Academic Goals in Surgery

Abstract

The development of an academic surgical career can be an overwhelming prospect, and one that is not intuitive. Establishing a structured plan and support structure is critical to success. Starting a successful academic surgical career begins with defining one's academic goals within several broad categories: personal goals, academic goals, research goals, educational goals, and financial goals. Learning the art of self-promotion is the means by which many of these goals are achieved. It is important to realize that achieving these goals requires a delicate personal balance between work and home life, and the key ways in which to achieve success require establishment of well thought-out goals, a reliable support structure, realistic and clear expectations, and frequent re-evaluation.

Objectives: After reading this article, the reader should be able to: (1) Understand the categories of goals required for establishing an academic surgical career. (2) Understand the various tools by which one can establish a support structure in the development of an academic surgical career. (3) Understand and implement means of promoting one's career as an academic surgeon.

The goal of this article is to provide overview of the development of academic goals within the broader context of the development of a career in academic surgery. This is a broad and far-reaching topic, and one who's content will describe some basic overall plans designed to help develop and achieve academic goals as well as methods by which an aspiring academic surgeon can serve to promote his or her career. There will be further discussion, in much greater depth, of many of these topics throughout the rest of this issue. This article is meant to serve as an introductory guide to the foundation of developing an academic career.

Setting Academic Goals

The first step in developing an academic surgical career is to define what goals are required for each individual. The relative importance and weight of each of these goals will vary depending on the type, or “track” that each individual surgeon intends to take. Initially, each faculty member must keep an overall perspective on the timeline of his or her development. The process begins as soon as he or she is hired, and each individual institution has a different timeline for stepwise review of career development. It is incumbent upon each surgeon to maintain an open dialog with their division chief and/or department chair on a regular basis so that this process may be reviewed in a timely fashion, and so that they will stay on track.

Broadly speaking, academic goals can be divided into several groups:

1. Personal goals

2. Clinical goals

3. Research goals

4. Educational goals

5. Financial goals.

Each of these categories must be considered both in isolation as well as in how they relate to each other. A clear understanding of the job description and the intended measures of success is paramount in getting this on track from day 1. This requires a careful and detailed dialog with one's division chief or chairperson, as well as development and clarification of what is to be expected in all of these areas of professional development.

Personal Goals

Personal goals encompasses a broad category which often overlaps with the other groups, and includes not only an understanding of the type of academic surgeon one wishes to be, but also how one's job will impact on one's personal life and family sphere. There are only 24 hours in a day and 7 days in a week. Within that time, all clinical and academic responsibilities must be met, as must one's responsibility to family, which is often the key support structure that maintains an academic surgeon's ability to sustain a happy and healthy career. No one is more productive than a fully developed person, and maintenance of a fulfilling personal life provides an ineffable buffer to the rigors of a busy academic surgical career—one that helps weather the lows and also helps celebrate the highs of fulfilling accomplishments.

Clinical Goals

Clinical goals are usually set by one's division or department chair, and vary from institution to institution. Often there is a productivity requirement that is graduated based on years of experience, but clinical goals also include the development and honing of surgical skills, as well as the acquisition of new skills and techniques. Identifying productivity expectations and the amount of time allotted to clinical practice will result in the development of clinical efficiency. In addition, clinical goals may also encompass development of expertise in a specific area of practice—development of a local and national reputation is frequently a component of any job description and necessary as one proceeds toward promotion.

Research Goals

Research goals are an important component of any academic surgical career. Each surgeon's academic track will contain research requirements to varying degrees of intensity; this is usually a necessary component of a promotional dossier. Research goals may range from contribution to the academic literature in the form of book chapters and review writing, to local and national presentations, and to production of primary research and grant writing. It is important to make sure that one's personal goals are aligned with the academic requirements enumerated in the job description. As such, choosing the appropriate academic “track” and its attendant requirements are critically important for maintaining a sustainable academic career. This may often seem to be one of the more time-consuming components of an academic career; ironically, a disproportionately small amount of time is usually allocated to it. Defining what proportion of time is to be “protected” or allotted for this is necessary at the beginning of one's career, and frequent re-evaluation may be needed to ensure that these goals are met. One of my research mentors once said that “the only protected time you truly have is at night, once you are home and the day is done.” Although these words are ironically spoken, there is a significant component of truth to them since, as physicians, our duty to our patients trumps all other responsibilities and cannot simply be shucked off under the guise of “protected time.”

