Career Planning: Achieving Success in Your First Job Post-Fellowship

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When I was a resident, one of my faculty mentors suggested that I read the book Lean In by Sheryl Sandberg. On her advice, I read the book and absorbed Sandberg's wisdom regarding the power of saying "yes" to work opportunities.

I thought of this book again as I started my first faculty position as a pediatric cardiologist at NYU/Hassenfeld Children's Hospital.

The first job after fellowship can be daunting, especially for those interested in academia. Many positions expect academic productivity but with a clinically heavy schedule.

How does one go about navigating the world of academia and saying "yes" to opportunity, all while balancing life responsibilities?

I decided to interview three cardiologists in different subspecialties on how they successfully navigated their first few years after fellowship and sought advice on how to transition from fellowship to faculty.

Negotiating Your Role

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There are many pathways to asking for protected time for administrative and research responsibilities. Some junior faculty negotiate these points before they start.

Anna Joong Hoeppner, MD, a heart failure and transplant specialist, accepted a position to grow a ventricular assist device program at Northwestern/Lurie Children's Hospital.

She asked for 70 percent clinical and 30 percent administrative time, stating, "I negotiated this with my initial contract, specifying that I wanted administrative time to grow a clinical program."

Lindsay R. Freud, MD, a noninvasive imager at Columbia/Morgan Stanley Children's Hospital, also had a similar structure that she negotiated: 70 percent clinical and 30 percent research for the first two to three years. This structure came with the expectation to have grant funding thereafter, which she was able to attain.

From a different perspective, Matthew A. Crystal, MD, FACC, an interventionalist at Columbia/Morgan Stanley Children's Hospital, eventually ended up 90 percent clinical and 10 percent administrative, with the expectation of growing a fetal interventional program. He states, "These changes came with the appointment of titles, unrelated to time accrued."

It is important to remember that even if you start with a certain structure, things can always be negotiated and changed as you develop more responsibility in your institution.

Navigating the First Year

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The universal advice was focused on growing your clinical skill set during the first year as an attending and setting boundaries. Joong Hoeppner states, "I think a huge component of being successful early on at a new institution is all about trust: you want to gain the trust from your colleagues that you are a team player who is reliable…you want to gain the trust from your patients and families, that you listen to their needs and have their best interest at heart – and you want to gain trust in yourself."

As important as it is to gain clinical skills, Freud recommends setting boundaries from a clinical perspective, stating, "It's very easy to get sucked into clinical work, especially if you have complex patients. Set boundaries with both patients and colleagues where feasible."

Crystal cautions as an interventionalist, "The advice I was given in my first year as an attending was to avoid taking on something too complex and advanced…the complexity and challenging cases will come, but it is important to fully get your feet on the ground and transition into life as an attending before stretching into potential challenges."

Creating Work-Life Balance

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Work-life balance appears to be a challenge across subspecialties. Freud states, "It's pretty hard in the first one to two years, then you gradually get the swing of things and make things work."

For those with young children, the first few years can also be difficult when balancing your growing family. Joong Hoeppner suggests, "Try and be purposeful about work-life balance. Decide on what your priorities are and work to make that happen. For me, I wanted to be home for dinner as often as possible."

Crystal agrees, stating, "I try very hard to take advantage of the times I am with my family. They are very understanding that my position is time-consuming and challenging, but it remains a challenge to explain to my younger children why I'm not always home when they want to play."

It does not hurt to ask for help from those around you.

Crystal states, "I have been very lucky to have wonderful colleagues who help support the time away for these events."

What I Wish I Had Known

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Joong Hoeppner says, "I wish I had kept a better log of patients and the clinical decisions I was involved in as a fellow. Now as a junior attending, we are much more likely to second guess ourselves, question assumptions and think back to the patients we learned from as trainees."

Many junior attendings benefit from seeking our senior mentorship. Joong Hoeppner states, "Don't wait for a mentor to find you or be assigned, seek out mentors!" Freud has similar advice in terms of mentors.

"The most important thing to do is find a research mentor. A good mentor will help with resources until you attain independent grant funding."

Putting it All Together

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While these three cardiologists are part of large, academic centers, there are certain pearls that are applicable at any type of institution.

It is possible to prioritize your academic interests and create a strong clinical skill set, all while maintaining boundaries and having time for a personal life.

Every career path is going to look different, but with clearly defined roles, mentorship and not being afraid to ask for what you need, it is possible to create a structure within your first position that allows personal and professional success.

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This article was authored by Ranjini Srinivasan, MD, pediatric cardiologist at New York University in New York, NY.