Not a Trainee, Not Yet Mid-Career: Navigating being an Early Career Pediatric Psychologist

Abstract

Objective:

The American Psychological Association (APA) defines early career (EC) status as occurring in the 10 years following earning a doctorate. As EC pediatric and behavioral health psychologists (ECPP) who work with and conduct research with adolescents and young adults (AYA), we have noted that our own and our peers’ experiences during this career phase have mirrored that of our AYA research participants and patients. Namely, no longer scaffolded by training milestones and supervision, yet still often viewed as green, EC psychologists may often feel and be treated like they are experiencing a career-based emerging adulthood. Despite the presence of some institutional support during this career phase, we and our peers have found difficulty in navigating this career phase–something compounded by concurrent life events (e.g., parenting, pandemic).

Method:

Grounded in our own current and recent histories, this Commentary provides examples of common experiences across the EC--from fellowship to nearing mid-career.

Results:

To improve the EC experience for pediatric psychologists and beyond, recommendations are made at the institutional, mentor, and ECPP-levels.

Conclusions:

Given the risks for burnout during this phase of career, when workforce demands are at all-time high, this Commentary aims to draw attention to the developmental norms of EC and to improve the EC experience for pediatric psychologists and our peers. The hope is that in doing so, pediatric patients and their families may be better served via a well-supported EC workforce.

The American Psychological Association defines early career (EC) status as occurring in the first 10 years following earning a doctorate and roughly 20% of its members are in this career stage (Stamm et al., 2017). The current workforce of EC psychologists is primarily female; more likely than any other career stage to identify with a minoritized identity in terms of race, ethnicity, and sexual orientation; and to have dependents under the age of six (Pedrotti & Burnes, 2016; Stamm et al., 2017). Despite multiple achievements, including: 1) obtaining a doctorate and its related training; 2) potentially overcoming systemic barriers associated with one or more minoritized identities; 3) potentially becoming a parent; and 4) starting to establish an independent line of research, EC Pediatric Psychologists (ECPPs) in academic research and/or academic medical settings may find themselves empathizing with the identity-related challenges of their adolescent and young adult (AYA) research participants and patients. Indeed, several years into EC status, many find themselves feeling as if they are in a career-based form of emerging adulthood.

We, as the authors, are in the late stages of our EC (CSS, AMP, EGL), or in midcareer (KM). Further, we all work with AYAs–a group that: 1) has been historically underserved (Institute of Medicine et al., 2009; National Research Council et al., 2015); 2) is often excluded as a voice on research for themselves (Betz et al., 2013); 3) is at heightened risk for lapses in care when transitioning to adult healthcare (Pai & McGrady, 2014); and 4) for whom prevention and treatment efforts have been lacking during an unprecedented mental health crisis (Murthy, 2021, 2022). During our ECs, we and our peers have experienced a multitude of life experiences, notwithstanding multiple endemics. We have identified with visible and invisible minoritized identities and experiences that often do not align with the identities and experiences of our mentors. Further, we have noted a variable amount of support and pitfalls specific to this career stage (Green & Hawley, 2009; Stamm et al., 2017). As such, ECPP experiences mirror that of our AYA participants–placing much of a new workforce at risk for burnout when they are at a critically high need (Gewin, 2022; Murthy, 2021). To re-conceptualize how ECPPs are treated and supported, it is crucial to first shift the lens through which this career phase and individuals are viewed. As such, this Commentary seeks to: 1) name and validate the unique aspects of this phase of career; and 2) suggest improvements that may better support ECPPs to successfully enter their mid-career and avoid burnout. Namely, bolstered by our own and colleagues’ experiences, and the EC literature within and beyond Pediatric Psychology, the complexities, benefits, and scaffolding suggestions for being an ECPP follow.

Positionality

Of note, this Commentary details anecdotes from the authors’ personal experiences. As such, this work is exempt from Institutional Review Board approval and informed consent was not completed. Related to our experiences, we are a group of Clinical Psychologists, trained in Pediatric Psychology and Behavioral Medicine, and who have worked in multiple academic medical centers across the Southern, mid-Atlantic, and Midwestern United States (U.S.), as well as part-time private practice. We identify as cisgender, straight and bisexual, White and Asian women who have experienced multiple physical health (i.e., pregnancy/birth, pregnancy loss/fertility treatment, cancer, chronic pain), mental health (e.g., postpartum depression, anxiety), and early- to mid-adulthood developmental experiences during our ECs (e.g., death of loved ones, moves to new states, parental leave, child rearing). While some authors come from families in which higher education was a norm, others are first generation scholars or from families educated outside the U.S. systems. Figure 1 details our experiences across our EC to date. Given our experiences, please note that the current Commentary may be biased toward our own experiences, which have primarily been grounded in research settings.

