first 90 days in academic medicine 052516
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[00:00:00] Hello, and welcome back to the Academic Medicine Strategy Podcast. I'm your host, Stacey Ishman, and today we are talking about the first 90 days in academic medicine and what actually matters. And the reason we're talking about this is it's not what you think. So in my first year as an attending, I had no filter, and I don't mean I said whatever I wanted, although I might have done more than I should have, but I mean I said yes to everything.
I had a small child at home, I was working on getting pregnant with the next one, I was finishing my master's degree, I was starting as a new attending, I was trying to get pregnant again and it was not going well, and I still said yes to everything. And I mean everything because I was new and that's what I thought I was supposed to do.
And what got crowded out was time with my son, time to study any personal relationship that was not directly related to work. My husband carried that primary weight of parenting, and I missed pediatrician appointments. I never went to the supermarket. I became a [00:01:00] weekend parent and, only when I wasn't on call, so that was every other week.
And I wasn't failing 'cause I lacked discipline. I failed because I had no infrastructure. There was no framework for me to start with. I didn't understand where my yeses and nos should have. I didn't even know what a filter was. And so I know this happens to a lot of faculty today, and I wanna help to make sure that doesn't continue Now, in your early career, you feel like everything's urgent.
There's pressure to say yes to everything. You're new. You don't even know the culture unless you train there, and then you still don't know the culture because things change. Things are not the same when you're a resident as they are when you're attending, and you don't understand if there's a fantastic relationship with the other department or not a great relationship.
There's a lot of uncertainty. And I can tell you, I had some great mentors. I just didn't feel comfortable asking all the questions that I wanted to ask. I didn't wanna look stupid, or I just felt like it wasn't important enough, even though it was critically important for me to figure out what I was doing with my career.
So the requests that [00:02:00] arrive in the first three months of practice are not always calibrated to your career. They're oftentimes service that the department needs, and there's some of that you should say yes to. But there's some of that you can craft to the things that you care most about. The department needs a lot of things.
It may be that there are several that are very well aligned with what you wanna do, but you have to start by knowing what you wanna do, and most of us don't know. I didn't know. You'll be busy, you'll be helpful, and you'll be quietly falling behind in the work that actually determines your promotion. And many of us don't even know what that criteria is.
We think we know. We have this vague idea, or people tell us, "This will be great for promotion," but is it? It really depends on what your promotion is supposed to look like. And so what I really want you to do is think about the fact that this first 90 days is setting up the expectations for your availability.
If you yes, say yes to everything, then they expect you to say yes to everything, and the day you say no, they're like, "Ugh, what's wrong with Stacey?" There's nothing wrong with Stacey. She's overwhelmed. She's exhausted. She's tired. This is not aligned. She's not interested. All of those are reasonable. [00:03:00] But you've taught people that you say yes to everything, so there must be something wrong, and it's hard to change as you move along.
It gets harder as you move, although doable, so don't worry. But it is fantastic if you can start strategically, and it's dramatically easier than trying to reset several years down the road Now, what actually matters in those first few months is establishing your clinical foundation, but not to the exclusion of everything else.
It is not that you have to say yes to every single case, every add-on appointment, unless you're, not full and you have lots of space. But clinical credibility is non-negotiable, and you wanna make sure that you're excellent at what you do, that you're kind to other people, that you're somebody they wanna call.
But it doesn't mean that you wanna be the most available physician in the department, because then you just get dumped on with everything, including complaints that you never wanna see in your clinic or that are no- not your expertise. So what you do wanna do is be reliably excellent in your clinic, but don't spend all your time trying to fill it up.
It will fill [00:04:00] up. I have never met anybody who was really concerned in the long term that they couldn't find enough patients. It's not a problem. There are not enough of us. It will come. So instead of being worried that your clinic isn't full, and I know that your boss or the administrator is saying something to you, but you have a guaranteed contract at the beginning for a reason.
We know it takes time to fill up. At the same time, you have this time that's never coming back to you. So protect that time for whatever your primary research interest is, or education interest, or curriculum development, whatever it is. But set it up so that your scholarship is gonna be something that can shine through, that you can create.
And if you arrived without any deep work scheduled into your calendar- I'm gonna tell you, you need to find some. Even if it's one day a month, even if it's a half of a day a month, you need to find some time that you can actually think and then m- make sure you're moving your career forward on the things that you care about.
