Training for a Career in Academic Surgery

This is a piece I wrote for the Association of Academic Surgery Official Blog, The Academic Surgeon.

Recently my fellow residents and I attended the AAS Fall Courses. The air in the DC hotel conference room was thick with the ambition of residents, fellows, and young faculty. To my fellow residents and I, the unofficial theme of the conference was: “Be excellent. Be excellent in all ways as soon as possible.” The roadmap to success held a dizzying number of to-dos: Find a world-class mentor who is also your friend. Assemble a mentor group. Join committees. Become an officer. Get your NIH T-K-R grants. After two days, I had to suppress feelings of “how am I going to accomplish all these checkboxes, I’m already behind!”

Surgeons, ready-made natural perfectionists, are bound to feel troubled when transitioning into academics. An academic surgical career demands compromise and imperfection in some area – education, research, or clinical practice. The struggle to maintain excellence in all facets appears to be a major source of stress. Perhaps the conference’s most discussed topic was “how to say no.” That question emphasized the unspoken anxiety of a young academician: wanting to continually push for success, yet afraid to show weakness or limits. Being any less than perfect in every way is to be avoided at all costs.

How do young surgeons address difficult situations in their early career? We heard only one: work harder. One presenter overcame his lack of support by obtaining an additional graduate degree, as an attending, without sacrificing his clinical productivity. One of his messages: it’s ok to say, “I don’t want to bring work home,” but—good luck climbing up that academic ladder! I admire his conviction; however, the “compensate by working harder than everyone else” has its limits. Conversely, the lectures on time management and work-life balance came from surgeons with the most celebrated success. Lists of “secret ingredients for success” likened academic surgery to stopping by the grocery store on the way home. Little was said of what difficult decisions had to be made, or what hardships must be anticipated and prepared for.

The adversities are there. In 2009 32% of academic surgeons reported they would not recommend academic surgery to medical students or their children. Almost 1/3 considered a non-academic career due to their educational debt, which is only rising for new graduates. There is new scarcity of NIH funding. Upcoming healthcare reform is assured to bring about increased administrative and clinical duties.

I believe a candid conversation about navigating an early academic career, particularly the hazards and pitfalls, would be a welcome, tremendous benefit to trainees. What activities were crucial to success, and which are low yield and can be minimized? When are the right times to refuse to compromise, and when is compromise necessary? How does a young academician identify and improve a bad situation? What are the frustrations, or factors that can limit an academic career? Can we do anything to change or avoid them? An open, uncensored discussion won’t drive away aspiring residents. Rather, it will allow us to make an informed decision about our own careers, set realistic goals, manage our research time efficiently, and ease our anxiety.

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