Figure 1.

Early Career Experiences of the Author Team

The Start: Early, Early Career Experiences

Many consider the “start” to their early career commencing with a faculty appointment and this work primarily focuses on this time period. However, the “clock” officially starts following graduation. Many Pediatric Psychologists spend some time completing fellowship during their first one to two years after obtaining their doctoral degree. Fellowships often, but do not always, include: structured mentorship, milestones that mimic recently completed graduate training (e.g., completing clinical hours for licensure), continued cohort assignment/peer support (O’Connell et al., 2023), and opportunities for training-level grant funding (Brown et al., 2009). As such, when ECPPs enter what feels like the “start” of their career as new faculty, they are often, for the first time, independent Pediatric Psychologists. Indeed, it did not dawn on one of us until sitting in an Epic training (i.e., a platform to access electronic health records) as new faculty that we were now “the Attendings.” Given the dizzying mixture of having achieved doctoral-level expertise on a given topic–yet, no longer having the same structure or support of mandated mentorship, milestones, cohorts, and funding opportunities of graduate/postdoctoral experiences, ECPP faculty may both feel and be treated like “professional teenagers.” While some institutions have developed pathways to provide structured mentorship programs for faculty and professional development programs (Ward, 2017), our experience in consulting with peers is that these structures are not universal. We have experienced the relative lack of milestones in EC–apart from promotion or tenure–to be accompanied by feelings akin to a career-based existential crisis (e.g., “What am I doing? Am I doing enough? Do I like what I am doing? Do I have to do this exact thing forever?”). Further, depending on the context, different colleagues might view their ECPP counterparts as “new” vs. “established.” In a single hour, one of us was both invited to join an international expert panel presentation and introduced in a departmental meeting as “fresh out of post doc.” Looking to peers to identify how well we were performing, we found that our ECPP peers had vastly different metrics to use for themselves based on career track (e.g., clinical vs. research) or institution. Further, our peers outside of Psychology were often, in this time period, approaching a decade of work experience and had difficulty understanding our professional confusion.

In trying to feel grounded amid what has sometimes felt like a career-based emerging adulthood and celebrating growing independence, we have been motivated to make values-based decisions (“want to” tasks), while simultaneously navigating systemically-driven expectations (“have to” tasks; Good et al., 2013). “Have to” tasks have taken the form of chasing grant funding or clinical blocks that might be poorly aligned with our values and interests, to feeling departmental pressures to take on extra unpaid administrative or service tasks (Babcock et al., 2017), to balancing launching an independent career with raising small children and caretaking for parents (Stall et al., 2023), to navigating achievement or setbacks with visible or invisible minoritized identities that are often misaligned with mentors or superiors (O’Shaughnessy & Burnes, 2016; Stamm et al., 2017). Of note, even when identities or experiences may align with mentors or superiors, the difference in when these life events occur can cause miscommunication or misunderstanding, despite good intentions. Indeed, a sleepless ECPP who spent the night caring for a sick toddler might be first met with an empathetic statement from a supervisor, followed by a mentioning of “missing those days” and laughing about their teenager never wanting a hug, and then the request to take on an extra task for the week. Conversely, “benevolent marginalization” has occurred, in that mentors and colleagues have not offered the option of opportunities after having a baby (e.g., “Oh, they’re probably so busy with the new baby, let’s not bother them with this…”), rather than providing the option to accept or decline (Macapagal & Lattie, 2019). Realizing that the Venn diagram of “want to” and “have to” is not well proportioned with their desires, ECPPs are at risk for burnout and/or leaving their planned career trajectories (Gewin, 2022). Of note, resultant changes in trajectory are not necessarily to be avoided, as they may be better aligned with values. Indeed, transitions that meet these criteria are to be celebrated! However, changes in institution, division of clinical vs. research responsibilities, or moving from academic settings to private practice or industry settings, may feel like “one step forward, two steps back,” as there are new systems to learn and manage. Conversely, without some of the burdens of extra responsibilities about to “kick in” that are associated with being a mid- (years 11–20) or later-career psychologist (years 21+; Stamm et al., 2017; e.g., leading divisions, centers, clinics), ECPPs have the knowledge, capacity, bandwidth, and inspired passion to advocate for changes for trainees and peers.

