Early Career and the Path Without Direction: What Can Be Done About This?

Getting Lost

I graduated fellowship in 2015 thinking I knew what I wanted in my career. What I wanted did not equate to things just falling into place. Quickly I realized that a junior physician can get easily distracted with “opportunities” for extra positions, research projects, clinical work in addition to life outside work. I was also in a place where I had no friends or family outside of my husband and 3-year-old. I was a foreigner in this big academic center. In my first year, I was “catching” up and trying to finish leftover research projects, trying to “make-up” for lost time with my family and basically just adjusting with this new responsibility in this new environment. As I went through 6 months into a year, I realized what my strengths and areas of improvement were. While I was going through this period of self-reflection, I would read about other neurointensivists around the same age as I publishing multiple studies, and getting multiple grants. That caused a sense of anxiety and panic in me resulting in me questioning where I was in my career. I would work with this feeling at the back of my head and the vicious cycle of non-productivity in my career started. I accepted several departmental and institutional projects thinking that it was increasing my academic productivity. I started research projects, educational curriculum, and established collaborations. By the end of the year, I had a lot of things going on, but when I asked myself to what end, I did not know the answer.

Collaborate Outside Your Department

I had to reach out to a friend. She was one of my friends that I knew was going to be successful in her academic career. She told me that she had a hard time also as a junior attending. But she started looking for collaborations outside her department. That helped open up more opportunities for her to learn what direction she wants for her career. It opened up opportunities for her to strengthen her career path and research career. Taking her advice, I started reaching out to basic science researchers, academic administrators, internal medicine physicians, and other intensivists to just talk and discuss their thoughts on academic career and research. This led me to the opportunity of being one of the first 7 clinicians asked to apply for the Masters of Science in Clinical Investigation in our institution under the Graduate School Dean’s scholarship. I considered this a nudge towards “A” career direction.

On Mentorship and Sponsorship

A lot of institutions struggle with mentorship and how to have a successful sustainable mentorship program for faculty. I struggled to find an institutional mentor. Mentorship is one of the most important but not readily available career development tool to enable a successful career path. However, not everyone understands its importance. Mentorship involves someone who can help both personal and professional development in terms of improving skills towards a goal, provide feedback and is not limited by rank or institution (1). I had great mentors in my medical school, residency and fellowship. However, as a junior attending, I felt like I was in limbo. Am I supposed to mentor residents and medical students? Should I look for a mentor as an attending? Where do I even start?

Because of collaborations, in a social media forum, I saw a discussion regarding struggles in mentorship and someone mentioned the best book about it: “Mentorship in Academic Medicine”. I decided to commit myself into reading this book and realized that mentorship is not a “boxed” definition where you will have one mentor tackling several aspects of your career. As a matter of fact, it is encouraged to have several mentors who will guide you. With this new knowledge in mind, I continued communication with my former attendings for them to be my external academic mentors providing me with a broader view of my career trajectory. I identified a “clinical mentor”, someone I will discuss cases about, someone who will give me honest feedback of what I could improve on with patient management. I identified a “business/administrative” mentor who I can go to regarding matters of hospital management and administration strategies. I also identified a “peer mentor” whom I can talk to and discuss similar things that we are going through as junior attendings.

The importance of sponsorship was never instilled in me until I became a junior attending. The word “sponsor” means “to pledge” from the Latin term “spondee” (1). Sponsors focus on “enhancing the visibility, credibility and professional networks” (1). A sponsor can also be your mentor however a mentor does not necessarily mean that they are also your sponsor. I have been fortunate to be mentored early on to be able to gain the trust of several sponsors that have provided me with opportunities and have pushed me to face and accept new challenges. Overall, mentorship and sponsorship was extremely important in molding me towards having a better direction in my career.

Be Part of the “Blue Ocean” Strategists

When asked about “life-changing” book recommendations, I never fail to mention “The Blue Ocean Strategy” by W. Chan Kim and Renée Mauborgne (2). This book stopped my habit of questioning my self-worth against others in my profession. It was eye-opening. It basically teaches you to approach a problem using the “blue ocean” strategy which is to be innovative to the point that the solution to a problem opens up new ideas or solutions that make the innovation unique and makes the competition irrelevant. This was how I thought of utilizing the “Hogwarts” and incorporating “games” and education to be able to sustain the interest of residents in didactics. This enabled me to conceptualize an evolving simulation program for neurology residents to prepare them for independent call. Both of these projects led me to be more “in-touch” with the residents and open the door for the opportunity to be involved with medical students. Because of this, I found a deep interest in mentorship which led me to participate in the Women in Neurocritical Care Section mentorship program, as well as, Women Excellence in Mentorship group and Women Issues in Neurology section.  Be an innovator and make competition irrelevant. I stopped comparing myself to others, I learned to appreciate more and I was able to focus. This approach became a part of my problem-solving method not only for myself but in any project that I am part of.

Look Back and Be Grateful            

I am not perfect. I do have a better sense of direction now, in my career. However, I would not have had this direction if not for all the people that supported my growth. I never fail to look back and just be thankful for the opportunities, challenges, and guidance that they have given me. And with all that I have received, I try to pay it forward. To the best of my capability, I try to mentor and sponsor. I try to teach my mentees to face forward but to not forget to look back sometimes and appreciate lessons learned. I tell my mentees that I owe who I am and what I have to a lot of people. “My” achievements are never mine alone. Someone has always opened a door to give me a chance and I try to do the same. It is hard to be an “early career attending” especially when there is no specific instruction given to us when we graduate as to what direction we should take when we become attendings. But we have to remember that there are always people who are around us that can nudge us in the right direction if we keep an open mind. We have to be humble to know that we do not know everything and that what we know will never be enough. And when we find our path, don’t forget to look back and be grateful.

Hana Nobleza, MD, MSCI
Neurointensivist
Bridging the ICU Gap Moderator
iWIN Conference, Executive Planning Committee

References:

1. Gottlieb AS, Travis EL. Rationale and Models for Career Advancement Sponsorship in Academic Medicine: The Time Is Here; the Time Is Now. Acad Med. 2018;93(11):1620‐1623. doi:10.1097/ACM.0000000000002342
2. https://www.blueoceanstrategy.com/what-is-blue-ocean-strategy/, Accessed: May 25, 2020