New year, greater impact

Career advice for young (and not so young) people

As we turn the page to a new year, many of us are reflecting on our lives, our goals, and our careers. Whether you’re just starting out or looking to shift directions, the New Year is the perfect time to assess where you are and where you want to be. Drawing on my 40-year career spanning medicine, bioethics, and global health, here are three principles that will help you succeed: find a problem and solve it, getting the right mentors working for you, and choosing the platforms that will enable you to make the biggest impact.

Find a Problem and Solve It

Forty years ago, when I was an intern making ward rounds with the attending physician, we were reviewing the case of a woman in her 30s with widespread cervical cancer who was in my care. She was dying. On rounds, I noticed that we discussed at length the many causes of low phosphorus level in her blood, but not whether to resuscitate her when she would, sadly and foreseeably, have a cardiac arrest. I found this outrageous and wanted to do something about it.

Over the following decade, I set about trying to improve end of life discussions and decisions. I designed a living will to help people plan the end of their lives, described the process of advance care planning, identified key parameters of quality end of life care, edited and co-authored a series of articles and a book to teach clinicians how to provide quality end of life care.

I learned that impact begins with identifying a concrete problem to solve. The best problems to solve are often those that are directly in front of us or that personally irritate us or that we find most unjust.

I also learned to plan from right to left—start with the desired impact and work backward to determine the steps needed to achieve it.

When evaluating the impact of your problem-solving efforts, adopt an honest and non-defensive mindset. Early in one’s career, there can be a tendency to avoid discussing failures. However, acknowledging both successes and failures builds credibility and trust.

An important part of career development is telling the story of the problems you’ve solved. In job interviews, focus on sharing the problems you addressed, what actions you took, and the impact those actions had. It’s crucial to link the outcomes of your work to the real impact on people. Outputs (the result of actions you take) are less interesting, while outcomes (the results those outputs create for people) are inspiring.

Rather than think of your career as your role, think about it as the series of successively important problems you’ve tackled and solved. It isn’t your title that matters; it’s what you accomplish.

Here is the career advice I received from the late Dr. John Evans, a global health and medical education pioneer: “It doesn’t matter what it says on the outside of your tombstone. What matters is what it says on the inside of your tombstone.”

Get the right mentors working for you

Once you’ve found your problem to solve, you need the right mentors to help you solve it. The best mentors don’t only teach you subject matter content; they teach you how to think, as I said in this interview following the death of one of my own mentors:

Alvan R. Feinstein … joked in his 400th scholarly article that he hoped to continue writing until he faced “the ultimate rejection, by adverse pathophysiology.” When Feinstein did die in October [2001]—at age 75, while participating in the Gairdner Foundation conference in Toronto—his former student, Peter A. Singer, M.D., M.P.H., found himself taking Feinstein’s place on the podium. Instead of listening to Feinstein speak, Singer delivered a eulogy.

The first part of Singer’s tribute was what one might expect: He described Feinstein’s leadership in establishing the field of clinical epidemiology … But then Singer did something unusual: he quoted a comment Feinstein had written on a manuscript that Singer sent him.

“I don’t think your writing is actually bad,” Feinstein wrote to Singer, the Sun Life chair in bioethics at the University of Toronto. “After you fixed the tone and removed most of the sociobabble in this manuscript, the paper could be understood despite its prolixity, verbosity, and subadequate inter- and intra-sentence structure.”

That Singer would affectionately recall the man who offered such criticism reflects Feinstein’s mystique: he had almost impossibly high standards and never minced words, yet his students deeply valued his guidance …

Mentors can open doors, offer support during career-defining moments, and collaborate on projects. They can bring instant legitimacy and wisdom to new organizations you launch together. Mentorship provides you with critical thinking tools, helps you develop leadership skills, and introduces you to networks that further your professional growth. (I discuss more of my mentors and what I learned from there here.)

Mentorship also plays a key role in leadership development. As a mentor, you help others grow, become independent, and contribute to future leadership. Mentorship is a form of servant leadership, focusing on helping others succeed while gaining insight and satisfaction from their progress. This reciprocal relationship benefits both mentor and mentee, and ideally, those you mentor will eventually surpass you in their achievements.

