, especially when you are a practicing doctor, at times, the family gets compromised. I do have to admit that my family life was somewhat compromised in the start of my career in Pakistan. Eventually, kind of an equilibrium and a little bit more towards the family. The tilt has been more evident.

Joseph: Let’s go back in time and let’s talk about how you became a doctor in the first place. You haven’t always been the medical director at Wilcare. Can we talk about your days when you were focused solely on the clinical side of medicine? I’d like to start from the very, very beginning. When did you decide that you wanted to be a doctor?

Ali: [07:08] In Pakistan, when I was growing up, the usual choices, the preferred choices were to be either a doctor or an engineer. Pretty much the decision happens based on how much marks do you get, and when you get a good grade, and they say, “Oh, you are eligible to become enrolled in a medical college. You should become a doctor or an engineer.” If not, then everything else comes afterward.

Fortunately, I had good marks and my family persuaded me to become a doctor so I became a doctor. When I was still in the final year of my medical training, undergrad medical training, my friends and my family kind of nudged me to consider going to United States for post-graduation. In 1996, after I completed my med school, I went to America. I did my residency in internal medicine. Afterward, I’m in primary care doc in the VA system up there in Upstate New York. Afterward, I did my fellowship at Tulane University New Orleans, Louisiana.

Afterward, almost after 10 years of being in United States, I came back to Pakistan as a professor and I joined a leading public sector University in Rohan. I started with practice, built my practice, while also setting up my medical center, which started in 2008. I juggled academic, appointment in the morning, clinic in the afternoon, as well as managing my medical center somewhere in between wherever I had time. This overlap lasted about I would say almost seven years.

Joseph: Let’s go through these one at a time here. Because I know you went through a quick time-lapse of some major — both geographical and also professional changes. When you first went to the United States, did you know what kind of doctor you wanted to be?

Ali: [09:05] I wanted to be a gastroenterologist. However, during my training, I tend to develop a little interest in pulmonology, that’s being a lung specialist. And then, I said, “You know what? I don’t like it either.” So, I took two years working as a primary care doc to have a feel what is actually in real life. I said either I become a rheumatologist or an endocrinologist. Since some of my family members had diabetes, I said, “I’ll become an endocrinologist.” My decision-making was not that complex. It was probably emotional in nature, I guess.

Joseph: Can you explain exactly what endocrinology is? For those people who are not familiar with it. What drew you to that? I know you mentioned you knew some people who had diabetes. Was there something in particular that enabled you to choose that over the rheumatology or the pulmonology, some of those other things you were considering?

Ali: [10:04] Endocrinology is primarily, in layman’s terms, is somebody who deals with hormones. But that’s an oversimplification. It is a two-year training in the United States. After you have completed three years of internal medicine residency. Most of the patients in endocrinology are pertaining to diabetes, and also thyroid and other hormonal diseases come under the ambit of endocrinology.

I realized kind of during my training that I’m not a very hands-on guy. I like more intellectual work in which there is complex decision-making that requires a little bit more attention to detail. Rheumatology and endocrinology both appealed to me. There was a sense overall that the diabetes epidemic is a clear and present danger for humanity. I tended to find that to be something more relevant for me. But that was just my feeling at that time, and that’s why I pursued endocrinology.

Joseph: The other thing I would love to hear about is your first years there in the United States. I know you’re focused on your medical studies there, but I’ve been to Lahore and I’ve been to Upstate New York and I’ve been to New Orleans. Those places are very different from one another. What was it like to go from Pakistan and live and learn in the United States for you during those years?

Ali: [11:38] It was very challenging for several reasons. Starting from how we drive here to how we interact with patients, how do you get your children to go to school, what is the education system for them, how do you interact with your family and extended family after such a long gap. All of the things were challenges and they were welcome challenges. I believe I was ready for it. I knew because I came from here, I went from here. I was familiar with the overall situation. It took some time but I had a big support from my wife and my family. When you reach a certain level of frustration, you have a support group that helps you cope with it. That has been a great blessing for me.

