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Entering an academic practice can be very intimidating and the attributes and skills that make you a great attending physician feel very different from those that made you a successful trainee. Here’s what you need to know. By Brittany Reardon MD

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Medical students and residents spend a great deal of time preparing for the “next step” in their careers. They’ve worked tirelessly to progress from college to medical school and then from medical school to residency training, and possibly even fellowship after that. Preparing for these transitions is something trainees are well versed in, but what happens when you arrive at the destination is something else entirely. The specialty of anesthesiology is dynamic and fast-paced and it requires the practitioner to be flexible, without compromising judgment or patient care.

Perhaps the most challenging transition when becoming an attending in academic practice is the number of locations you may be asked to cover. As a resident your day takes a very linear and predictable path. You are assigned to an operating room and are responsible for only those patients one at a time. As an attending you have to adapt to covering multiple locations with trainees or CRNAs or a combination of the two, all with different skill levels and training. You now are responsible for simultaneous patients and have to learn to effectively manage the colleagues you're working with and the needs of each individual patient. As a junior attending, this could be one of the most stressful aspects of your day. It requires organization and excellent communication with those you are working with.

Finding your place in a new academic setting presents its own set of challenges. The most jarring realization is that you may have to administer anesthetics for cases that you had only done infrequently during training. Perhaps you have just completed a fellowship and only practiced in that subspecialty for the previous year, but now you are expected to manage cases outside of your comfort zone. This can be a very demanding experience for a new faculty. It is critical to identify mentors early on in your career who you can call upon for help and guidance when you need it. Choosing an academic practice where the environment is supportive will help you hone your skills as an attending physician. Remember that the end of residency does not mark the end of learning. The early years of being an attending lend themselves to continued years of training and adaptation.

Although during residency you may have felt deeply invested in your patients, this sense of responsibility is amplified when you become an attending physician. During residency training you have the luxury of practicing with a safety net, which is of course what residency is meant for. When you become an attending, you are now the final decision maker and ultimate authority. Regardless of the practice model that you will work in, beware of decision fatigue, and remember to exercise wellness activities to keep you at the top of your game.

If coverage, inexperience and decision fatigue are the day to day struggles of transitioning to academic practice, an overarching issue is finding your niche in this new environment. Academia has many routes you can pursue in ordered to be considered successful. These avenues traditionally are research, administration, and teaching. A research-based career might seem alluring to someone who has experience in academic research in residency. Most institutions have tracts to advance professionally based on publication and your ability to stand out as a well-regarded member in your field. More recently, institutions have placed more focus on education and the merits of being involved in resident education. Involving yourself early on in a residency program is a good way to get involved in a department, especially given you are so close the experience yourself. If neither of these options appeal to you, an administrative role, such as getting involved in quality assurance projects, can give you a foothold and insight into the inner workings of a department.  As a new academic attending you might feel pressure to try and advance in multiple areas. Early on, it is best to try multiple avenues seeking to find something that interests you. Providing yourself with both short term and long-term goals can help you stay focused as well as keep momentum.

Becoming an attending is both an exciting and overwhelming time. It is well known that transitions can cause physicians to deal with imposter syndrome. The key to success as a junior attending is developing a support system within your practice. For those at a new institution, you can still reach out to those who trained you in residency for guidance and clinical questions. You can further expand your support system to new individuals that you meet who you identify with and feel you want to emulate as well as department leadership. Identifying a mentor will help you create goals both in the short term and long-term such as a five-year plan to develop your niche and tract within your career. Transitions are always a tumultuous period by nature, but approaching your practice with humility, excitement and engagement will set you up for success. It is comforting to know that every practitioner in every academic department has, at some point in their career navigated their way to success. 

References: 

Swaminathan M, Glas KE, Heller L, Augoustides JGT, Culp WC, Sniecinski RM. Mission Possible: Successful Careers in Adult Cardiothoracic Anesthesiology—What I Wish I Had Known in the First 5 Years After Fellowship. Journal of cardiothoracic and vascular anesthesia. 2016;31(1):321-328. doi:10.1053/j.jvca.2016.10.013

Kuza CM, Harbell MW, Malinzak EB, et al. Transition to Practice in Anesthesiology: Survey Results of Practicing Anesthesiologists on Their Experience. The journal of education in perioperative medicine. 2019;21(2):E619-E619. doi:10.46374/volxxi-issue2-kuza

LaDonna KA, Ginsburg S, Watling C. “Rising to the Level of Your Incompetence”: What Physicians’ Self-Assessment of Their Performance Reveals About the Imposter Syndrome in Medicine. Academic medicine. 2018;93(5):763-768. doi:10.1097/ACM.0000000000002046

Brittany Reardon MD is Assistant Professor at Mount Sinai Morningside and Mount Sinai West Hospitals. As Assistant Program Director, she is passionate about graduate medical education. She believes that house staff are a unique group of individuals who each deserve personalized mentorship. Her clinical interests include otolaryngologic and neuroanesthesiology.