**Note: As some of you may already know, Dr. Nattinger had a mishap and injured her shoulder. She is grateful for all the kind remarks and well wishes she has received. She also appreciates everyone’s understanding as she takes the necessary time to allow her shoulder to heal.
This month is a combined issue in part due to the timing of Dr. Nattinger’s injury. You will see double articles for most of the sections below. Thanks again for your understanding and enjoy this October/November combined Newsletter.**
Outlier is a scientific term to describe things or phenomena that lie outside normal experience. In the book Outlier: the Story of Success, Malcolm Gladwell examines what it takes for individuals to become very successful in their fields. He argues that extraordinary achievement is less about talent than it is about opportunity, creativity, practical intelligence, and good old-fashioned practice.
Gladwell acknowledges that general intelligence is a factor in determining success, up to a point. However, he sees the important aspect as a minimum requirement – once the minimum is met for a particular field, a higher IQ usually does not matter. For example, he quotes evidence that a mature scientist with an adult IQ of 130 is as likely to win a Nobel Prize as one whose IQ is 180. Beyond the minimum IQ level, other factors become much more important in determining success.
One of those other factors is opportunity. Opportunity is partially about the family environment and milieu. However, opportunity is also about being in the right place at the right time. For example, if Bill Gates had lived a hundred years earlier, he would not have become a computer genius because the technical innovations needed for the PC computer era had not yet been made. Another important factor is creativity, or the ability to use your mind to think in many different directions.
A skill that is important in determining success is called by Gladwell “practical intelligence,” although others have referred to a similar skill as “emotional intelligence.” Practical intelligence includes “knowing what to say to whom, knowing when to say it, and knowing how to say it for maximum effect.” While general intelligence is mostly genetically determined, practical intelligence comes from an understanding of one’s culture. Practical intelligence can be learned as an adult, although it is learned to some degree by socio-cultural interactions early in life.
Of all the factors that Gladwell believes determine success, practice is by far the one most under an individual’s control. He quotes studies of expertise that in aggregate support a conclusion that about 10,000 hours of practice are needed to achieve mastery in an area. The studies are from a wide variety of fields, including studies of musicians, athletes, writers, and others. In all of these areas, there is a remarkable consistency in that real excellence is rarely, if ever, achieved with less than 10,000 hours of practice.
I believe that most internal medicine physicians achieve close to 10,000 hours of practice in our field at about the end of residency, even with current work hours rules. However, those who go on to subspecialize or develop their careers in research or education also should recognize and embrace the substantial investment that will be needed to achieve mastery in these areas. The ability to achieve excellence in an area cannot be rushed. It requires great persistence. On the other hand, this knowledge speaks to the importance of selecting goals and career paths carefully – it is so important to love what you do, because you will invest a great deal of time achieving excellence in your field.