Educational Goals

Educational goals are also critically important in the practice of an academic surgical career. These are manifested in the form of educating others as well as educating ourselves. The education of others is usually built-in to our everyday practice in the form of student and resident education. However, the time for dedicated teaching to medical students and lecture presentations requires carving out extra time needed to develop talks and lesson plans. If focused teaching is desired or required, planning ahead to set aside time, or formally getting involved with divisional education committees will require reshuffling of clinical duties, and should be reviewed with one's division or department chief. The other educational component is continuing personal education, in the form of maintenance of certification, CME requirements, learning new techniques, and so on. This can often be addressed by active involvement with one's national organizations and attending surgical meetings. Staying at the forefront of surgical technology and practice is an active, continuous form of education that is usually assumed in academic surgical careers; often this defines the level of care and expertise that can be expected at an academic, tertiary care institution.

Financial Goals

Financial goals round out the broad categories of goals and are felt by many to be the least important component of an academic career. However, they cannot be left without emphasis. In the end, every surgical department lives off of the productivity of its members, and divisional and departmental budgets are built upon surgical productivity. Although this emphasis varies from institution to institution, maintaining and meeting financial goals is what allows us to continue to practice medicine and sustain our everyday lives. It is important to understand the financial structure underlying every contract, and for it to be sustainable of one's lifestyle. Each institution's pay structure varies, but usually contains a component of fixed salary and a component of productivity. As a surgical career develops, productivity expectations will increase as well, and the balance of all of the pressures must be appropriate to meet these goals to remain a viable member of a division or department. The development of a successful surgeon involves development of a busy clinical practice which will not only allow surgical skills to mature but also allow efficiencies to develop which allow for increased productivity within a fixed amount of clinical time. Continuing to ensure that these goals and rewards are aligned requires regular review of productivity and remuneration with one's division or department chief.

Accomplishment of Goals

Successful accomplishment on the above categories of goals is a complex process and one that requires growth and support in many areas of academia. There are many avenues through which to accomplish these goals, and in the following paragraphs, we detail some of these areas.

Identification of a Mentor

The importance of a mentor cannot be overemphasized. This will be detailed to a much greater degree in article “Mentorship.” However, identification of a mentor is critical to a successful career. This is typically a senior surgeon who has already navigated the complicated waters into which you are wading and can provide key advice and help in avoidance of pitfalls, as well as assistance in gaining academic opportunities and assistance in growing a successful clinical practice.

Prioritizing

Prioritizing of the many requirements is a critical skill in successful accomplishment. Identification of what needs to be done first, and how long it will take, will allow the successful completion of the myriad and endless tasks that arise. This is a process that evolves as skills and interests develop and require frequent reassessment. Each surgeon has different skills and abilities, and finding the right way to prioritize is a learned skill.

Figuring Out How You “Work”

The process for moving from a trainee to a faculty member is a radical departure from the “rotational” lifestyle trainees have lived for 5 to 8 years. Adapting to a sustained and less dynamic work, life requires some self-assessment to figure out what is most productive. Determination of our productive “academic” hours will help development of time and energy budgeting.

Tools and Skills Acquisition

The development and honing of new skills and tools, whether mental or technical, is what allows us to grow as academic surgeons. Attending workshops for skills building, group dynamics, leadership skills, and teaching skills, as well as seminars and classes in new clinical techniques and devices are needed to keep you at the forefront and mature as a surgeon, teacher, and leader.

Career Development Awards

These can be an important means to justify and maintain research interests and provide continued motivation for growth, in addition to satisfying research requirements.

