After five to ten years of postgraduate residency and fellowship training, it’s been a while since your job has been decided by anything other than a computer matching algorithm and luck. So the opportunity to choose your first faculty job deserves a great deal of careful thought and planning. These are reflections on my process, but it was an incredibly personal decision, so your experience may certainly differ.
The choice comes in three stages – looking for jobs, screening opportunities, and crafting the position. Before embarking on Step 1, however, make sure you’ve done some good soul-searching. Spend some time to develop a “mission statement” detailing your motivations, methods and goals for the 2, 5, and 10 year marks. It should address your clinical interests, leadership goals, roles in education, and a research plan and structure. Will you be a clinical surgeon who publishes – “surgeon-educator”, “clinical scientist” – or a primary researcher and externally-funded investigator who operates and sees patients part-time? Most importantly, what are your “stretch goals” – the achievements that would really set you apart? Are they clinical expertise and recognition, academic or administrative promotion, or an NIH grant and a paper in NEJM? Identify the elements that are flexible and those that are non-negotiable. A well-matched work environment should offer the opportunity to shoot for your loftiest goals, and must provide the non-negotiables.
Starting the job search itself may be hard, because your job likely will not be in the want-ads. Make yourself known by seeking out people whose papers you’ve read and talks you’ve admired at meetings. You’ll find these people at the ACS Surgical Forum Quality/Outcomes/Cost sessions, the ASC Outcomes Sessions, and the Surgical Outcomes Club. My job offer began with a simple lunch conversation over sandwiches with the discussant of my Surgical Forum paper.
An essential early decision in screening opportunities is what type of research setting you want. Will you “go it alone” and start a shop in an institution without an HSR track record? Will you join a successful medical HSR group as their surgical expert? Or will you seek out one of the few established surgical HSR groups with will and resources to support young faculty in academic development? Investigating opportunities requires careful attention to the priorities, culture, and reward structure of the department and the institution. Will research success be rewarded, or is the incentive structure defined by clinical revenue? Be sure that your mission will be valued and supported, and that achievement of your goals will be appreciated. Talk with new junior faculty hires about their experiences, as this will be a very good measure of your opportunity for success there.
When crafting the position, the indispensable component of any academic surgery job is the real availability of time for focused academic work. The early years as a surgical attending are mentally draining, and clear delineations between clinical and academic time are critical. A system in which academics take place on nights and weekends is not a formula for quality work. Identify resources for mentorship and collaboration. Look for mentors and groups with a track record for elevating junior faculty toward independence. And be sure you understand where your resources will come from. Can you draft off an existing infrastructure, or will start-up funds be the sole source of support? How long will your salary be supported by the department before it depends only on revenue? Be sure that there is clinical need for what you do, so that you aren’t beating the bushes for patients, but that there are limits to the demand to prevent overflow.
As job offers develop, return frequently to your mission statement. Identify and demand the resources essential to your goals in each of the domains. Keep the long view and think about your overall research themes and arcs. Set early precedents about your clinical availability and put academic time on your calendar. Don’t let it just fill in the gaps around other commitments. If you recognize and pursue your personal mission and goals, identify and take advantage of a great position in a well-suited environment, and get both financial and institutional support for your academic development, you will have every opportunity to do meaningful work and make important contributions.
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