Additionally, mentorship can be a powerful way to promote equality of opportunity. Historically, mentorship has often reinforced privilege, but it can also be a vehicle to elevate underrepresented voices. Both mentors and mentees benefit when mentorship is used to support equality, diverse perspectives, and new opportunities for those who may have been historically excluded.

Mentorship is a critical factor in shaping careers and achieving long-term success. Rather than asking yourself, “What do I want to do in 10 years?” a more effective question is, “Who are three to five people currently doing what I want to be doing?” This not only helps you clarify your vision but provides concrete examples of success to learn from.

Once you have identified these people, reach out to them. They will not all reply, but you wouldn’t want the ones who don’t as mentors anyway. Ask to speak with them for 30 minutes so they can give you career advice. (Who doesn’t love to give advice?!)

Think of the conversation as a job interview: you are interviewing them for the position of mentor! If the conversation goes well, and they give useful advice, ask if it would be ok if you contacted them again in 6 months to let them know how their advice worked out. (By this point, its difficult for anyone to say no.)

To maximize the impact of mentorship, ask yourself: Do I have 3-5 mentors who are doing now what I want to be doing in 10 years? Are they working for me in the ways I need? Are they diverse? The answers to these questions can guide you in finding the right mentors to support your career goals and help you build meaningful relationships.

Hop aboard a rocket-ship

Finally, harness the power of your platform. The organizations you work for and the environments you choose can either amplify or limit your ability to make a difference. I often tell people, “If you see a rocket ship, hop aboard.”

For me, one of those rocket ships was the Grand Challenges in Global Health initiative. In 2002, my colleague Abdallah Daar and I received an email from Dr. Richard Klausner of the Bill & Melinda Gates Foundation. Bill Gates was preparing to launch a groundbreaking initiative, and Klausner saw our recent work in Nature Genetics on top biotechnologies for global health as a starting point for identifying grand challenges.

We met, shared our ideas, and just a few months later, I was invited to Washington to present our methodology to leading figures in global health, including Nobel Laureate Harold Varmus. This meeting led to the identification of the original Grand Challenges, which were announced in 2003 and became an important global health movement. That experience later helped us found Grand Challenges Canada.

Platforms matter. Whether it’s the university where you study, the NGO you work for, or the startup you join, make sure the platform aligns with the problem you wish to solve, and will give you the tools to succeed.

Admittedly, most people won’t be working on rocket-ships. They will be working on a massive cargo freighter. These are much more difficult to turn around. If you’re not on a rocket-ship, build your own launchpad by being the problem solver in your own organization.

After co-founding two start ups (University of Toronto Joint Centre for Bioethics and Grand Challenges Canada), I went to WHO with Dr Tedros to help turn it into a more results-based organization. While I thought of my role as a social entrepreneur in the start-ups, I thought of myself as a social intra-preneur at WHO. The essence of intra-preneurship is that even within a large organization, you can find a problem and solve it.

Although it’s more difficult to solve problems in a large organization, once you do it’s on a larger scale. And often it takes supportive mentors within the organization.

When choosing platforms, take on enough risk that you won’t later feel regret. This is an individual choice, often shaped by deep psychological and social forces in your life. Since my mother had lived through the horrors of the Holocaust and Stalinism, she sought stability for her only child. Her career advice to me was that I should be a doctor, dentist or lawyer. I did take on significant risk in my career choices, but in retrospect, I wish I had taken on just a bit more (and tried politics).

Leadership, Character, and a Challenge for the New Year

These three pillars—solving a problem, getting the right mentors, and choosing the right platform—are essential. But there’s one more element that often goes unspoken, and that’s character. The pandemic, in many ways, acted as an X-ray of our soul. It revealed strengths and weaknesses not only in systems but in ourselves. As I wrote here, effective leadership is the ultimate vaccine.

At the end of the day, your career is about more than just solving problems or advancing on the right platforms. It’s about who you are, how you treat others, and whether you act with integrity. Leadership is not just about making decisions—it’s also about building trust.

As you look ahead to this new year, I encourage you to think deeply about your career. What problem are you most passionate about solving? Are you surrounding yourself with mentors who will push you to be your best? Have you chosen the right platform to make the biggest impact?

And finally, reflect on your character. Are you acting with integrity? Are you promoting equity and opportunity for those around you? Are you the leader you want to be?