Big Fish in a Small Pond
Tracy McGrady, known as T-Mac, and Allen Iverson, known as The Answer, are two of the most talented scorers to ever play basketball. At their peak, they were considered equals to Kobe Bryant. Both played more than a decade in the league, and looking back at their careers, fans often wonder what might have been if they had faced fewer injuries or, in Iverson’s case, had Kobe’s dedication. These “what if” scenarios are common in sports. What if Derrick Rose never got injured? What if the Oklahoma City Thunder’s big three of Durant, Harden, and Westbrook never split? What if David Stern had allowed Chris Paul’s trade to the Lakers? The truth is, we will never know. Another truth is that it’s unlikely things would have turned out as fans hope. These scenarios often assume a flawed counterfactual—that everything else would have remained the same.
Is it reasonable to assume that Harden and Westbrook would have developed into MVP-caliber players if they had stayed together in Oklahoma? Both players thrived by becoming the number one option on their respective teams—Harden in Houston and Westbrook in Oklahoma. They had plays designed specifically to leverage their strengths. Had they stayed together, it’s improbable they would have had as many opportunities. The Oklahoma big three counterfactual fails to acknowledge that basketball opportunities are zero-sum. The more challenges a player faces, the more likely they are to improve. Not having the ball as often means you’re not in rhythm, reducing your chances of success in key moments. There is a limit to how much talent one team can have without stifling individual growth and team production. This has been proven by most big threes and the USA basketball team. On paper, the Brooklyn Nets’ big three of Kevin Durant, Kyrie Irving, and James Harden should have dominated the league. Similarly, the USA 2024 Olympics team should have, at least on paper, defeated every team by a 20+ point margin. Both of these did not happen.
These counterfactuals fail to appreciate the value of being in the right context. As a health professional, you should not make this mistake. Many assume they would grow more if they were at the top-ranked medical school, residency, or fellowship program, but this is often not the case. There is evidence that growth at these highly ranked programs can be stifled. For many, the adjustment that comes with not being the “number one” option can be daunting. Worse still, being in a position where one is now among the lower performers can take a toll. Malcolm Gladwell argues that intense competition can deter talented students from pursuing their courses. In his book “David and Goliath,” he illustrates this with the story of a young woman passionate about science who chose to attend Brown University over the University of Maryland. At Brown, she faced such fierce competition that she became discouraged and switched to a less challenging field. Gladwell suggests that had she attended Maryland, where the competition was less intense, she might have excelled in her science courses and continued on to a successful career in STEM. Gladwell’s broader point is that the Ivy League environment, while prestigious, isn’t always the best fit for every student. The high-pressure atmosphere can sometimes stifle potential by making students feel inadequate compared to their peers.
In medicine, we can observe similar tendencies. Residents might be more likely to get one-on-one attention or hands-on experience at smaller programs where there are fewer fellows and residents. Here, they can easily shine and feed off the positive feelings that come with being the number one option. For some at these programs, it can be easy to think they would have had a better growth trajectory at the bigger programs. Back to sports, we have seen players who are stars in small market teams get traded to big market teams and crumble under the pressure. The high expectations, distractions, and constant scrutiny of New York or Los Angeles mean that promising players like James Harden, Russell Westbrook, Paul George, and Chris Webber often end up being less appreciated once they move to the big market teams. In Westbrook’s case, his time with the Lakers took a toll on him and his family. Initially seen as a promising addition to form a super team with LeBron James and Anthony Davis, Westbrook struggled to find his rhythm and fit within the team dynamics. His performance was often inconsistent, and he faced significant criticism from fans and media alike. The pressure of playing in his hometown, combined with the relentless spotlight of Los Angeles, led to a challenging period for Westbrook and his family. Westbrook described how his family faced harassment and how the constant criticism and negative comments had a significant impact on them.
One of the key lessons for young medical professionals is the importance of context in career development. Just as athletes thrive in environments that suit their strengths, medical professionals should seek out programs and workplaces where they can excel. The prestige of a program is less important than finding a place where you can grow and develop your skills effectively. This means considering factors such as the level of support, opportunities for hands-on experience, and the overall environment rather than just the name of the institution.
Another important lesson is to avoid the comparison trap. Comparing yourself to peers in more prestigious programs can be detrimental. Focus on your own growth and the opportunities available to you. Success is not solely determined by the name of the institution but by the experiences and learning you gain. Embrace the challenges you face and overcome them, but ensure that these challenges are within a supportive environment where you can receive the necessary guidance and mentorship.
The value of being a “big fish in a small pond” is also significant. Sometimes, being in a smaller program can provide more hands-on experience and individual attention, which can be more beneficial than being in a highly competitive, larger program where you might struggle to stand out. This can lead to greater confidence and a more positive learning experience, which is crucial for long-term success.
Mental health and well-being should always be a priority. High-pressure environments can take a toll on mental health, so it is important to prioritize your well-being and seek support when needed. Just as athletes like Westbrook faced personal challenges due to intense scrutiny, medical professionals can also experience burnout and stress. Ensuring a balance between work and personal life is essential for maintaining overall health and career longevity.
Finally, it is important to maintain a long-term perspective. Career growth is a marathon, not a sprint. Immediate prestige and recognition are not as important as long-term development and satisfaction. Focus on building a sustainable and fulfilling career, and be open to changing paths if necessary. Just as athletes sometimes need to switch teams to find the right fit, you might need to explore different specialties or practice settings to find where you truly thrive. Adaptability and a willingness to seek out the best environment for your growth are key to a successful career in medicine.
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