Reflections from the Liminal Space: Life After Residency Director

By Michael Gisondi (@MikeGisondi

So much liminality!

When did all this liminality begin? And when will it end???

For a person who does not love change, liminality = stress. Perhaps healthy, manageable, good-for-you-like-a-vitamin, growth mindset stress… but stress, nonetheless.

I’m deep in the liminality these days, because I just changed jobs.

My first faculty position after fellowship was in the Department of Emergency Medicine at Northwestern University Feinberg School of Medicine (2003-2017), where I served as Residency Program Director for the last 7 years. I was pleased with my clinical practice, colleagues, research and administrative projects, life in Chicago… and importantly, I loved the residents.Questioning

Then a colleague at a meeting asked if I would consider interviewing for another job. (That’s the moment the liminality began.) And within days, another colleague from another institution asked the same question. My mind began to wander. I dreamt about what it might be like to live in a different city, to do different work. Would I enjoy it? Would I enjoy it more than my current (wonderful) job? Would different work, if not necessarily better work, be worth uprooting my family?

Ultimately, the casual inquiries about whether I might consider changing jobs transitioned into a comprehensive evaluation of my life: professionally and personally, top to bottom. I interviewed at several institutions and I felt that I could be happy at all of them. But I was still unsure whether it was worth moving, just for the sake of different, or even better opportunities. And by what measures should I define a ‘better’ job?

I offer a few important reflections that perhaps can be useful to others when their potential job change liminality begins.

First, my longtime colleague and friend, Dr. Tammie Quest of Emory University, summed up my dilemma as this: “You have to be able to go, to stay.” Any of the day-to-day stressors that cause angst at work are magnified when you believe you don’t have options. Knowing that you have options helps you reengage in your current role, if necessary. It’s nice to know the grass might be the greenest at your current job. Based on her advice, I went on a few interviews.

When I was later considering potential offers, Dr. Quest gave a second piece of sage advice, as a simple question, “How many moves do you have left in you: 0, 1, or 2?” Based on my age, my child’s age, and my stage in my career, I answered “not more than 2, not zero, and likely only 1.” Therefore, the consideration of a new position was that much more serious. Because I may not have the stomach for any further moves, my decision to relocate had to be to a place that I could live forever.

After recognizing that I could move, and that I might not have another move in me later in life, I had one final challenge to my professional identity to overcome. Was I ready to walk away from my role as residency program director? The average life span of a program director is commonly said to be about 5 years, with several studies in different specialties documenting high job turnover before the 10-year mark. I replaced a program director who lasted 9 years, in her words as she passed the torch to me, “two years too many.” What should be the target for my tenure in the role? If I spent the first 10 years of my career preparing to be a program director, shouldn’t I hold that role at least just as long?


Many factors drove my decision to walk away from a job and a city that I loved. Change is a good thing. For Northwestern Emergency Medicine, change comes in my replacement: a dynamic individual who I know will continue to elevate an already wonderful program. For my family: adventure and rebirth… and a lot less snow.

I’ve spent many years considering the professional identity formation of my former residents. Now, I spend a lot of time considering my own. There is a certain freedom in changing jobs that allows an academician to prioritize research and administrative contributions in different ways. It is exciting to take stock at the midpoint of my career, consider what skills I still want to acquire, and what impact I might still have to make in medicine. A professional bucket list is actively being crafted.

Some business authors suggest that it can take up to 18 months to decide if you truly fit at a new job. So, the liminality continues, at least for now.

Featured image via Amman Wahab Nizamani on Wikimedia Commons

Image 1 via Marco Bellucci on Flickr

Image 2 via  chintermeyer on Flickr