I am nearing the one year anniversary of my first day as a new faculty member and have been reflecting on the past year. A number of thoughts and questions regarding the transition from resident to fellow to faculty member came to mind and since my institution hired a bunch of us “newbies” around the same time, I was interested to know if my colleagues had similar feelings, or at least advice to offer those who are about to embark upon their first year.
Below you will find a list I have compiled of questions and answers from a handful of my colleagues also finishing their first year.
What were the unanticipated difficulties encountered during the transition from resident/fellow/faculty?
- Finding time to pursue my academic interests. I knew it would be hard. I did not appreciate just how hard.
- Convincing my mentors to make time for me, before I’d proven that my ideas made any sense
- I think the hardest thing at first was being the “buck stops here” person. It was easy to be confident in my plans when I knew someone was watching but when you are the last check it is different. I also didn’t realize how much other “stuff” there is to do other than take care of patients. Things like coding and billing aren’t taught well in residency and fellowship so that took some getting up to speed. Also I never really thought about communication with referring docs, outreach, marketing, etc. I guess the business side is the best way to put that.
- Not a difficulty per se, but the decrease in actual clinical time (operative time) felt very extreme after operating 5 days a week. Also, having to do operations that I hadn’t done in several years right out of the gate was challenging.
- Clinical practice: clinical practices that I’ve learned during fellowship and/or residency vs. existing practices of your division. Sometimes it could be something that you welcome because you didn’t like the ways it was done during your fellowship/residency anyway. However, sometimes it could be something that you feel strongly about and don’t want to change.
- Teaching: as a fellow, you’re often assisted by your attendings who knows what they’re doing. In a practice where there’s no fellowship, the level of assistance can be varied. Some of my colleagues would book difficult cases with 2 attendings. I’m still not used to that but sometimes I feel like it’s a struggle when your chief resident isn’t as prepared with the case.
- Academic: setting up a lab is way slower than I expected. Everything from hiring personnel, protocols, proposal, etc. Your ideas might not be as “sexy” as you think they are at the beginning – the more you do more research about it, the more you might think it’s so low impact.
What advice do you have for new faculty making the transition?
- Be aggressive about blocking time for yourself. It’s part of your job but only you will appreciate that.
- Don’t leave gaps in your calendar — book yourself for research or reading or whatever, but don’t leave your calendar open
- Find people at your level and work with and around them — if you don’t have a grant writing group, for instance, you should make one.
- Get a plan in place early. Even if it’s not a great plan at first, it will help to have a framework on which you can build your mentors and funding
- Be friendly, introduce yourself to others, work on a clear set of expectations early on (even while negotiating the job), know what you want and what you are willing to compromise on, know that it is going to be challenging, look to the support of your partners and mentors.
- Borrow your mentors’ templates, clinical resources (handouts), preference cards. Collect them as you go through training. Make notes of the techniques you want to employ in your practice. Better yet, make videos of the procedures you will do. As you start, don’t hesitate to reach out to those that trained you for advice and technical help. And don’t be afraid to reach out to your new partners for help with clinical/operative decision making or operative help.
- Communicate with your group partners often, especially if you’re doing some difficult cases.
- Communicate with the NPs – they know how the service is run
- Spend time to think and write your research proposal/grants early and revise it frequently. Stick with your plan, don’t change it too much.
Thinking back to the expectations of and by you – were they congruent with what you thought they would be?
- I think so, for the most part. But we had some personnel issues that required me to put research on the back burner for a while, and which were not anticipated. You always have to put patients first, of course, so that was fine, but it was important to be open with my partners about what I was doing vs. what I wanted to be doing.
- Surprisingly, yes. Crazy as it sounds the job turned out to be exactly what I expected it to be. I think everyone was pretty transparent on both sides when I was negotiating and thankfully there haven’t been any big surprises and only a few small ones.
- I think the expectations are reasonable; it’s just that they often take longer to get there
What time management issues have you encountered and have you figured out the magic solution (ha!)?
- See above about filling out your calendar. Also, keeping my office door closed and/or working outside of my faculty office (in my research office, for instance, or outside of the hospital all together) was helpful.
