Q&A: Why Saying 'No' is a Career Skill as a Clinician, with Adam Friedman, MD

Adam Friedman, MD, FAAD, is professor and chair of dermatology at George Washington University School of Medicine & Health Sciences in Washington, DC. At LEADderm 2026, he built his table discussion around a skill he says rarely factors into clinical training: saying no.¹ LEADderm was founded to address what organizers call dermatology's missing curriculum, covering skills such as mentorship, negotiation, and practice management.¹

Friedman used his own struggle with overcommitment as the starting point for a broader conversation about protecting limited time. Dermatology remains one of medicine's most selective specialties.² Friedman says competitive pressure trains applicants to say yes to nearly everything long before residency even begins, and the habit persists into academic and practice leadership roles.

Friedman's table centers on practical tactics: delaying an answer, and weighing whether an opportunity serves a career goal or personal energy. He also invites the requester into a shared decision about feasibility, an approach modeled on shared decision-making in patient care. He is also delivering an unrehearsed product theater at the meeting, delegating slides in real time with a co-presenter he had not previously met.

Friedman spoke in this Q&A discussion with HCPLive on-site at LEADderm 2026 in Newport Beach, California, about managing competing career demands.

HCPLive: Can you walk us through the theme of your table here at LEADderm 2026?

Adam Friedman, MD: When I was asked to come up with a discussion point around the table I am positioned at with attendees of LEADderm 2026, the first thing that came to mind was the power of yes, and even more so, the power of saying no, which, full disclosure, I am absolutely terrible at. Part of this is not just educating those sitting with me, but also an opportunity to self-reflect on how I manage my time and consider when I say yes and when I say no.

I'm a firm believer that early in your career, you should say yes to literally everything. You have no idea what door will open from saying yes to something that seems seemingly simple and how it can propel your career forward very quickly. The problem is you get very used to saying yes, and as you ascend the ranks, whether in academia or in practice, there is only a finite amount of time. So what you end up doing is not multitasking, which is not a real thing; you end up diluting your efforts. If you say yes to everything, you are giving less time to each thing and not doing anything with your full attention, and that's when you start dropping balls and undermining your reputation.

I think the biggest issue for any of us full-on yes responders is we're afraid if we say no, the opportunities disappear. I can tell you that is absolutely not true, unless you say no in the wrong way, which is also very possible. So I'll provide some tips I've learned over the years for how to say no in a way that doesn't disenfranchise others from inviting you again.

First, when you're asked to do something, do not shoot from the hip. You do not need an answer that second. You can say, let me circle back, let me look at my schedule, let me see what I can do. What that allows you to do is step back and ask: do I need to do this? Do I need to do this right now, for career gain, for personal gain, for personal life? And even if I don't need to do it, is it something I enjoy that will fill my cup so it invigorates me to take on the other soul-crushing things in my career?

The other thing I've started doing recently is applying shared decision-making, the same concept we use in patient care, to yes-or-no requests. You can go back to someone and say, I would really love to do this, but here are the things on my plate right now. What do you think? How do you think I can do this? Now you've passed it back to the person asking, and they may say, you're right, your plate is too full, you probably shouldn't be doing this. And now you didn't have to say the negative word, no. No doesn't have to be negative, but it's often perceived that way.

Taking time to make the decision, and including the person who asked you, takes the pressure and anxiety off of you. Now you've shared that load, and the perception will be that you thought about it critically, that you do want to do it, but you also want to give it your all. You'll be better respected for it.

HCPLive: What do you feel is the biggest contributor to dermatologists taking on too much?

Adam Friedman, MD: I think it actually starts before our training, given dermatology is one of the most competitive fields. Not to scare anyone watching this, but last year's match rate was 46%. When I went into dermatology, it was roughly around 60%. I think because of that competitive nature, we are pushed to say yes to everything because we have to. If we want to get to the promised land, we have to do as many things as possible.

Even during residency, even though we have our MD and training licenses and are seeing patients, we still have this mindset that you've got to say yes to be part of the club, and it's really hard to learn how to turn that off. Even where I am in my career, sometimes I still think of myself in that position of trying to get into that cool club, so to speak, and it gives you that little bit of anxiety that pushes you to say yes even when you probably shouldn't.

So I think taking a step back to evaluate whether what you're being asked to do is really important right now is something we've never really done, because we've always said say yes, say yes, say yes. Now you actually can say not right now, or I'd love to but I'm just not available. I don't think anyone has talked about that along the pathway. It's always been, if you want this, you've got to suck it up and just say yes. As you go through your career that changes, but no one has given us the green flag for when that can happen.

HCPLive: Are there other key points you highlight in your LEADderm presentation?

Adam Friedman, MD: One of the things I get to do at LEADderm 2026 is a product theater, which is no different from any conference. What's unique here is I'm doing it with a fellow faculty member I've never met before, and to keep it a little spicy, we didn't prep whatsoever. The LEADderm twist is we are going to delegate slides to each other in real time, just like you would in the real world, with some negotiation around whether my partner wants to take a slide or not, and vice versa.

That kind of unique spin on something we see at every conference really makes you think critically about how to deliver a presentation in partnership with someone else, because that mirrors what we do in negotiation regardless of where we are in our careers. We might negotiate in real time with a medical assistant, a practice manager, a resident, a fellow attending, or even the C-suite. There isn't all this prep time before a conference; it has to happen often in real time, and that's why I'm excited to present in that manner. Who knows what's going to happen? It'll be a huge success, of course, but we'll see. TBD.

Editor's Note: This transcript has been edited for grammar and clarity using artificial intelligence tools. Friedman had no relevant disclosures of note.

References

1. LEADderm. About LEADderm: a new kind of dermatology conference. leadderm.org. Accessed September 13, 2026. https://www.leadderm.org.