Lesson Two: The Doctor’s Paradox – Why do some people get worse with more experience and how do you avoid the same fate?

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This lesson was written by Scott Young.

The Doctor’s Paradox

One of the major lessons from So Good They Can’t Ignore You was that having a career you love depends on cultivating rare and valuable skills. A related idea is that, through experience and hard work, you can get better at those skills. Simple, right?

But what if having more experience actually made you worse at your job? What if instead of increasing your skills, it weakened them?

This was a finding from a 2005 study from the Annals of Internal Medicine. What they found was that, contrary to expectations, general practitioners tended to get worse with more experience. Quoting from the original abstract:

“Physicians with more experience are generally believed to have accumulated knowledge and skills during years in practice and therefore to deliver high-quality care. However, evidence suggests that there is an inverse relationship between the number of years that a physician has been in practice and the quality of care that the physician provides.”

You might think this is just a quirk of the medical system. After all, with the intense studying and preparation done in medical school, it might make sense that doctors would get a little rustier after that period.

But interestingly, a different group of practitioners, surgeons, were shown in a different study to get better with more experience, as expected.

What’s going on here?

A Tale of Two Doctors

A major explanation proposed for the difference between the two types of doctors was deliberate practice. Timely feedback, one of the key components of deliberate practice, is something surgeons get while operating. General practitioners, on the other hand, often receive feedback months later, or not at all, on whether their prescriptions worked as intended.

The 10,000 hour rule—that it takes 10,000 hours of practice to become an expert—has created the popular impression that getting really good is simply a matter of time. Put in the effort, the meme goes, and you’ll get better automatically. The difficulty is simply in the time spent.

However, this notion that more experience is all that matters not only contradicts the Doctor’s Paradox, but also the key principles of deliberate practice as researched by Anders Ericsson. More time spent using a skill, on its own, might not make you any better at it.

Instead of continuous progress, plateaus—where you stay at the same level of skill for a long time—are not only common, they’re the norm. Thinking back, you’ve probably experienced plateaus yourself. Times when you’ve stayed stuck at a certain skill level, despite putting in more and more time at it. Chances are those plateaus struck you a lot earlier than 10,000 hours.

Rethinking Career Development

The fusion of these two ideas: that rare and valuable skills are what matters in having a career you love, and the idea that deliberate practice is both tricky and not automatic, were the motivation behind designing Top Performer.

One of the lessons we learned from running the pilot groups of the course, was that developing small projects was a good way to shift yourself out of a rut and back onto the rapid part of the learning curve. In the full course, which we’ll open for a new session after these lessons, we’ll be guiding a new set of students through the process of designing and executing their own deliberate practice projects.

In the meantime, ask yourself this: Are your the skills that matter for having a career you love improving as you’d like? If not, how could you improve the speed and quality of feedback you get to escape the Doctor’s Paradox?