Volume 7 no 4

PERSPECTIVE: It’s not what you know, it’s who you know: diagnosing and healing your informal professional networks

Raphaël Kraus, MD


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PERSPECTIVE: It’s not what you know, it’s who you know: diagnosing and healing your informal professional networks

Raphaël Kraus, MD


Traditional medical training fails to address the competitive realities of the job market and the critical role of informal professional networks in career development and advancement. Moreover, the concept of informal professional networking is scarcely represented in the medical literature. Borrowing from management science, I discuss the roles of informal professional networks; strategies to establish healthy and effective networks; and important barriers encountered by networkers, namely feelings of inauthenticity and inequities resulting from gender and race.


KEYWORDS: networking, professional networks, medical education, professional education, career planning, career advancement


CITATION: Kraus R. It’s not what you know, it’s who you know: diagnosing and healing your informal professional networks [perspective]. Can J Physician Leadersh 2021;7(4):153-158  https//doi.org/10.37964/cr24741


My own path across the landscape of medical training has been rather straightforward. Although not immune to self-doubt, I trod my way through medical school, residency, and a subspecialty fellowship with the naïve conviction that, at the end of the pipeline, I would be met with a neat blueprint for professional success. I have since learned that the shift from the linear structure of medical education — where the required steps are overt, concrete, and reproducible — to the thick bramble of the early-career physician is rife with anxious uncertainty. Many peers echo my experience. How, then, might we better prepare our trainees for

this transition? Top


Although not unique to medicine, postgraduation existential angst among young physicians is amplified by the protracted nature and intensity of our training, which fails to address the competitive realities of the job market and the critical role of informal professional networks in career development and advancement. The focus of our clinical training is rightfully on what you know and how to apply this knowledge to the benefit of the patient. Lost in this pursuit is who you know and the immeasurable value of relationships — the concept of informal professional networking is scarcely represented in the medical literature.


Here, I draw from the expertise of our colleagues in management science to provide an overview — with the early-career physician in mind — of the roles of informal professional networks; proposed strategies to establish healthy and effective informal networks; and important barriers encountered by networkers, namely feelings of inauthenticity and inequities resulting from gender and race.


Why network?


First, let’s distinguish formal from informal networks. Formal networks refer to specified, on-paper organizational relationships — between an attending physician and a trainee or between the hospital chief executive and the chief medical officer, for example. Informal networks bridge professional and social relationships and involve “more discretionary patterns of interaction.”1,2 In other words, we get to choose what connections to forge, which to sustain, and which to break. Often, we cast these “discretionary” links based in shared interests or common ground. Top


However, unlike friendship, informal networking is not purely social. We strategically develop these relationships with people who stand to help us in our work and our careers. Management and organizational science literature have proven time and again that networking is a professional necessity, leading to more career opportunities, knowledge sharing, innovation, accrual of status and authority, in addition to improved quality of life and job satisfaction.3


To network is to weave “a fabric of… contacts who will provide support, feedback, insight, resources, and information.”4 Ultimately, our networks’ greatest power lies in their referral potential: our professional relationships are “valuable to the extent that they help us reach, in as few connections as possible, the far-off person who has the information we need.4 Top


The healthy informal network


Not all informal networks are equal, and size appears not to be the lone — or even the most important — factor. In fact, the most effective “core networks,” made up of those in your inner professional circle, typically range from 12 to 18 people.5 Most impactful are structure and variety: “core connections must bridge smaller, more-diverse kinds of groups and cross hierarchical, organizational, functional, and geographic lines.”5 The results of this selective diversity and breadth are better opportunities for learning, decreased risk of bias, and greater personal and professional growth.


So, who are the key players in a diverse yet selective informal network? The most effective informal networks include people with new information or expertise, people wielding power, and people who dissent, those who challenge and push back. Beyond career advancement, healthy informal networks also nurture engagement and personal satisfaction. For this, our informal networks must include people to lean on for emotional support; people who reflect back the broader meaning and impact of our work; and people who prioritize and hold us accountable for maintaining work–life balance.5


Finally, much like your muscles during a pandemic, professional relationships atrophy with disuse or neglect. The best networkers stick to an “exercise” regimen and “take every opportunity to give to, and receive from, the network, whether they need help or not.”4 Top


Diagnosing your informal network


The six archetypes of dysfunctional informal professional networking

Careful history and examination are key to diagnosing a networking illness. Rob Cross, professor of Global Leadership at Babson College, and Robert Thomas, executive director at the Accenture Institute for High Performance Business, argue that dysfunctional networkers broadly fit six archetypes boxed into three categories of impairment: wrong structure, wrong relationships, and wrong behaviour (see Figure 1).5


Mapping your informal professional network

Next, let’s explore the self-similarity principle (or homophily), our natural tendency to gravitate toward those who resemble us in experience and opinion. Closely related is the proximity principle: as with the Disconnected Expert, we tend to fill our informal networks with people we see and speak to most often. This can be efficient — when we all speak the same language, information flows quickly. However, we risk cocooning ourselves in echo chambers, shielded from differing or dissenting information.6 Mapping out your informal network can unmask any overinvestment in self-similarity (Figure 1). Top


