Academic Colorectal Surgery Job Search

Abstract

The field of academic colorectal surgery encompasses a vast array of possibilities. Clinical care accompanied by research, teaching, innovation, and/or administration provides the foundation for what is considered an academic career. For those choosing academic colorectal surgery, the process of finding and selecting a first job can provoke much angst. This article describes some strategies to approach the academic colorectal job search and provides insight into deciding a career focus, exploring relevant positions, weighing specific factors, and negotiating your first offer.

CME Objectives: After reading this article, one should be able to (1) discuss the various types of academic opportunities available in the field of colorectal surgery; (2) discuss strategies for seeking and obtaining academic surgery positions.

The scope of academic surgery continues to evolve and is no longer confined to the classical triple threat of clinical care, education, and basic science research. While patient care remains the cornerstone of surgery, the umbrella of academics has further extended to cover new types of research, novel approaches to education, leadership in administration, and a focus on innovation. In addition, the research paradigm has expanded beyond basic science to include clinical trials, outcomes, and education, among others. Each of these by themselves can be the foundation of a productive academic surgery career. Opportunities abound in the field of colorectal surgery and the limits are restricted only by creativity and energy. However, figuring out how to harness this energy into the correct academic job following colorectal surgery residency is often daunting. This manuscript provides one surgeon's opinion and advice that will hopefully assist those embarking on a career in academic colorectal surgery. It is written for the trainee finishing residency, but most principals may be applied to any point in your career.

Getting Started: What Do You Want?

To paraphrase the great baseball player philosopher Yogi Berra, “If you don't know where you're going, you might wind up some place else.” This unassuming quip rings true for academic colorectal surgery. Before venturing into the job market, you must ask yourself a very simple but challenging question, “what do I want in a job or career?” The introspection required to find that answer will add clarity to your search. There are myriad options and intricacies when designing a colorectal practice. For most colorectal surgeons leaving residency training, it is the first time in their surgery life with flexibility and empowerment to design a niche. No one practice is exactly alike and determining which factors are most important to you will determine your approach.

Factors to consider include, but are not limited to, the following: practice setting (university, hospital based, private group), focus of practice (colorectal only, general surgery), type of research (basic science, clinical trials, outcomes), commitment to resident training and education (fellows, residents, and/or medical students), and the complexity of cases and referral patterns. Other factors that may influence choice include the number of partners, the geographic location, city or rural area, and the quality of life or schedule. Among the several characteristics that define a job, you must choose which of those matter most to you. For example, you may want to live in a small coastal town, but the best powerhouse academic center for your research interests is in Missouri. Priorities must be made and weighed. This is not always easy, as there have often been external expectations placed upon you by faculty and mentors. But once you are true to yourself, the rest comes easier.

I personally have always been a list maker. In looking for my first job after completing training, I made a list of the top priorities for me and my family and then sought academic centers that could put me an environment to pursue my interests. Obviously not every place that fits your criteria will have an available position. Similarly, jobs offered may not be able to accommodate all of your wishes. And that is where prioritizing is essential.

Identifying Available Positions: Use Your Resources

Once you outline the essential components of your academic career, you must actively seek opportunities. In general, people are hired in a few situations: there is a publicized position available for anyone to apply; there is a position of which a select few are privy via word of mouth; there is not a specific job opening, but because of the quality or skills of the candidate, a position may be created. The first situation is obviously the most accessible. These jobs are often listed in Diseases of the Colon and Rectum, Annals of Surgery, or Surgical Endoscopy. Similarly, the jobs are posted on the American Society of Colon and Rectal Surgeons Web site or other similar surgical Web sites. Candidates should scour these sources early in their colorectal surgery residency year for a possible match. The other two situations rely heavily on relationships that your mentors or programs have fostered with programs and centers around the country. It is not unusual for an alumnus who is looking to hire, to contact his/her alma mater program for qualified current fellows. Thus, it is imperative to meet with your chairman and program director early in the year to discuss your career ambitions so that they may recommend you appropriately for opportunities.