Joseph: The other thing I was wondering if you could talk about was this balance between being a professor at Tulane versus actually seeing patients in the clinic. Can you explain how you balance those two, and how much you enjoyed one versus the other?

Ali: [12:55] Honestly, I think I enjoyed teaching more than clinical. However, clinical has its own advantages. You tend to apply what you’ve learned and you teach if you’ve been teaching to your med school students and other doctors. When you test them in real life, they kind of reaffirm as well as instigate or agitate you to perhaps do some research on them. Many of the clinical trials that are conducted in the United States, as well as in Pakistan, they were driven by the real-life scenarios, the challenges that we’re facing.

In Pakistan, the research was a little different for us. Because they were so-called clinical research that was strongly anchored into the real life. We had to utilize methods in which we did not do a lot of laboratory testing, but it was worth my while. The time I spent in research in Pakistan.

Joseph: You’re at Tulane University. You’re an assistant professor of medicine there. What triggered you to then return to Pakistan?

Ali: [14:10] Actually, when I left, I had made my plan that I am going to return back. The psychological limit was 10 years. As soon I was close to it, I was already wrapping it up. Fortunately, there was an opportunity in which the government of Pakistan would hire you from the United States when you come back to Pakistan into a leading university. They would place you. They would pay you. They would facilitate research for you. It was a dream come true for me because that’s what kind of let me stay in academics for almost 15 years when I returned to Pakistan.

Joseph: Do you remember the moment when you stepped off the airplane there in Pakistan, and what that was like for you to be back there after being away for so long? Can you take me back to that moment?

Ali: [15:06] I was very happy because it was a new challenge. I knew I had the support of my family who were in Pakistan. I had the support of my wife who was also in alignment and was committed along with me to make it in Pakistan.

Joseph: Before we talk about what you’re currently doing, I do want to dive a little bit deeper into your life as a doctor and as an endocrinologist. I was out to dinner with my 5-year-old daughter the other day. We were talking about the different jobs that people have in the restaurant where we were eating. She asked me, “Daddy, who has the busiest job in the world?” The very first profession that I could come up with was a doctor, which is what I actually told her.

As you know, many years ago, I thought about becoming a doctor myself. One of the things that eventually convinced me not to pursue medicine was a realization that the pace and the intensity of the job was not something I was going to be able to handle. How intense was your life as an endocrinologist and what was your day-to-day life like?

Ali: [16:11] It was brutal. Especially, the first three, four years after I came back to Pakistan because the challenge was that I need to demonstrate that I am fit to integrate. In the morning, from 8:00 to 2:00, I would be at the university. I would be doing clinical rounds. I would be supervising the medical doctors in the outpatient clinic, that would start somewhere like 10:30ish till 1:30. I would also be giving talks to all levels of medical students and doctors. After 2 o’clock, I would take a small break to have lunch. And then, I would start my clinic, like 3 o’clock-ish till like 7:00, 8:00.

Joseph: That’s when you see your own patients between 3:00 –?

Ali: [16:58] My own patients. It was a challenge in that sense that the patients at time would not follow you as you would like them to be. They have different motivations. You get frustrated that they know that this thing is not working, and they still don’t follow the advice. With time, I tend to realize that I cannot control my patients. All I can do is the best advice I can give, adjust it for them. You be keeping their socioeconomic status in mind, keeping their physical ability to take medicine in mind, keeping their support at home in mind. And if they still don’t follow, it’s up to them.

This realization came after a couple of years. Because I was very much used to giving advice in the United States, and the patient would follow. Because they would — medicine will be covered by the insurance. They would have a minimum co-payment for their visit. They would keep to their appointment, but this was 180 degrees. But when I adjusted to it, I started to realize not every patient is going to be a model patient. I need to be accepting of it and not worry too much about it. That was the moment when it became a little easier.

However, it was tough because patients in Pakistan demand you to be present and available even in off hours. At times, it is very inconvenient. I had to make a compromise that I had to draw a limit to when I’m going to answer their questions when even if they’re calling from home. This took some time. It was back and forth. And then, you eventually find your sweet spot. When you don’t compromise your family life and you also deliver service to your patients.

