Common Pitfalls of Junior Faculty

1
Common Pitfalls of Junior Faculty

• Marc Borenstein, MD, FACEP, FACP
• Chairman and Residency Program Director
• Newark Beth Israel Medical Center

2
Common Pitfall

• Underestimating the importance of time
• Not realizing progress is occurring
• The overnight success of the chick
• Wax on, wax off, paint the fence

3
The Importance of Time

• Getting started
• The first 1 3 years
• Gaining momentum
• Years 4 10
• In the zone the medical career sweet spot
• Years 10 25

4
The First 1-3 Years

• Getting board-certified
• Honing clinical excellence
• Achieving teaching excellence
• Acquiring institutional knowledge

5
The First 1-3 Years

• Finding a mentor
• Understanding the categories of scholarly
  activity
• Identifying your career path

6
Clinical Excellence

• Bedrock of academic excellence
• Clinical judgment and decisiveness
• Productivity
• Satisfaction
• Documentation and billing

7
Clinical Excellence

• Flexibility and availability
• Delivering on quality measures
• STEMI
• PN

8
Common Pitfall

• Underestimating the total time required to
  complete teaching attending expectations
• The clinical trap
• Too little years 1 4
• Too much years 5 15 when academic career
  development is at its peak

9
Common Pitfall

• Hours scheduled v. actual hours worked
• 28 clinical hours/wk x 45 wks/yr
• 1260 annual scheduled hours
• 126 10-hour shifts

10
Common Pitfall

• Actual hours worked
• 1 hr average post-shift
• Charting, completion of cases, and sign-out
• Monthly staff meeting
• 1 committee
• Presence at conference

11
Annual Hours Calculations

• 40 minute home to ED travel time
• 168 hrs
• Post-shift
• 126 hrs
• ED monthly staff meeting and 1 committee
• 30 hrs

12
Annual Hours Calculations

• Presence at conference
• 2 hrs/wk x 23 wks 46 hrs
• Actual hours needed
• 1260 168 126 30 46
• 1630 36.2 hrs/wk

13
Annual Hours Calculations

• 1.5 2 hrs needed per 1 non-clinical hr received
• Total
• 36.2 18 to 24 54 60 hours

14
Teaching Excellence

• Knowledge and ability
• Bringing out the best in others
• Acknowledgment
• Encouragement
• Guided independence

15
Teaching Excellence

• Curriculum design
• Evaluation methodology
• Designing and delivering constructive criticism
• Coaching
• Knowledge v. experiential learning

16
Teaching Excellence

• Role modeling
• Professionalism
• Communication
• Team play

17
Common Pitfall

• Thinking that upon residency graduation you know
  how to teach effectively
• Knowing what to teach ? how to teach it
  effectively
• Formal classes and mentoring on how to teach

18
Acquiring Institutional Knowledge

• Hospital DME
• Medical school deans for GME, UME
• Administrators responsible for ED operations
• Institutional RPDs, researchers, educators
• Integrate research/education with other
  specialties

19
Acquiring Institutional Knowledge

• Committees, interdepartmental working groups
• GME
• Program internal reviews
• IRB
• Clinical operations

20
Acquiring Institutional Knowledge

• Clinical pathways/guidelines
• Stroke
• STEMI, non-STEMI

21
Common Pitfall

• Going it alone
• The importance of a mentor

22
The Value of a Mentor

• Coach
• Observer
• Committed Listener
• Guide
• Role model

23
Finding a Mentor

• Does not always have to be an EM physician
• Especially for research development
• Does not always have to be at your institution
• You can have more than one mentor

24
Categories of Scholarly Activity

• Discovery
• Creative scientific inquiry
• Dissemination
• State of the art reviews and chapters
• Application
• Case reports, clinical series

25
Categories of Scholarly Activity

• Education
• Invited speaker
• Participation
• Regional and national professional societies

26
Common Pitfall

• Not planning
• Short and long term career goals
• The difference between the goals and the road to
  achieve them

27
Identifying Your Career Path

• Administration
• Maintaining compliance and function
• Teaching
• Educating and training the next generation
• Research
• Discovery of new insight that changes how we view
  the world

28
Using Protected Time Wisely

• What is it worth?
• What is it for?
• What is expected for it?