Involvement in National Organizations

This provides a critical support structure, not only to provide a platform for visibility on a national level but also an important avenue for social networking with peers and mentors who will be positioned to help promote your career. Seek out opportunities to participate in committees and look for opportunities to submit original work for presentation.

Social and Professional Networking

Within national organizations, within the department, and across departments in an institution, peer socializing can be personally fulfilling. However, such relationships will also allow for the possibility of interdepartmental collaborative research, which in turn will potentially broaden other horizons for visibility. Networking will also help develop referral sources and opportunities for academic productivity in the form of invited speaking, grand rounds, etc.

Attitude

The degree of success in an academic career is influenced by many forces, the majority of which are extrinsic and beyond an individual's control. However, the one powerful factor that can pervasively affect one's growth and is entirely within our control is attitude and work ethic. This is a highly personal issue, and every faculty member must find his or her own comfort level. I pass along the sage words I received when I completed my own residency: “When asked to do something, the answer should always be YES. And once you have committed to a project, do it reliably and well.”

Progress Assessment and Establishing Interim Goals

The development of an academic career is a long and gradual process. Built into most promotional structures are several points, usually years apart. Although these are built-in to allow review and reappointment, as well as a gross overview of progression toward promotion, it is prudent to take a more frequent opportunity to assess progress as well as developing smaller, more achievable interim goals. Collaboration with a mentor or division chief is necessary for the addition of an appropriate perspective. During these periods of interim review, a faculty member should focus not only on establishment of goals but also on critical self-assessment of weaknesses and areas that require remediation. Again, the perspective of a senior mentor is imperative. It is only through this honest self-assessment that we can work to correct deficits where possible, and if not, how to redirect effort toward areas of strength.

Graceful Self-Promotion

A critical aspect to achieving one's academic goals and achieving academic promotion is learning the art of graceful self-promotion, which can be critical to career advancement. This encompasses several aspects of academic medicine, including clinical practice, administration, research, publications, mentoring, resident and student education, and society involvement. It also involves promoting oneself at the institutional, local, and national levels. Many of these intertwine on several different levels, which will be discussed further.

Promoting Yourself Clinically

Promoting yourself clinically is probably the most intuitive means for the practicing surgeon to promote his/her career. Unless you are on a pure “research scientist” track, clinical productivity is the motor that keeps the machine running. Clinical productivity is what allows all of the other aspects of academic medicine to fall into place. However, this can be difficult without a clear plan in place, especially for a surgeon embarking on his/her first job after completing training, or even a more senior surgeon who has moved to a different institution.

Building a clinical practice in a new position is incumbent upon the division head or department chief positioning the surgeon with an opportunity to be successful as well as the institution's marketing department to a certain extent, but the new surgeon also has to actively market him/herself as well. Maintain a high profile with referring physicians by volunteering to give talks or presentations for other department's lectures series or grand rounds. Speak with the office manager of potential referring physicians to set up face-to-face meetings. Volunteer for committees at your home institution—this is a good way to get to know other physicians in your institution and gain valuable “face time.” Surgical residents are taught the “Three A's” of a good surgeon—availability, affability, and ability. The first two of these cannot be emphasized enough to the surgeon who is trying to market him/herself and promote his/her practice and career.

When you start a new job, expectations for clinical productivity should be made clear up front, acknowledging that productivity during the first year may take time to build. A majority of institutions and practices have productivity-based incentives in place—know what your productivity targets are when budgeting your time and prioritizing other nonclinical activities. Keep in mind that incentive targets may increase significantly after the first year and priorities may need to be readjusted.

Being as active as you can clinically also helps you to hone your skills and stay abreast of current technologies and evidence-based patient care. This information and expertise can then be conveyed to others by authoring book chapters and review articles, thus increasing exposure as an expert in the field, initially at a local and institutional level, and eventually at a national level. Seek out opportunities to speak at local continuing medical education activities. Give lectures to the lay community and become a liaison between your academic medical center and the community. Anything you can do to increase your exposure to your peers, colleagues, potential referring physicians, and potential future patients goes a long way toward promoting your career as a successful surgeon.