Joseph: You mentioned family life there, Ali. I know you’ve got five children now. At the time, when you were working these really long days, starting off with doing rounds, 8:00 a.m., and then spending the last half of your day seeing your own patients, can you describe what your family life was like at that time?

Ali: [19:12] I might have neglected and might have missed some very precious moments in an early part of my transition in the couple of years. Eventually, when things started to settle down, first, I drew a line that I will never practice on a Saturday. In America, it’s five days. In Pakistan, it was unheard of. People still practice six days a week. Second, I made a vow that I will not practice in the evening. Most people did tend to practice in the evening. Sometimes, late hours. The third thing was that I had some dedicated off hours and days, which I started to enforce in the third year after I settled in Pakistan. Eventually, I was able to carve a safe time for me and my family. It was a challenge but I did eventually find what I wanted to do.

Joseph: This pace of being a doctor where you are working these long hours, seeing people who are in a lot of need, who are sick, need a lot of help, I suppose it doesn’t leave you with a tremendous amount of time to think about yourself as much. I’m curious to hear a little bit about the typical career trajectory of a doctor. In many professions and in many industries, a lot of people are thinking about, “When am I going to get promoted? Which company am I going to move to next?” In the world of physicians, in the world of doctors, how does that look in terms of your own career progression? How much do you think about it, and what does it typically look like for the average doctor?

Ali: [20:56] Student academics, it is presumed that you will take the linear pathway. You will be from assistant professor to become an associate professor, then a professor. Then, you’ll become head of the department. If luck would have it, you would become dean or a principal of a medical college. That is a typical trajectory.

If you’re in the private practice, you build your practice to a certain level that you’re in demand and get other people to request you to give them an early appointment. That is the other trajectory. Third is that people tend to go to administration. They tend to like to manage a system. Including managing the schedules of doctors, as well as the non-doctor support staff.

Academically, I think I was already ahead of the game. So, there was not much for me to further hone but I did enjoy it. I enjoyed training other doctors to become endocrinologists like myself. That was my passion. I became an examiner. I traveled a lot to take their exams. I mentored them. I taught them. That gave me a lot of joy.

As with practice, I reached the pinnacle very, very soon. That was, to be very straightforward, was very boring. Practice was somewhat not a very engaging activity for me.

Joseph: Does it get repetitive to see the same type of patient?

Ali: [22:31] Yes.

Joseph: Because I guess most doctors are specialists. And so, I’ve always wondered what that’s like how repetitive it gets.

Ali: [22:36] You’re seeing the same kind of patients: different names, different ages, different backgrounds. They pretty much have a certain level of complexity, and you tend to crave complex patients. Not the really simple ones. The really simple ones are easy breezy but there’s no intellectual challenge. That is what makes it difficult for you to keep the same enthusiasm that you would have in other challenging situation. Frankly speaking, I lost interest in practice not because it was not financially rewarding, it was not intellectually challenging for me anymore.

Joseph: You’re about to talk about the administrative side of things. I know that you eventually made a pivot toward the business side of things. Can you take me through those years when you were starting to tinker with the idea of moving into the more business side of medicine?

Ali: [23:37] The medical center was like if you can call it on the back burner and simmering along very nicely and quietly on a certain pace, while I was teaching and seeing patients. Something happened in 2015. The stimulus and the nudge that I got was from a younger brother, who’s also a businessman. He had attended an immersive learning activity that was a two-week workshop in Lahore in one of the leading management schools. LUMS (Lahore University of Management Sciences) is the name of it.

He took it in 2013, and he was able to apply all those tools in the business. He encouraged me to attend that. I took that course in 2015. The tools, it gave me, the ability to lead my team. I was able to objectively quantify improvement in my business. That was exhilarating because it was a very different way. Being a doctor, it’s a one-man show. You are where the buck stops. You are there but you say the patient either does it or doesn’t do it.

But in managing people, you need to be able to mobilize a team. The team consists of people who are very different. Some have a different aptitude. Some have different approach to work and you cannot force anything. In students, you have a certain influence. You are a senior doc. You have a gravitas, you have a certain influence. But to develop an interest in your workplace, it’s a very different approach. Once I got hooked to it, I was not turning back.