Late Early Career Experiences

As their specific expertise and recognition grows, ECPPs in the latter part of their ECs may have increasing confidence in their own value. Increased prestige and self-confidence in one’s own expertise may create positive ripple effects, such as being sought out for leadership positions, enhancing one’s departmental or institutional footprint, and feeling more job security–or even the ability to re-negotiate a contract based on other offers. After fully shaking off the “trainee” label, we have stopped fixating on inconsequential worries (e.g., “What if this paper/grant/idea gets rejected?”). Instead, we have felt more confident to focus on the research topics and priorities that are important to us, and improving the system for up-and-coming trainees. Further, we are increasingly asked to take on formal and informal mentorship roles, which provides further opportunity to advocate for new ECPPs.

Yet, accumulated accomplishments that have promoted confidence during the later years can also lock ECPPs out of specific opportunities. For example, as one approaches mid-career and/or secures NIH-level funding, we have found ourselves ineligible for numerous trainings, fellowships, and grants. Further, for those who secured an Early Career Award from the NIH, many find themselves nearing or “falling off” the “K-award cliff,” the difficult switch from an Early Career Award–with a heavy emphasis on training and a substantial amount of salary support, to an R01 grant (which is associated with established researchers and covers much less of a Principal Investigator’s time). Anecdotally, for those of us in “soft money” environments, where research time/promotion criteria are dependent on grant funding (ideally, NIH funding), this often means submitting an NIH grant every cycle as either a Principal Investigator or Co-Investigator to cover our time. Due to ongoing clinical and research responsibilities, grant writing often collides with personal time. While personal time is always important and valuable, EC overlaps with when a psychologist is most likely to have children under the age of five (Stamm et al., 2017). As such, a high tension is often set up that pits working towards funding against caring for small children. Due to the developmental nature of a K-Award, structured mentorship may also be at a minimum during this time, given that the training period is designed to “launch” an ECPP investigator. While ECPPs at this phase may be actively working towards new opportunities and trying their best to “launch,” they are often yearning for more specific supports to scaffold how to move towards whatever comes next (e.g., R01 proposal, increased clinical load, shift to private practice or industry work settings, early leadership opportunities, re-negotiation of salaries and responsibilities within their institution).

Support Recommendations

We now will review support recommendations for ECPPs. However, we would be remiss to not highlight recent aspects of the existing literature that aims to support facets of the ECPP experience. These include, but are not limited to: 1) systems- and person-level considerations for Career Development Awards and EC funding for ECPP who are women (Bates et al., 2023); 2) faculty development programming (Ward, 2017); 3) qualities that are critical to longitudinal and successful mentor-mentee relationships (Hill et al., 2022); and 4) institutional changes to have diversity grow and thrive in our field (Bernard et al., 2023), as well as to dismantle structural racism in our work and field (West et al., 2023).

Unsurprisingly, institutional level strategies have demonstrated an impact on the promotion or degradation of EC psychologists’ resiliency (Kolar et al., 2017; Pedrotti & Burnes, 2016). Subsequently, our institutional-level recommendations, which may also include departmental or college-level support and mentorship, include: 1) Start early. First, formally assign and compensate time for “onboarding buddies” from the department for ECPPs to have a “go to” person or group for common questions (e.g., “Where is this building?” or “How can I make Epic [medical record system] process this request?” or “Who is the go-to for creative clinical engagement strategies?”; Sterling et al., 2023). Second, departments or institutions should offer skill-building seminar series for faculty success that align with the promotion metrics and values of the department/institution (e.g., research, teaching, leadership, and communication skills; personnel management; incorporating a justice, equity, diversity, and inclusion [JEDI] lens to clinical, teaching, research, and administrative work; Danhauer et al., 2019). Third, encourage discussions around ECPP trajectories and supports. This includes providing direct training and opportunities to practice asking for and negotiating for needs. This should ideally start while future Pediatric Psychologists are still in training, particularly for trainees with minoritized identities (Pedrotti & Burnes, 2016). 2) Create mentoring and training opportunities specific to both the early and later years of ECPP (Silver, 2023). Particularly for the later years of ECPP, it is critical to recognize that achieving “success” bars some from stepping-stone opportunities (e.g., ineligible to apply to trainings/professional development opportunities after receiving NIH-funding). As such, faculty development programs that focus on ECPPs may consider offering the option to have later ECPPs become “alumni.” This status change could allow later year ECPPs to still access the EC resources, while purposefully shifting their focus towards mentorship by connecting early and later ECPPs as “new members” and “alumni” (Sandi & Chubinskaya, 2020). 3) Make equitable caregiving adjustments, given the likelihood of multiple caregiving roles for EC psychologists (Stall et al., 2023; Stamm et al., 2017). While tenure and promotion extensions are often available, they also inevitably extend timelines for being paid and recognized less than other colleagues who do not take these extensions. 4) Pay equity adjustments for remaining at an institution. The practice of requiring a competitive offer from another institution to open negotiations at one’s current institution takes time away from the work for everyone involved. 5) Require cultural competency and JEDI training for all levels of leadership so that such efforts do not unduly fall on ECPPs, particularly those with one or more minoritized identities (Galán et al., 2021; Goghari, 2022; Pedrotti & Burnes, 2016). 6) Offer mentorship training programs, including continuing education in this domain, for ECPP, mid-career, and senior faculty. Further, this training should be bolstered through the offer of incentives to devote time and efforts towards this training. Indeed, mentoring, supporting, and interacting with one another will reinforce the likelihood of such training “paying off” at all career stages (Brown et al., 2009; Chao, 2009; Forehand, 2008; Okon et al., 2022; Silva et al., 2016; Troisi et al., 2015).