The last situation is the most delicate because there is not a readily available spot, but these situations can often be the most fruitful and rewarding because you have the potential to design your own position. This is your chance to be proactive and sell yourself into the position. Ideally, your chairman or program director can inquire on your behalf about a potential job, and encourage them to receive your inquest. Even if there is not a prior personal relationship, I would encourage the interaction be initiated at the faculty level. If that is not possible or feasible, contact the program or center of interest with a cover letter highlighting your skills and what you could bring to the group, along with a curriculum vitae. Emphasize your strengths with particular attention to skills that may be rare in that practice. For instance, if you are looking to join an academic surgery group that does not have colorectal surgeons, the simple fact that you are trained in colorectal surgery may be a significant attraction. This is also an opportunity to point out any specialized experience or productivity in prior research endeavors or teaching. Most importantly, do not get discouraged. Be persistent and be true to your principles of what you are seeking in a job.

Evaluating Opportunities

As the job search advances to a more concrete point at individual institutions, evaluation of specific aspects most relevant to your goals is imperative.

Identify a Mentor

Perhaps the most critical factor influencing future success is identifying a career mentor. The mentor can be anyone who has the experience in your area to help guide you along in your career path both clinically and academically. You may have several mentors who guide you in different aspects of your job. For example, someone interested in a basic science career may develop a relationship with a PhD in the genetics department to oversee that aspect of career progress, and also use a senior surgeon as a clinical mentor. Choosing an appropriate mentor is discussed in detail elsewhere in this issue (Establishing a Successful Basic Science Research Program by Dr Wick, p. 58). Briefly, a mentor should have the ability, interest, and time to foster your development, whether with technical skills, clinical judgment and decision making, or applying to the appropriate societies.

Assessing Your Partners

The professional and personal qualities of your partners can make or break your happiness in your practice. You will constantly interact with them whether discussing cases, sharing clinic space, operating in the next room, or learning/teaching at educational conferences. You will also rely on each other to cover patients when you are away professionally or on vacation. It is critical to assess the interests of your future partners to see how your practice may be viewed. If you want an academic practice, it is helpful to be in an environment where your partners also have interest in an academic career. It does not need to be the same interest, but a general philosophy within the group that developing an academic career is important and that time can be devoted to doing so. A team environment where you not only trust but like the people around you will greatly facilitate your own productivity.

Is There a Current Model in Place?

In evaluating a job situation, you should look at the current faculty and determine what you want to achieve is feasible in the given environment. If you want to become a world's expert in clinical trials, but no one at that institution has any experience in clinical trials and there is no infrastructure in place to do so, then it is less of a fit for your needs. In my opinion, an ideal situation includes a senior academic surgeon who is established and facile in a similar field to your interest. Ideally he or she has gotten to that level at the same institution and both the chairman and partners realize the commitment needed to get to that level. Even if the experience at the potential institution is not exactly in your subject matter, it is important that there is an academic roadmap in place.

Opportunities for Growth and Advancement

Education is a lifelong process and this could not be more true in academic colorectal surgery. In addition to continuing to hone your technical skills, you will also be developing your new academic skills. Depending on your chosen career, different resources may be required. Do you need to be in a university setting where there are multiple basic science departments, experts in epidemiology or bioinformatics, or a school of public health? Is there infrastructure to assist with grant writing, budgeting, or clinical trial initiatives? Are there scientific cores available and willing collaborators in the basic science fields or in other professional schools? In addition to the existence of these opportunities, you will need to have the commitment from your chairman and partners to spend time pursuing your goals. Will there be financial support to attend meetings, give talks and presentations, and attend courses? Is the group conducive and accepting for you to step into leadership roles early in your practice? What is the promotion process and criteria for academic promotion? All of these are relevant questions when deciding if an institution is right for you.