Attracting referring physicians and potential patients is only part of the job. Maintaining an open line of communication with referring physicians and patients is essential. Once you have seen a consult from a referring physician, be sure to communicate your plan in a timely fashion. Although a letter to the referring physician is a common courtesy (and a requirement to bill for a consultation), a phone call to the referring physician goes a long way toward establishing a long-lasting, productive relationship and ensuring future referrals. When a patient calls with a question or concern, give them the courtesy of a timely return call. Referring physicians are advocates for their patients—when a patient tells his/her doctor that you did not return his/her calls or address his/her concerns, do not count on further referrals from that physician. Good surgical outcomes also go a long way toward building this trusting relationship, both with referring physicians and patients. Word-of-mouth is free advertising.

Balancing clinical responsibilities and other nonclinical responsibilities necessary for academic advancement and promotion can be extremely challenging. In today's world of academic medicine, clinical responsibilities are rising exponentially. Although there may be some financial reward attached to increased clinical production in terms of graduated incentive payments, very little reward is attached to this function in the academic promotion arena. Finding the balance between clinical responsibilities and nonclinical responsibilities that will position you for academic promotion is incumbent upon the academic surgeon. Working with a more senior surgeon as a mentor in the regard can be invaluable.

Promoting Yourself Academically

In the midst of promoting yourself clinically, you must also learn to promote yourself as an academician. This can encompass several different avenues, including research, writing, and teaching/mentoring students and residents. Again, the balancing act is a difficult one, but one that the successful academic surgeon must master.

Criteria for academic promotion should be explicitly stated at the onset of one's academic career or a new academic position. The first part of this article dealt with establishing and achieving academic goals. Be clear to your division chief and department chair what your academic goals are so that they can help position you to achieve them. You will need to rely on senior faculty to help align you with those who will be able to help you achieve those goals. However, while a plan can be put into place based on the wisdom and guidance of others, execution of that plan by the individual is what brings it to fruition and promotes one's career.

If research is on your academic agenda, the degree of support that your department and institution will provide, both direct and indirect, also must be explicitly stated from the onset. Will you have a research assistant or coordinator? How much “protected time” for research will you have? Will your targets for clinical productivity be decreased to allow for research? Will you have access to a biostatistician? Is there an organized curriculum to provide the investigator with knowledge and understanding of the complexities of performing quality research? Will there be clinical coverage provided during so-called “protected research time?” Again, expectations should be clear from the onset, but be realistic about what you need to accomplish what you want to. Be cautious to ask for more than you need or bite off more than you can chew, as this detracts from your credibility. Also, realize that increased research time detracts from clinical productivity. The balance between the two needs to be clear in terms of expectations—both yours and your departments'.

A relatively easy way to promote yourself academically is by writing reviews and book chapters. Seek out opportunities for this type of academic activity. Again, this may require some help from your division chief or department chair in terms of making connections in the right circles, but chances are that somewhere along the way during residency/fellowship training, you have made these type of connections as well. When asked to write a review or chapter, you again must weigh the balance of other responsibilities. If you are able to accept the invitation, be sure to complete the assignment on time. A well-written book chapter or review article can open many professional doors for you, possibly leading to invited talks at local or national meetings, or invitations to contribute further to the medical literature. This in turn contributes to a self-perpetuating cycle of academic productivity and self-promotion.

Another way to promote yourself academically is to take an active role in teaching medical students and residents. Many institutions take teaching evaluations into account when considering a faculty member for promotion. Make yourself available to the students and residents. Strive to be someone that students and residents seek to emulate. Often, lack of an “external reward” for teaching discourages the surgeon who is focused on building a practice and establishing a clinical reputation from realizing the unique position he/she is in to participate in the education of a future physician or a physician-in-training. The rewards of having a lasting impact and helping to shape the education of a future surgeon are immense. However, here is where the never ending struggle between clinical productivity and nonclinical responsibilities rears its ugly head again. To keep things in perspective, remember that taking a moment of extra time to explain a concept to a student during clinic hours or taking the extra time in the operating room to correct a resident's technique is much more valuable in the long run than the 5 extra minutes you might save by not doing it.

