There seems to be an odd phenomenon going on in medicine right now. Perhaps it isn't just medicine, but that is the field with which we are most familiar, so it is the one in which it is felt most acutely by us. That phenomenon is a disconnect, two conflicting concepts between what one should do and be for learners or others following in our footsteps.

There has been a tremendous push over the past several years for mentorship, or the more in vogue term sponsorship. The concept behind mentorship is solid and difficult to argue against—the goal is to provide guidance that can only be learned through experience to those who haven't had the opportunity or time to gain that experience themselves. Most importantly, I suppose, the goal of mentorship is to guide people in what not to do, since the most influential experiences and those we learn the most from are typically mistakes. So our discussion as mentors often starts with, “In my experience….” Read—don't mess it up like I did.

Sponsorship is mentorship to the next degree, and really takes a much more active form. Not only are mentors supposed to counsel their mentees, but they should do what they can to jumpstart the mentee's (“sponsorees?”) career by using their influence to obtain everything from committee assignments, to lecture invitations, to exposure to financial decisions, etc. To me, sponsorship and apprenticeship are complementary but distinct concepts. In many ways the old vernacular for sponsorship was “networking,” although presumably one can network on their own while sponsorship requires a second active and interested individual.

Here, however, is where things get fuzzy. Because concurrent with the idea of mentorship and sponsorship that have been promoted over the past several years has developed the concern centered around partiality, for being certain the same opportunities exist for all. Everyone should be entitled to the same opportunities, or so the theory goes—a level playing field. As one who is at the “mentoring” phase of life (like, I like to tell stories on rounds, evidently, as has been pointed out to me on more than one occasion), I have a difficult time wrapping my head around what appear to be contradictory viewpoints. If I can truly sponsor a trainee or junior faculty member and promote them for an opportunity, should I not do so? Or is that playing favorites, particularly if I am one of the decision makers?

When I sponsor an individual, it seems that there is someone I will offend with that sponsorship. Certain characteristics, largely physical, of the mentee can play a role in this response by others, but not always. The perception of favoritism encompasses all of us, regardless of attributes. I have been called nearly every name in the book on this topic (I'm not sure I've read “the book,” but I'm pretty sure I don't want to). I, and many others, have been accused of favoritism and in today's world that allegation—indictment—often revolves around race or gender. As one who feels that I have consciously promoted those who don't look like me, I have to admit that those allegations are both hurtful and deflating.

I have been very fortunate to have had many mentors on my career path, and many more in my personal life. I cannot imagine being where I am today, wherever that may be, without having these individuals taking an active part in my development. But what if they hesitated, pulled away from me because they were concerned that they would be perceived as admitting me into that venerable ancient institution, the “old boy's club”? When does sponsorship step over that line?

I think there are very few people who admit to being members of the OBC (or the old girl's club which seems to be quickly coming into existence). All of us believe that we achieved what we have through grit, determination, hard work, and luck. Many of us will now add the benefit of a head start to that list. So—when does one enter that institution? I have come to a conclusion on this, and it is the following: when one is on the outside looking in, it's an old boys club; but once one is admitted and is on the inside, it is simply a result of appropriate networking, in some cases mentoring, but always considered an achievement well deserved. I'm not sure how that justification works, but it seems to be the case.

So let me end by posing the real question—how can I as an old boy promote someone who needs to and should be endorsed while at the same time not have that person be considered part of the “club”? Because it isn't me I'm worried about—it's him or her who would now have that moniker of “insider,” and being a part of an institution of which they never wanted to be a part. I don't think I have an answer, but I do have a strategy. And that strategy is to continue to promote those who should be promoted, who show particular promise at advancing our field, and letting the court of public opinion punish me if it sees fit. Sponsorship trumps perceived favoritism every time, and I plan to follow that approach indefinitely and unapologetically.

Article published online:
17 November 2022

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