There’s an old and valuable adage in Medicine known as the “3 A’s of Success.” In order of importance, these are Affability, Availability and Ability. After much searching, I couldn’t find the origin of this sage advice, but did find the oldest article discussing these traits of success in an article in the 1960s¹. Many of those that are successful in Medicine, or really in any walk of life, naturally happen upon these characteristics without knowing that they’re doing them; but, sometimes being able to hone in on these individual elements can help to brighten one’s success in any industry, especially Medicine. I would make an argument that there is a 4th and 5th A for success that, when approached humbly can open even more doors – and in some regards is important to achieving even higher success. These A’s are: Adaptability and Aggressiveness (to go after opportunity, NOT in regards to interpersonal relationships). Now, for the record, I don’t at all claim to have mastered even one of these skills but more so, in my goal to be constantly improving, I constantly check myself to see where I am in achieving each one.

Affability, is, “the quality of being pleasantly easy to approach and talk to; friendliness or warm politeness.” In short, it’s likeability. In my opinion, this is the most important of the 5 A’s. “Even if you show up (availability), and have excellent skills (ability), it’s difficult to succeed if your colleagues think you’re a jerk.”² We all know that one coworker that is a total jerk, that is rude or lacks any sort of emotional intelligence to deal with others. Not that we aren’t all, from time to time not in the greatest of moods; but, I’m talking about the person that is constantly like this. We all have bad days, but for the most part being a pleasant person to work with can lead to success with both patients and staff, not to mention hopefully less law suits… While there is a delicate line between professionalism and friendliness, it is important to get along with coworkers and to present a personality that is more optimistic and inviting, especially during difficult times.

Availability, or I would even say Accessibility. Show up on time, establish good communication and respond when needed. I’ll never forget my high school teacher that once said to me, “When you’re early you’re on time, when you’re on time you’re late, and when you’re late you’re f***ed.” It has been a phrase I have lived by for the better part of the last 2 decades. This has importance for a couple of reasons, and although this may sound like common sense, believe me it is definitely not. First, in Medicine, we are often showing up to relieve someone else from work, promptness shows respect for the tired person you are coming to replace. Second, it shows initiative and preparedness. And last, nobody likes waiting around for someone, whether that be a patient or a coworker. Being responsive and communicative helps to increase clarity among a team and being on the same page with closed-loop communication ensures less errors, increased transparency and overall better team morality. As a Physician in particular, having crystal clear discussions with my team in regards to the care of a patient helps overall understanding, agreement and also, most importantly, helps to double-check myself since… Well, I’m human too. When my call radius for the hospital is 30 minutes, I try to be there in less than 15 or hopefully less than 10. When I’m asked to respond within 2 business days, I try to respond within 1. When I’m called for a question, I share my thought process or show up to discuss the situation in person. Overall, I feel this can lead to overall success not just personally but also for a team.

Ability. As a doctor, this is what everyone expects you to have and one of the easier skills to work on, in my opinion. It can not be overstated how important it is to have skill at one’s job, but that’s why it’s called “practicing medicine.” I remember a talk I had with one of my seniors, Dr. Valenti, shortly after becoming an attending. I was nervous to be an attending, and still am, but he so easily said that I would have to constantly reassess what I knew and doublecheck what I thought to make sure I wasn’t slipping into something ‘easy’ and possibly missing something important. And also, I read one time a concept for Surgeons that should be applied to all medicine that was along these lines: Most practice until they make few mistakes, but some practice until they aren’t capable of making a mistake. Obviously an unachievable goal, having this mindset leads to the best success for oneself that you can find.

Adaptability. Ah, now this one I came across myself particularly in the job search in the last year. Not everything goes by the book, not everything is always going to be the same. Being able to have evolution on the go is important. In the last year I have had to change my career goals constantly to deal with the shifting market of COVID-19. I obtained several medical licenses in attempts to broaden my marketability. I settled for a lower salary knowing that it would give me the edge in obtaining a certain position – it worked. I remember being at a facility that didn’t have the normal respiratory equipment for a neonatal resuscitation so I worked with the respiratory therapist to rig an old vent with a small mask and create makeshift CPAP. Adaptability is important, we do it without always being aware of it, but it is one of the most important tools for a Physician and for success in general.

Aggression. Lastly, I present this potential skill as a possibly controversial one, but I couldn’t figure out another word that started with an A, so, honestly for the sake of alliteration and consistently, we’ll use Aggression. Really what I mean is going after something with full earnest and full intent. I had a friend from high school that dropped out of college before it started to go after becoming a race car driver. I asked him, “What’s Plan B?” He responded, with confidence, “There is no Plan B. Having a Plan B takes away from focusing on Plan A.” I’ve made it as far as I have only due to some element of aggression. Whether that is pushing myself to get up early to get something done or to push myself past my boundaries to go after a certain goal, I have been aggressive. With looking for jobs in the setting of COVID-19, I have been particularly aggressive. As stated above, I’ve taken lower salaries, I’ve molded my schedule and availability; yet, I have pushed back when I have felt like I am close to getting taken advantage of. However, as a person that is innately not confrontational, I do NOT mean to say aggressiveness within interpersonal relationships is a good idea – I still subscribe much more to Affability. But, you’ll never get anything done if you’re not aggressive enough about it.

Everyone has their own concepts of what defines “Success.” Everyone has their own model and tools to achieve it. There is not one right answer, nor is there any sure answer. However, with the above 5 A’s, I have found my path and believe that it can help you to focus on these particular skills in addition to whatever you’re already doing. Nobody is perfect, but the goal is striving for perfection, not achieving it. Only then, can you reach Success.

References:
1. DICKERSON DL. THE THREE A’S OF MEDICAL SUCCESS. West Med Med J West. 1964 Aug;5:245. PMID: 14180032. (https://pubmed.ncbi.nlm.nih.gov/14180032/)
2. 5 mistakes first-time locums make and how to avoid them (https://comphealth.com/resources/common-locum-tenens-mistakes/)
3. https://stage-journals.lww.com/jbjsjournal/subjects/Orthopaedic%20Essentials/Fulltext/2020/06030/What_s_Important__The_3_A_s_Revisited.15.aspx
4. https://www.hcplive.com/view/the-three-as-of-medicine