- I have found that staying organized and trying to stay on top of things works best for me. When I am on service, I do my best to get each days work done by the end of that day (sign the notes, do the dictations, etc). I also try to do the same with email, although more triage is needed there. It isn’t always possible, but I find if I get behind, then things start to snowball. I also look for areas of free or protected time where I can schedule upcoming things (time to work on slides or a paper or a grant or a review, etc). I even put them on my calendar to block the time from others and to keep me on track.
- Having a “research day” is such a misnomer. My research day gets filled up fast with non-research duties (see the part about saying “no” below!). I have no magic solution. Turning my pager off might help!
- Big issues with those who cover many hospitals. A patient encounter isn’t just in clinic and in OR. You’re expected to follow up on studies, communicate to PCPs, arrange follow up/studies. These things take time that eat into your research time or even your time with family.
Have you encountered difficulty saying “no” when you are so new?
- Most of the time. There was a long period where we had to just be good soldiers while we were understaffed, and it was hard to work out of that, but when it started getting old I talked to my partners and it got a LOT better.
- This has been a little bit of a problem, but my division chief has been good at protecting me and helping me triage. I guess my advice would be to bounce things you are approached to do off of a mentor or division chief so they can help you sort out what is useful and what is busy work. Obviously this is harder when the division chief is the one asking you to do something.
- Also no magic solution for this.
- Yes, I feel like I always wanted to say “yes” at the beginning. There’s an up-side in that as I can get my clinical skills to the level that I feel more comfortable being independent. Also, be “picky” in saying “yes” – for me, I like a subspecialty within my specialty with cases that are rare so any opportunity to do one, I will mostly likely say “yes”. I don’t have a problem saying “no” to cases that I think don’t offer any benefit in term of clinical growth or interest.
Can you reflect on what you didn’t know as a resident about being a new faculty member…aka advice to the senior residents about why they should remember to cut some slack for new faculty and drop the judgment about how much you let them do, how much you check in, etc?
- I tell the residents that I’m still learning how to do these operations as an attending, which means that sometimes I’m going to have to do more than they would like. Generally speaking, I find being open about that, and not pretending that I know everything, is good. There’s nothing I hated more as a resident than a new attending who said, “What I usually do here is…” or “my practice is to…” when you knew full well it was their first time doing the case as the attending.
- One of the great things about being a trainee is you get to see different ways of doing things from each of your attendings. As you enter the last part of your training, start to make sure you know how you are going to do things when you are on your own. There will likely be some different instruments and cultural norms where you go for your first job, so you need to know your process, what you can be flexible on and what you can’t. It was also helpful for me to get an OR pick list for different cases from the attending(s) I wanted to emulate and a list of what instruments are in each pan. That way I was able to get a few new things when I came here so I could do things the way I was trained. It also takes an adjustment to learn to trust the trainees, especially when you are just getting to know them. Figure out what the critical things you need to know are, and make a determination early on by observation who you can trust and who you can’t.
- I was that senior resident that gave a lot of grief to the new attendings for not letting me do cases. I have a whole new level of empathy for them, and have even reached back out to them to apologize. Its hard! I’m a stealth checker, but try to let the residents think they are doing their thing without much of my involvement on the floor.
- Ownership of patients. I want them to have the perfect care – both in and out of OR. For me, there’s no room to trial and error in little kids. I tell the residents to put themselves in the parents’ shoes – imaging that their kids are being taken care of here. I get it when parents say “I want YOU to do the operation”. Of course, if I think the residents can do any part of the operation – then I’ll supervise them doing it – but I won’t let it compromise the care of my patients.
Well, there you have it – from the mouth of babes. It was comforting that we are all going through the same transitions. It has been an exciting and grueling time both physically and mentally. I feel like I have had more freedom (my schedule, operative decisions, patient care decisions, research questions) but this has come with a cost…I feel I have aged more in this year than in any year previously. Maybe that’s a good thing – I never had a patient ask me how long I had been doing this or if this was my first year. I guess a few wrinkles are worth it!