Our mentor and ECPP-level recommendations, which should also be considered by ECPPs who themselves are mentoring others, include: 1) Create an annual individualized development plan (IDP; Gould, 2017), ensuring accountability (e.g., formal/informal mentors, peer) and directing reflections to values-consistent goals. Within these IDPs, ECPPs might consider quarterly check-ins, revising their overarching goals (e.g., “what keeps you up at night or makes you feel excited to chat about with a colleague at happy hour?”) and their quarterly task goals, ensuring the two are remaining connected. ECPPs might also reflect how they use IDPs to inform their goals and trajectories with input from both formal and informal mentors (Pedrotti & Burnes, 2016). 2) Identify skills and resources that benefit your own AYA patients and participants–there may be a great deal of overlap in what is helpful for AYAs and for us in EC while many transitions are managed (e.g., tolerance of ambiguity and distress around big decisions and life transitions). 3) Reflect upon the points that were trickiest in your own development and use that insight to offer specific support for peers and your own mentees. 4) Related to tricky points, anticipate that life events are likely to occur frequently and sometimes without warning during this phase. Ensure for yourself and for mentees and peers that support plans are in place should an emergency occur. 5) Celebrate the freedom to choose one’s own adventure. There is no “one” path. Indeed, moves to switch clinical, research, or industry paths can be worthwhile!

Our ECPP recommendations include: 1) Take care of yourself and consider your pacing. You are no longer in training and therefore the amount of work you are doing will likely change. The work pace you choose to have in your EC can help set the tone for much of your career (e.g., marathon vs. sprint mentality). 2) Consider your audience when seeking and/or receiving mentorship. Generational differences are expected and may sometimes be uncomfortable–but may also hold promise. Pausing to consider what may be helpful or gleaned from mentors’ contributions may be helpful both personally and for the bi-directional mentoring relationship. Indeed, mid- and later-career mentors have lived experience that can be invaluable, even when attempting to navigate relatively uncharted waters. For example, as ECPPs question and push against long-standing systems that may promote injustice in the wake of overlapping social justice movements and a global pandemic, mentors may be able to provide insights into strategic “battles” to choose and allies to engage from their own development and work experiences. Also, a team of formal and informal mentors may be established, allowing ECPPs to seek specific mentors for specific types of questions or problems. 3) As said above, celebrate the freedom to choose one’s own adventure. This is your adventure. Whenever possible, choose paths that align with your values, both professionally and personally.

Conclusion

ECPPs make up a significant workforce promoting the clinical and research advancements of AYAs, yet lessons learned are infrequently reflected back for these professionals who are experiencing similar developmental trajectories in their careers. This Comment seeks to validate the complex experience of navigating the EC experience, while also encouraging institutions, mentors, and ECPPs themselves to advocate for improving this experience. Calls for research on how to better scaffold and mentor EC psychologists are longstanding (Green & Hawley, 2009). In the face of an unprecedented youth mental health crisis (Murthy, 2021) and unknown ripple effects of multiple endemics (Valenzuela et al., 2020), perhaps one of the best actions to take is to ensure that the workforce that will serve our AYAs for decades to come is properly supported.

Implications for Impact Statement:

Based upon the existing literature and the personal experiences of the authorship team, common experiences and challenges relating to being an early career pediatric psychologist are stated and normalized. Recommendations to better support individuals through this career phase are posed to ultimately better support the workforce that serves pediatric populations.