But in an ideal world, you build that schedule before the calendar fills up, and [00:05:00] it's so much easier now before you're incredibly busy. It may align a research meeting with another department. It may align with a special clinical meeting that's important for your research or for your clinical interest.
But I want you to pay attention to those things before you even say yes. Lots of times we don't get to pick exactly our clinic and our OR, but sometimes we can, or sometimes we can our start time or what it looks like with how long I have for lunch or when my last clinic appointment is.
The other thing I want to do is have you identify two or three relationships to invest in strategically. Ideally, one of these should be with your division director or department chair, whoever's gonna be your advocate when you ultimately get promoted. But you also want mentors who understand how promotion actually works.
And ideally at your institution, but many have great mentors at an outside place, all they need to do is look with you at your promotion criteria. You want a collaborator in your research area. So take the time. It may be a peer who's navigating this in another institution. It may be a senior person in your department or another department who really understands the [00:06:00] work you wanna do.
But these investments are genuinely worth it. Take the time to build these relationships. Now, the other thing to do in an ideal world is to take the time to figure out your values and then figure out your goals so you understand your filter. If I really value my clinical time, my specific research topic, and making sure I get home to my family, then it's really sets up my yeses and my nos much more easily.
But the principle in your first year is not to take on many service commitments that don't either directly advance your career or fulfill a department obligation that your chair has explicitly told you is expected or appreciated. There are things you're gonna do that you don't love. I started on a compliance committee.
It was helpful in the end. I learned a lot. But would I have raised my hand for it? No. Was it useful? Sure. Did I write a paper about it? I did. I taught it to the residents, and I did a pre- and post-assessment. You can turn anything into scholarship Now, what are the things that you can think about declining?
It [00:07:00] may be that there are committees that are not in your promotion area. So an example may be an education committee when you're really focused on research or primary clinical work, and that's not necessarily gonna get you where you wanna go. So you can say, "Really appreciate doing this committee. I'm happy to do it, but the next time I'd love it to be X," whatever you're interested in.
Or, "Hey, is there a- another opportunity to be on this other committee or something else that's more operations-focused?" Now, the other thing to think about is institutional task forces outside your research area. If you can avoid this, don't do this in your first year because they may not be useful, but there's lots of times where you're gonna meet a great collaborator, you're gonna meet the statistician, you're gonna meet the head of research, somebody who may be looking at your grants later or understand funding.
Those are still valuable even if they're not specific to what you wanna do. And then the other thing I wanna tell you, especially if you're female, is you will often get asked to do the invisible work, like organizing the department retreat or setting up the social hour or hosting the baby shower. All of those are great if you enjoy doing them.
But if it's not your zone of genius and you don't necessarily enjoy doing [00:08:00] them, it's okay also to say, "This isn't really my area, but if you have somebody who needs help with setting up the call schedule or looking at our clinical setup or figuring out how to, optimize things in the outpatient clinic," all of those are reasonable if that's really more important.
And know that no is a complete sentence. Reasonable cogu- colleagues will hear it. You can't say no to everything, but you can be strategic in saying, "I can help you with this, but I'm not gonna be able to do it next time," or, "This is really not my area of genius, but I'd be happy to help with something else that is Now, the other trap that looks like foundation building is that people will actually have you overcommit without you realizing it.
So there may be six research collaborators who you try and establish relationships with, and that's fine. They may all be in your area of interest. But don't actually align with all of them and pick a project with everyone, unless you can come up with one project that includes all of them. Maybe it's a scoping review of an area you all care about.
But if you're really trying to do this, going deep with one or two is probably a better way to start. [00:09:00] The other thing is that national committees do build your reputation, but if you start off on three or four of them, it may be that you are diluting your focus and not doing as good a job as you can, especially as you're trying to figure out your niche and you try and build things.
So I would really recommend picking one or two to start. And then every speaking invitation that you get is important, okay? And if you're getting those in your first year, you are doing something extremely well. So it may be you say yes to more of them at the beginning, but over time, what you wanna do is make sure they're strategic about what you want and give people a list of your top talks.
So what you wanna do is create a signature talk that's in the area you wanna be known for. You're gonna go forward. And when I call and say, "Hey, would you come give Grand Rounds?" You say, "I would love to, and I would love to be able to talk on one of these topics." And you give me talk number one and two, both of which are either aligned with a clinical interest or a research interest, and that you basically have ready to go, and all you have to do is update or customize to the location you're going to.