Let’s take the example of Ken (see Table 1). First, Ken lists out his key contacts in the leftmost column, those he relies on most for advice, information, and support. Next, he thinks back to how he met each person, placing the name of the person who introduced them, or the “broker,” in the centre column; notably, one can serve as one’s own broker. Then, he jots down the name of someone to whom he introduced his key contact in the rightmost column — these are times he acted as the broker. Finally, Ken tabulates the number of times his own name is listed in the centre column: two of five, or 40%. If you’ve served as your own broker more than 65% of the time, your informal network is likely “inbred” and you risk becoming the Disconnected Expert or the Biased Networker.6


Cross and Thomas recommend further classifying your relationships by the benefits they provide, whether information, political influence, personal development, personal support, sense of purpose, or work–life balance as described above.5 This shows where your informal network needs bulking and where you can trim the fat. Top


Healing your informal network


“Building a leadership network is less a matter of skill than of will.”4


Having completed the diagnostic exercises, it is time to lay out a treatment plan. Within the described classes of benefits (information, political influence, personal development, personal support, sense of purpose, or work–life balance), what do you have too much of, and who asks too much of you? The Overloaded and Superficial networkers are particularly vulnerable to the accumulation of redundant network contacts. This is the most diplomatically challenging step: excising the superfluous, the overdemanding, and the toxic. Top


Next, where do you need to invest? Recall the diverse yet selective network. Look to fill the holes in your informal network with deliberate attention to diversity across hierarchy, organization, function, and geography — most applicable to the Formalist, whose scope must be broadened beyond formal organigrams, and the Disconnected Networker, who must deliberately seek out those with skills and interests outside their comfort zone. Cross and Thomas remind us to prioritize “positive, energetic, selfless people,” and to seek the recommendations of people both inside and out of our existing informal network.5 As you rebuild, remain mindful of the dangerous allure of self-similarity and proximity (the plight of the Biased Networker). Perhaps the most effective way to evade these hazards is through the “shared activities principle.”6 The most impactful relationships grow not only from common background, but through shared, meaningful experiences. I stress meaningful, as not all activities carry the same networking weight. They should be relatively “high-stakes” (e.g., competing for a research grant) and should demand interdependence.4 Such activities cross many spheres — sports, charity and community work, interdepartmental projects — and, most important, gather people around a central goal (e.g., advocating a health policy initiative) rather than common background.4


Finally, “the best way to get invited to the party is to host the party.”7 Borrowed from the concept of “inbound marketing,” a commercial strategy focused on creating valuable content that draws customers to the product directly in lieu of advertising, “inbound networking” aims to attract valuable people to you.


In essence, writes Dorie Clark, professor at Duke University’s Fuqua School of Business, “make yourself interesting enough that they choose to seek you out.”7 First, Clark suggests that we target what sets us apart. For the Chameleon, this means representing oneself genuinely and with confidence rather than trying to fit in. This is easier said than done — we tend to overlook what makes us unique. Asking those who know us best (e.g., friends, family) to identify the most exceptional things about us, while admittedly awkward, can be a great way to suss this out. Next, become a connoisseur — true expertise, especially if outside what is expected of your field, is powerful fodder for conversation and connection. People like people who know things. Finally, place yourself at the centre of your informal network — have the gumption to host a dinner party or organize a lecture. “The best strategy is to make them come to you.”7 Top


Barriers to effective informal networking


These strategies alone are unfortunately not a networking panacea. Although medical culture is slowly evolving from rigid hierarchies to flatter structures of leadership that foster collaboration, networking with your “superiors,” those likely to open the most doors, is intimidating. It can feel inauthentic, disingenuous — even dirty.3,8 To overcome this aversion, focus on the opportunities for learning and discovery in your networking interactions; think not only about what you stand to gain from them, but also what you can give — trainees and early-career physicians are often better at having their finger on the pulse of emerging clinical and research trends; and “find a higher purpose” — should your networking efforts land you that dream job, what contributions, beyond your own career advancement, would you stand to make to your community, society, academia?3 Top


Most important, inequities and prejudice pervade informal networking as they do all facets of society. In a mixed-methods study of gender differences in science, technology, engineering, and mathematics (STEM) disciplines, researchers found that informal professional networks frequently lack women, are generally composed of only one ethnicity (think back to self-similarity or homophily) and are exclusionary.1 Most striking, although most men in the study reported that gender did not impact network access (failing to acknowledge their privilege), 40% of women described their gender as influential and a quarter reported their minority status as a major obstacle.1 Perhaps it is not surprising that women were found to have more diverse informal networks than men. Despite this greater diversity, women may not feel as empowered to leverage their professional networks: “Women may view asking for something as transactional, so they miss out on the value of the relationships,” says Sally Helgesen, best-selling author, speaker, and leadership coach.9 According to Helgesen, women in the professional context have traditionally been taught to “keep their heads down, do their jobs and expect that others will notice.”10