Joseph: How do you balance both the clinical and the medical director work during the early years of that transition into eventually running Wilcare?

Ali: [25:42] I hired a few people for the lead positions, including the administrative positions. Unfortunately, even that is somewhat true now, if they are good administrators, they don’t understand the medical or the healthcare business. If they are doctors, they are not good administrators. The challenge is there because the healthcare industry is still not as well-developed as in the United States. You have to groom them in-house. That is the conclusion I came up with.

In the initial years, it was very frustrating. Because when you are relying on someone to take care of your day-to-day task and it doesn’t get done, then you have to do it. To be in the firefighting mode, it’s very frustrating. That can easily be the summary of my first seven years, up till 2015 when I tried I had to make compromises. I had to try different people try to gel in and develop a culture. After 2015, I started to discipline myself, manage myself. And then, I started to get the people to work accordingly and did not — they were asked to move on. I eventually started to make a team that was aligned with my vision.

Joseph: Balancing two different worlds can be tricky. It’s something we talk about a lot on this show. You’ve got your day job, like your actual job. And then, you’ve got this other side interest that you’re nurturing and developing. At some point, it becomes very hard to balance the two. Did you experience that, and at what point did you decide that you had to make a choice to commit to one or the other?

Ali: [27:45] In 2015, I was appointed as a professor in Islamabad, the capital city of Pakistan. Since I was going to be there five days a week, I cut down my clinic to one day a week in Lahore. At that time, administration was 30%, clinical 10%, and the rest 50% was academic activity in Islamabad. In 2017, I quit academics totally and I cut down my clinical to 5%, and 95% was administration. At this time, that is pretty much the similar ratio. My clinical is now a barely 5% and it’s restricted to friends and families. Rest of the time is administration, mobilization, and team building for Wilcare.

Joseph: Do you feel like this was a natural evolution? Or did you have to make some choices at some point to say, “I’m going to stop seeing a certain number of patients. I’m not going to be in the classroom anymore.” I’m just curious to hear about whether this happened on its own, or did you make some intentional moves to make this happen.

Ali: [28:56] I wanted to get out of my comfort zone, and I wanted to go to a different academic university out of town, out of Lahore, so I can increase my exposure and learning. I knew that if I go out of Lahore, I will have to cut down my clinical practice and that was desired. Because if you’re in Lahore, people expect you to come in and see them even if you don’t want to. Because they see you, you are here, just come and see me and it becomes a challenge. It was somewhat intentional.

By not resuming clinical after leaving my government job in 2017, that was definitely intentional. Because I could not go back to my doctor’s chambers and start seeing patients again. It’s just that life is too short to not do what you want to do.

Joseph: That’s interesting. I think a lot of us have different interests and many of us have also invested into a particular path in our careers. Now, becoming a doctor requires many years of education, training, experience. Was that hard for you at all to let go of seeing patients or not?

Ali: [30:07] Not at all.

Joseph: Not at all.

Ali: [30:09] I was mentally prepared, and it was tough for my friends who referred patients to me because they trusted me. What I did was intentionally transitioned. Another colleague of mine who I referred all my patients in my absence to her so that she can build her practice. There was no excuse, “Oh, who do I get go and see?” I say, “Well, you can go and see her. She’s there.” But they would say, “Oh, she’s not you.” “Yes,” I say. “Yeah, that’s fine. But she’s as good or even better than me.”

Joseph: As you think about the doctors in your sphere professionally, I’m guessing there’s probably others that you know who maybe want to make a shift out of the clinical world and do more of what you’re doing, which is more of the business administrative side of things. What do you think stops doctors from letting go of the clinical side of things?

Ali: [31:04] It is the ego. When the patient comes and sees you for their ailment, you feel good in your heart. It boosts your ego. It makes you as if you have made a difference. This instant gratification holds you back.

Joseph: Well, the last thing I want to talk about before we wrap up with what some of your interests are outside of medicine are the lessons you’ve learned along the way of your career journey. Because I know you’ve made a couple major pivots here, both geographically and also in the nature of your work. What is something that you wished you had known about branching off to do something else in your career that you now know having made this transition from clinical endocrinologist to medical director?

