One of the greatest challenges for surgeons, particularly for junior faculty, is saying no. To anything. We want to 1) serve our patients who are in need, 2) be a helpful part of the health care team without offloading work to others, 3) ensure that our operative skills are maintained, 4) pursue other non-clinical interests (research, education, etc.) and 5) adhere to the adage of being ‘affable, able, and available’ in an attempt to build or maintain a clinical practice.
But nobody—not even the most accomplished, efficient, broad-bandwidth individual—can say yes to everything. Science has become too complex, funding too competitive, clinical care and regionalization too specialized, administrative responsibilities are expanding, and family (appropriately) demands the same quality time we give our patients and research teams.
Given individual deficiencies in time management, some institutions have taken that decision-making away from junior faculty. Some limit the clinical exposure of their junior faculty, either by limiting their RVU output or placing them in hospital systems that are not too demanding. Others place requirements on grant applications and funding, incentivizing (if not demanding) quality pursuit of extra-mural funding. But few institutions have the resources to aid their junior faculty in ‘saying no’. And the culture of surgery still (thankfully) demands personal responsibility, continuity, and ‘finishing’.
We should look to our senior faculty for guidance in this regard. Their career—and personal—experiences are invaluable in providing perspective for us all. The notion of senior partners having a reputation for ‘protecting’ themselves must be reconsidered—I would argue they have probably figured ‘it’ out without compromising patient care, their career or personal commitments. And to a degree, our senior colleagues have a responsibility to help their junior partners say no—we are often less empowered, insecure, or unwisely wanting to please everyone.
Everyone (I think) would agree that we must learn how to say no—but that is easier said than done. A dialogue that addresses this conundrum, with support and wisdom from our more experienced partners, is critical for success of our junior academic faculty.