What’s more — and further compounded at the intersection of gender and race — racialized professionals experience unique, marginalizing barriers to informal professional networking, and are misperceived as lacking power, credibility, or resourcefulness.11 The results can be professionally and personally isolating. Top


In the enduring wake of the Flexner Report (1910),12 the seminal framework for North American medical education forcing the closure of all but two historically Black medical schools, Black physicians remain heavily underrepresented — while Black Americans represent roughly 13% of the United States’ population, they represent only 5% of the physician workforce.13,14 Similar disparities are described in Canadian medicine.15 Moreover, many Black faculty are leaving academic medicine, citing inadequate mentorship, barriers to promotion and advancement, and a lack of supportive work environments.16 Quoting a Black venture capitalist, Laura Morgan Roberts, professor at the University of Virginia’s Darden School of Business, and Anthony Mayo, senior lecturer at Harvard Business School, write: “They don’t know us. They don’t have a rapport with us. They haven’t heard us talk about what we’ve accomplished. Then we’re not going to come up in the conversation when they decide who’s going to get the next high-level job.”11 When marginalized groups are ignored in medicine and other professional spheres, they are disconnected from the informal networks underpinning essential processes both inside and outside academia.17




“The alternative to networking is to fail — either in reaching for a leadership position or in succeeding at it.4


The existential angst of the early-career physician is partly a failure of our training to emphasize informal professional networks as vital to career development and advancement. Borrowing from the wisdom and experience of management science, I outline strategies to dissect, diagnose, and design your informal networks, cognizant of the important barriers encountered by networkers — by some inequitably more than others. With these tools, as health system leaders, you will “purposefully build partnerships and networks to create results.”18 Top



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2. Ibarra H. Personal networks of women and minorities in management: a conceptual framework. Acad Manag Rev 1993;18(1):56-87.


3. Casciaro T, Gino F, Kouchaki M. Learn to love networking. Harv Bus Rev 2016;May:634.

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5. Cross R, Thomas RJ. Managing yourself: a smarter way to network. Harv Bus Rev 2011;89(7/8):149-53.

6. Uzzi B, Dunlap S. How to build your network. Harv Bus Rev 2005;83(12):53-60.

7. Clark D. How successful people network with each other. Harv Bus Rev 2016;Jan.:2-5.

8. Casciaro T, Gino F, Kouchaki M. The contaminating effects of building instrumental ties: how networking can make us feel dirty. Adm Sci Q 2014;59(4):705-35. https://doi.org/10.1177/0001839214554990

9. Helgesen S, Goldsmith M. How women rise: break the 12 habits holding you back from your next raise, promotion, or job. Paris: Hachette Books; 2018.

10. Cohn A. Premier women’s leadership expert Sally Helgesen teaches women how to rise. Forbes 2018;4 Apr. Available:


11. Roberts LM, Mayo AJ. Remote networking as a person of color. Harv Bus Rev 2020;7 Sept.

12.Flexner A. Medical education in the United States and Canada: a report to the Carnegie Foundation for the Advancement of Teaching. New York: Carnegie Foundation; 1910.

13. Diversity in medicine: facts and figures 2019. Washington, DC: Association of American Medical Colleges; 2019. Available:


14. Hlavinka E. Racial bias in Flexner report permeates medical education today. MedPage Today 2020;18 June. Available: https://tinyurl.com/2knp2he6

15. Kassam A. Canadian medicine has a diversity problem. Toronto Star 2017;3 Sept. Available:


16. Blackstock U. Why Black doctors like me are leaving faculty positions in academic medical centers. STAT 2020;16 Jan. Available:


17. Milkman KL, Akinola M, Chugh D. What happens before? A field experiment exploring how pay and representation differentially shape bias on the pathway into organizations. J Appl Psychol 2015;100(6):1678-712. https://doi.org/10.1037/apl0000022

18. Leads leadership capabilities framework. Ottawa: LEADS Canada; 2018. Available:




Raphaël Kraus, MD, FRCPC, is a pediatric rheumatologist and childhood vasculitis clinical research fellow in the Department of Pediatrics, Division of Rheumatology, Hospital for Sick Children. He is also an MSc candidate, system leadership and innovation, Institute of Health Policy, Management, and Evaluation, University of Toronto, and will be joining the Division of Immunology and Rheumatology at the Centre Hospitalier Universitaire Sainte-Justine as an attending rheumatologist in September, 2021.


Author declaration: I have no conflicts of interest to disclose, nor have I received support in the form of grants or other industrial support relevant to this submission. The views expressed in the submitted article are my own and are not an official position of the institution.


Correspondence to:




KEYWORDS: networking, professional networks, medical education, professional education, career planning, career advancement