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Laying a Strong Foundation: How to Flourish as a Young Attending

By Currents Editor posted 06-27-2018 15:17

  
By Jennifer A. Kim
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Securing one’s first job as an attending is an exciting time! The first few years of being an attending form a crucial foundation for success throughout the remainder of your career. For those who choose to enter academics, we interviewed Dr. Thomas Bleck, founding chair of the Neurocritical Care Society and director of clinical neurophysiology at Rush University Medical Center; Dr. Jonathan Rosand, chief of neurocritical care and emergency neurology at Massachusetts General Hospital; and Dr. Jose Suarez, director of neurosciences critical care at Johns Hopkins Hospital and current vice president of the Neurocritical Care Society. (Note: This interview has been paraphrased for brevity.)

What should new faculty do in the first few months to ensure a successful start?

Bleck: 1) Make sure you’ve completed all mundane credentialing requirements because you don’t want to impact your start time and make the chair mad at the start. 2) Latch on to another junior faculty member (ideally at least 2 years ahead) in your division for advice. 3) Understand the conditions of your employment (like grants) and have a back-up plan from the start. Even if you have a start-up package or initial grant fund, start thinking early about what resources are available and needed for your next grant. 4) “Shadow” round another faculty member when you arrive to see the flow in their unit. 5) Make connections early, including with financial administrators to get to know them and build trust. 6) Billing training is part of credentialing, but understand local rules to avoid audits. 7) Navigating the academic landscape of a new institution takes time and can be a challenge. Set goals for yourself, but realize they are soft as things are likely to derail them.

Rosand: If you’ve found yourself a good institutional fit and negotiated effectively through building trusting relationships, then your sponsors are likely those most involved in your recruitment. Who spent the most time with you or advocating for your vision? Keep those people in mind because they are the most invested in your success. It is important to identify mentors early who could serve as role models or sounding boards invested in your future. NCC is also highly interdisciplinary (neurosurgery, neurology, critical care), and it is important to know how your new ICU is overseen within the hospital hierarchy. For example, neuro-ICUs are often fundamental to maintaining neurosurgical volume, so the neurosurgery department should also be invested in your success.

Suarez: It is very important that new faculty understand what is expected of them from the beginning to make sure that they meet those expectations. It is equally important to set realistic and achievable goals with their division or department director/ chair. New faculty should review and understand the pathways for promotion and advancement (in academics) or other administrative and clinical advancement (in nonacademic). Set specific yearly goals so when the time for promotion comes faculty members have everything covered and they can proceed without hiccups.

What are common challenges that junior faculty members face, and how should they approach them?

Bleck: Depending on department culture, you may be asked to provide coverage or other duties you weren’t expecting when you arrived. If you do commit to a task, take those commitments seriously and do a good job, as it reflects upon you at this early stage. If you are overwhelmed, ask your division chair for advice on balancing these “good citizenship” tasks with your other goals/ duties. Secondly, don’t be shy about asking for help, especially clinically. Put patient safety before any pride/embarrassment and you will be viewed as a better doctor. If after the first year or two, you are having difficulty with meeting expectations, like securing grants, discuss options with your division and department chairs early. Actively check in with senior members on how to improve. Take advantage of faculty development programs/office as a resource outside of the department.

Rosand: It is challenging to join a new community and find your voice. Learn to advocate for yourself. First, determine the metrics for promotion and success at your institution. Also, saying “no” can be difficult, but under promising and over-delivering is preferable to the opposite, especially for your first impression. Rely on mentors to advise you on when and how to say no. Don’t get burdened with committees or review articles that are time consuming at the start. Keep the perspective that your career is long-term. It is common for a new hire’s role to get redefined as they settle into their new environment. That transition, when successful, is usually because mentors and sponsors helped generate exciting new opportunities.

Suarez: In my opinion, the most common challenges are overcommittment, unrealistic goals, lack of proper mentorship and lack of protected time for scholarly activities. New faculty members must learn that it is perfectly acceptable to say no to activities that will not contribute to their academic advancement. They also need to negotiate protected time for scholarly activities prior to accepting a new position. New faculty should also know their limitations and be aware of burnout symptoms. The latter should be addressed immediately. They should notify their mentors and division chair if they feel their career path is not going in the right direction.

As an ICU director, what do you feel are the most important ways to foster success in your young faculty?

Bleck: It’s most important to get to know each new faculty and know their personal goals. Help direct them, foster their interests and keep them focused. Senior faculty should provide professional generosity like opportunities to write reviews, chapters or give talks to boost their visibility. It is equally important to protect them from mundane tasks. Keep them from overcommitting so they can perform well in what they take on. Basically, promote and protect!

Rosand: Most important is to be certain that they are good fit when you hire them. Have a vision of where they are headed and be comfortable with that vision shifting as they develop their interests and find their voice in the group and institution. Make sure there are mentors around.

Suarez: It is important to assign mentors from the start and offer a friendly and collegial atmosphere. It is our role to guide them to establish cordial relationships with the other faculty members and staff. It is also imperative to protect their time to dedicate themselves to scholarly activities.

What kind of mentorship is important for young faculty to succeed?

Bleck: Find someone who will listen to what you want to do. Have clear thoughts about your own career and draw upon people who inspire you. Make your gratitude for the relationship known. Bridging disciplines is becoming more important, so find mentors both within and outside the division to bring new collaborations.

Rosand: Find a group of mentors you can trust, who have experience at your institution and who work within disciplines that are relevant to your own. NCS is helpful for junior faculty members because so many people in the society have experienced the same issues. Having a network of colleagues from different institutions who are at your career stage can be crucial.

Suarez: One mentor is not sufficient. They should seek out at least three. The goals and expectation of the mentor-mentee relationship have to be very clearly stated from the beginning. These people should be truly invested in the mentee’s future. They have the mentee’s academic and personal futures as priorities and support them in an altruistic manner. The primary mentor should be someone senior with a record of successful mentoring and excellent scholarly activity. The other mentors may perform activities not directly related to the mentee’s career but can provide guidance. The other advantage of multiple mentors is the opportunity to balance the relationships. If the primary mentor relationship turns toxic, mentees can seek advice from other mentors. Mentees are free to break up a relationship if they feel the mentor no longer prioritizes their interest, including not meeting regularly, providing constructive feedback or becoming direct competitors. In this case, the mentee should break free and find new mentors to avoid pain and future disappointment.

Any parting words?

Bleck: Whatever you do, have fun with it or you won’t be able to sustain it. Success requires forging something that didn’t exist before. Take advantage of unexpected opportunities.

Rosand: Take work-life balance seriously to be happy, and work to achieve it. Try to always be home for dinner when you have young kids (you can always work after). Participating in family life keeps you present, and those are precious years.

Never say yes immediately; think about it first.

Rather than using competing job offers, negotiate based on understanding and demonstrating your value. Only bring a competing offer to the table if you are seriously considering it.

Suarez: New faculty members should remain enthusiastic about their future and keep their long-term goals in mind. This is not about who gets there first but who gets there while accomplishing all their goals.

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