Also look for opportunities to become integrated into the formal educational process within your department. Volunteer to participate in medical student lectures or the residents' didactic program. Take the opportunity to use your department's skills laboratory as an avenue to work with the residents. Many residents relate a one-on-one experience with a faculty member as being a seminal moment in their training that influences their ultimate choice of specialty. Strive to receive recognition for your teaching efforts in the form of departmental or institutional teaching awards. This type of recognition can be self-gratifying, not to mention advantageous during the process of academic promotion.

Although some surgeons are natural teachers, others are not. Take the time to develop clinical teaching excellence. Seek the guidance of your mentors regarding effective teaching strategies. Most academic medical centers have resources available to the practicing clinician in the form of seminars and courses to help him/her gain valuable teaching skills. The American College of Surgeons' “Surgeons as Educators” course is a week-long immersion in the skills necessary to become an effective surgical educator and is taught by some of the leading figures in the field of surgical education. Again, this comes at the expense of lost clinical productivity, but in the long run, it will give you valuable experience and expertise in promoting yourself as a surgical educator.

Promoting Yourself at a Society Level

Becoming an active and participating member in surgical societies is essential to promoting your academic surgical career. This should include, at a minimum, involvement in the American College of Surgeons as well as a society specific to your surgical specialty. Get to know the society leadership. Volunteer to participate in committees. Again, when you are asked to do something and you agree, do it well and do it on time—this will likely lead to further opportunities and advancement within the society.

Society involvement also can lead to relationships and connections that can lead to opportunities to speak at national meetings and participate in collaborative research efforts, not to mention lifelong relationships and friendships. Members of a surgical society share a common bond, a common raison d'etre—take advantage of this to form a network of colleagues that will allow you grow as a surgeon, as an educator, as a researcher, and as a person.

Promoting Yourself Administratively

Promoting yourself administratively within your department and institution is another valuable means of furthering your career. Volunteer to participate in hospital committees that pertain to your area of practice. This provides increased opportunities for networking, meeting other physicians in your institution, and opens the door for potential collaborations. Talk to your department chair or the residency director in your department about taking on an administrative role in the residency program. Seek the opportunity to develop leadership skills. Again, many academic medical centers offer resources such as seminars and web-based courses to help you attain such skills. Anything you can do to increase your visibility and willingness provides opportunities for you to advance your career.

Summary

The art of graceful self-promotion of your academic surgical career involves a delicate balance. Establishing personal and professional goals gives structure to your early career. Graceful self-promotion is the means by which these goals can be realized. The most important thing in developing the balance between clinical practice, academic duties, administrative responsibilities, and societal obligation is developing efficiency. Further, your family life and personal life outside of medicine must be integrated into this balance as well, which can often be difficult. In the midst of building, maintaining, and promoting your academic surgical practice, you must also remember to promote your health, personal relationships, and mental well-being—a “burnt-out” surgeon is no good to his/her patients or students/trainees. Recognize that your academic and clinical activities will require close collaboration with other professionals, but your life outside of medicine will also require collaboration with a different network of close friends and family. Foster and promote these relationships as well.

The importance of continual self-monitoring and self-evaluation cannot be overemphasized in your quest toward achieving your academic goals. Seek out opportunities to meet with your mentor(s), division chief, or department chair on a regular basis to discuss your progress, circumvent potential pitfalls, and occasionally revise your goals. Recognize that the steps you take early in your career provide a framework for the next 20 to 30 years of your professional life, and that it is a LONG race. Pace yourself, re-evaluate, and do not forget to take the revitalizing opportunities for water along the way.