So it's not a ton of work, and you continue to be [00:10:00] able to tell your story and build your narrative. And over time, that story will more and more include the work that you're doing or your clinical outco- outcomes Now, a strategic first year should include some protected deep work. And what does that mean?
That means a couple hours, ideally every week, where you can really spend time getting into a flow. You can get that paper going, you can get the grant written, you can work on the curriculum, you can do whatever it is that your scholarship entails. But please, don't make this your time to finish your notes.
I want this to be a time that you actually work on your clinical work, and you wanna start doing this from week one if you can. And if you have a clear primary research focus, this is even more important, 'cause what you wanna be able to do is identify the one word or phrase that helps everybody understand what you do.
So for me, it was sleep. It was sleep apnea when I was extending a little further, but if it had the word sleep in it, I knew that it was actually gonna be something that was good for me. There are other people who it's gonna be meta-analyses or it's going to be, [00:11:00] organelles, or it's gonna be opioids or whatever it is that your research is in.
And then clinical credibility is important, but it will build steadily. So do not be killing yourself to do that at the beginning. And then a few gracious declines already on the record is not the worst, so people know you're not just gonna say yes to everything. And I've had people say, "Hey, can you do blah, blah, blah?"
And I'll be like, "Eh, it's not really aligned with what I'm doing, but if you have an opportunity here I'm sorry, I can't do that." And they're like, "Oh, I didn't really think it was a good use of your time anyway. I just needed somebody to do it and thought you would say yes." It's good to not get every one of those sent to you.
And the other thing is you don't wanna be the busiest person in the department, and you don't wanna be on the most committees. What you want to be is ready to present at least one manuscript at the end of the year. It's submitted. You want a grant concept, if that's your goal, that's in development. You want a schedule that can be sustained, so you're not burnt out by the time you hit to the end of your first year.
And that's the foundation that makes everything else possible and helps you enjoy your job. So if you're thinking about what you wanna do, [00:12:00] I would start with writing down your three non-negotiable priorities for your first year. It may be the paper, it may be the grant, it may be getting on the education committee.
I want you to block some deep time, deep work time, into your schedule every week or every other week, so that you can really get it done before it gets filled with all the other commitments. And I want you to evaluate any existing commitments and see if they help you achieve your goals. And don't say no and quit them all right away, but if there's things that you don't need to do, you can get rid of some of those.
And if there's things that aren't something you're passionate about, let them know you're not gonna be asking for renewal on that committee, or you'll be passing it off to somebody else. 'Cause sponsoring somebody else is a great way to get rid of an obligation that doesn't necessarily align. And then I want you to practice a decline script so that you can say, "Hey, let me look at that, and I'll get back to you and see if I have time or if it fits in my schedule or if it makes sense, or I'm gonna talk to my mentor."
But just something so you don't have to say no in the immediate, which makes life much [00:13:00] easier the other thing I wanna say is that the promotion clock does start right at the beginning, and I will tell you, I was totally unaware. I had three protected years, and I was busy saying yes to everything and writing papers on 20 different topics and talking to every medical student I could find and be on every committee.
But at the end of three years, I didn't have a story. I didn't have a narrative. I barely had my one word for my niche, and it was hard to retrofit it after that. I really had to do a big shift. And so a well-executed first year, have that manuscript ready, have a clear primary research focus with your one word or your one phrase.
Think about a grant or funding mechanism that's in development if that's something that you're interested in. Have a mentor who knows your promotion goals at your institution can help you work through them, and be working on clinical credibility, but don't be killing yourself to get your clinic so full that you don't have time anymore.
Now, if you have any questions or any thoughts or if this re- really is something that makes sense to you, [00:14:00] please reach out. I would love to hear about it. You can join our newsletter at amedsg, A-M-E-D-S-G, .com. Or if you are ready for help so that you can get all of this going because it seems like a lot and you need an accountability partner, please join us with our Reset and Refocus one-on-one coaching or with our course that will allow you to figure it out from the start.
So se- check out our website at amedsg.com. And check out the podcast, which you're listening to, or the blog if you like to read things. And we hope to hear from you and see you next week. Thanks so much