Ali: [31:54] They always felt I knew everything, even if it’s not something to do with medicine. I heavily discounted the skill sets, the attitude, and the work ethic of people around me. This held me back because I was not appreciative enough of them, I was not grateful to them, I was not acknowledging them. So, if I had early on realized that, “You know what? I can do work maximum of two or three people. But if I have a well-honed team of people, like 10 people, I can do work of 30.” This realization came a little late, but better late than sorry, I guess.

I think the biggest influence one book that made in my life was “Rich Dad, Poor Dad.” It gave me hope. This is the book by Robert Kiyosaki. It gave me hope that even if you are working, you can become a businessman eventually. If you want to, do it side by side. That was one of the practical things that I learned. Similarly, other books when I started reading non-medical books, I came across a wealth of information and knowledge that how one can shift gears, take new challenges, and develop a business while still doing or working for someone.

Joseph: If you had to give advice to your younger self about what it takes to make your career in medicine evolve into what it’s become right now, what would that be?

Ali: [33:47] Marshall Goldsmith had very eloquently mentioned that we have a program identity and we have a created identity. Many times, we are working on a programmer identity most of our life, that is shaped at the age of 3 to 23. I would strongly urge the younger people to dig deeper and find out what are you, what do you think you are, and why do you want to do this work. Create your own identity.

Do you want to be a practicing doctor? Just go for it. You need to know why you want to do it. Because you like to treat people one-on-one. Do you want to create a system in which the patients or customers or clients they come in and get good service, and you think you can do it by being an administrator? Go for that.

If you find that you want to create a culture in which the society benefits from your presence, and you are able to build a system in the community by working for the government, or by teaching, become a professor. You need to know why you want to do something. Don’t keep doing it because somebody has told you early on, “You are good at this.” Dig deeper, find out what are you good at, what makes you happy, and what do you enjoy.

Joseph: Finally, what’s something you’ve learned about yourself, Ali, as you’ve made this move from the clinical side of medicine to the business side of medicine?

Ali: [35:18] I need to have patience. Another thing I want to know is that I need to have a certain stock gap or some kind of a limit to procrastination. I need to take action. Because I cannot keep on planning things forever. I need to get feedback from all stakeholders around because I may not have all the right answers or I might have missed something which can either illuminate and can make the process or project a success.

Joseph: Well, I want to wrap up with some of your interests outside of medicine and the medical world, Ali. We had a chance to spend a bit of time together last month when I was in Lahore, both at my workshop and also afterward over dinner and I know you have a lot of different interests. Let’s just pick one here. Can you tell me a little bit more about your interest in food security, which I know is another area you’re very passionate about?

Ali: [36:14] It’s simply fascinating. I came across this concept when there was a USAID grant program for people to set up a business. One of the areas they had was agriculture. When I dig deeper, I came across that almost 70% of the fruit and vegetables that are produced in Pakistan, get lost after harvesting. I thought this was a huge loss. What if there is a way to save it? When you save it and you make it useful for the people to consume it, maybe you can contribute significantly to reduce hunger in the world.

This has been my passion since 2017, and I had been studying it. I had the chance to interact with a lot of people, especially the young entrepreneurs. Recently, I came across a couple of entrepreneurs who are working on projects to extract value from fruits so that they are able to reduce waste and create food that is to be consumed by the people. I feel that if courage ordinary people, students, and other business-inclined people to start looking at it that how we can save fruit, food, vegetables, and grains so that they can be useful for people in Pakistan and the world. This could really change the landscape. With climate change, the food scarcity roaming around all over the world, this could be a very good way to secure food for the world.

Joseph: Very interesting, Ali. I just really appreciated you taking the time today to tell us more about your time as an endocrinologist, your shift into the business side of medicine, and also the importance of making sure you take the time to understand your motivations behind your career moves.

So, best of luck with everything at Wilcare, your interest in food security and scarcity, and also with everything you’ve got going on there in Lahore.