Is There Professional and Clinical Support?

Building an academic career takes time and effort. Clinical support to assist in running your practice in the form of physician extenders, clinical nurses, and administrative support is invaluable. Any piece of the workload that can be handled by your staff will allow more time for you to conduct academic work. In evaluating a position, determine what ancillary support will be available.

Know the Expectations

The academic model is constantly in flux. It is easy to be torn between the many different aspects of your new professional life. New recruits are often viewed as young, energetic, and willing to do anything. The pressures can come from within yourself as you want to take on multiple tasks with the confidence of “I can do anything and everything.” External pressures from senior partners who rely on you for coverage or patient responsibilities are also a threat. It is crucial to avoid the dangers of trying to take on too much responsibility as you start your new job. With that in mind, it is important to set goals and expectations for yourself, and also clearly discuss the department's expectations of you.

Specific guidelines on how your performance will be evaluated and how you will be compensated should be made very clear at the onset. How many patients are you expected to see in clinic? Will you have assigned block time in the operating room? Will there be time dedicated to nonclinical academic endeavors? Although salary is often linked to clinical productivity, some academic jobs count academic productivity in the form of grants, publications, presentations, or teaching as relative value units. The expected clinical and academic responsibilities should be clearly defined and corresponding time be appropriately allotted.

Negotiating Your First Job

The reality is that most trainees graduating colorectal residency will have minimal negotiating power when it comes to salary and benefits in an academic career. Most salaries are determined by national and/or regional standards depending on the geographic location, cost of living, practice setting, and experience of the candidate. State university salaries are public knowledge and can be found on the Internet. Creative searching on the web will provide a general range of expected salaries. However, an academic job is not defined by the salary, but rather by the opportunities, and nonmonetary aspects of the job may be open to negotiation.

First and foremost, realize that you do have value. At the very least, you will have a unique clinical skill set as a colorectal surgeon. There are still many academic surgical departments that do not have colorectal-trained surgeons, and that alone may provide a selective advantage. If you are looking to join a large group of established colorectal surgeons, then a more unique skill that is not developed in the group may be very attractive. For example, perhaps you have a background in outcomes research using national databases; or you have studied an innovative approach to resident education; or you have a master's degree in public health; or you would be the lone person in the group trained in robotics. Whatever your strength, this should be emphasized with a plan of how that may benefit the larger group.

So what should you negotiate? To be an effective negotiator, you must first know what you want and why. Start with defining your academic goals and a plan to achieve those goals. Decipher if the essentials needed to achieve those goals will be supported, and if not, how they could be provided. The essentials in your plan can vary greatly between time, money, nurse support, the ability to do additional training, just to name a few examples. If you feel that you cannot achieve your goals without certain support, then that should be a priority in your negotiations. Importantly, you must have a rational explanation for your requests and a plausible plan to yield return on the investment. As a simple example, consider negotiating the basic structure of your week. Perhaps you will be collaborating with a basic scientist who has laboratory meetings on Wednesday afternoon. To throw yourself into the work and develop meaningful collaborations, it is important for you to participate and thus you may negotiate to have no clinical duties Wednesday afternoons. A return on that time investment may be submission of a research grant with your collaborator by the end of the first year. As another example, if you are asking for a clinical research nurse at the start of your career, you must justify how you will employ the nurse. It would be beneficial to demonstrate that you have ideas and the skill set to execute your plan for that nurse, and that a future plan is in place to fully fund that position once you collect preliminary data. Whatever it is that you negotiate, determine how long the arrangement will be in place and what criteria will be used to evaluate your success.

Summary

It is an exciting time in academic colorectal surgery. There are myriad opportunities to design your own path and influence the current state and future of medicine. First and foremost, be true to yourself and determine the type of career path you want to pursue. Develop a plan to find that opportunity and design what you want. Explore many options and put yourself in a position to maximize your chances of achieving your academic goals.