29
Using Protected Time Wisely

• What is it worth?
• 180,000 25 fringe benefits 225,000
• 12/40 30 67,500
• 15/40 37.5 84,375

30
Using Protected Time Wisely

• What is it for?
• Scholarly activities
• Administration
• Teaching

31
Using Protected Time Wisely

• What is expected for it?
• Whatever it takes to get the job done well
• Physicians with protected time positions are
  viewed as hospital management

32
Focus..

• Develop a niche
• Passion
• Existing talent and/or specialized skills
• Curiosity
• Contribution
• Develop regional and national recognition

33
Focus..

• Build research and scholarly activity around
  common themes
• Avoid a potpourri of small projects over time

34
Plan..

• Create specific goals and measurable outcomes
• Relate outcomes to the department and
  organizational mission

35
Plan..

• Take what you enjoy and connect it to work
• Short term
• 3 to 6 years
• Long term
• 7 to 15 years

36
And Plan to Work!

• The myth of the 40 hr work week
• The synergy and importance of on-site visibility

37
Common Pitfall

• Not knowing the rules and timeline for academic
  promotion
• Multiple tracks
• Rules vary with each institution
• 3 to 5 years in academic rank typical
• Senior appointments and promotion committee

38
Academic Tracks

• Unmodified/Tenure
• Associate Professor of _____
• Modified
• Associate Professor of Clinical _____
• Clinical Associate Professor of _____

39
Academic Tracks

• Teacher/Educator
• Evidence of teaching excellence
• Teaching portfolio
• Curriculum innovation very desirable

40
Research

• Still the One
• For advancement in an unmodified track
• Get experience with a funded investigator
• Research fellowship

41
Research

• Learn, take classes
• Biostatistics
• Grant writing for external funding
• Is start-up funding available?

42
Research

• Know the institutional resources
• Research study assistants
• Statisticians
• Grant application/writing experts

43
Research

• Publish
• Peer-reviewed (refereed) journals
• Clinical or bench scientific investigations
• Publish what youre already working on

44
Research

• Publish often
• Set specific goals
• Allocate regularly scheduled time
• Work on your research and write whether youre
  feeling inspired or not

45
Teaching/Academic Portfolio

• Keep accurate, on-going records
• Know what constitutes scholarly activity
• Dont underestimate accomplishments

46
The Power of Yes

• The value of optimism in an organization
• Being a yes person
• Focused on getting the results and finding
  solutions not being right
• Helping others without a quid pro quo attitude
• Generosity works

47
Trust Opportunity Will Arrive

• The job/task/problem you take on and handle well
  may open important doors to your future
• The value of an opportunity is not always
  apparent at the time it is presented to you

48
Trust Opportunity Will Arrive

• Contribute without expectation for quid pro quo
• Generosity works
• The importance of the volunteer spirit at work

49
Trust Opportunity Will Arrive

• The results of a project may segue into
  opportunities for publication, invited speaking,
  and teaching that become regional or national in
  scope
• Take a risk sometimes
• Life is not a spectator sport

50
Create Opportunity

• Be willing to move
• The greatest career opportunities may not be in
  your department or even geographically where you
  envisioned living

51
Create Opportunity

• Make requests
• Ask and pro-actively look for opportunities
• Reviews, chapters
• Participation in professional societies
• Take on a job no one wants
• Solve a problem/complaint no one wants to own

52
The Freedom of No

• When to say no
• May not be clear during the first 3 5 years
• Should be an already busy faculty member
• Limit administrative work unless your career path
  is to become a program or department director

53
When Its Time to Let Go

• The goal has been fulfilled
• You have arrived
• Its no longer fun
• Your interests have grown in new direction
• You have grown beyond the project

54
Common Pitfall

• Not knowing how to create and/or articulate a
  business plan when requesting money for
• A new program
• Expansion of an existing program

55
A Business Model for EM US

• Speak their language
• Satisfaction
• Cost
• Decreased use of on-call US techs
• Billing revenue
• Leasing v. buying

56
Qualities to Avoid

• Complaining, whining
• Trashing the hospital, department, or its
  leadership publicly
• Not taking ownership of a problem
• Argumentative, stubborn
• I am the attending!

57
Qualities to Avoid

• Gossiping
• Comparing yourself or others to others

58
Qualities You Need

• Affability
• The ability to get along with others
• Availability
• The yes mentality
• Ability

59
Qualities You Need

• Flexibility
• Humble confidence
• Timeliness
• Gratefulness

60
Qualities You Need

• Self-control, the ability to stay calm under fire
• Communication excellence
• Perseverance
• The ability to create empowering context
• Turn down the volume on negative thoughts

61
Proactive Faculty Development

• Create specific goals and measurable outcomes
• Relate the outcomes to the department and
  organizational mission

62
Proactive Faculty Development

• Know and support the department mission
• Education, research, scholarship
• Clinical excellence
• Institutional service
• An environment of satisfaction

63
Proactive Faculty Development

• Meet with your direct report at least monthly
• Formally interview your direct report at least
  annually
• What are the 3 most important areas you working
  on?

64
Proactive Faculty Development

• What can I provide to help you succeed in these
  areas?
• What can I do to help you win in your job?

65
Proactive Faculty Development

• What are the most important areas for me to work
  on?
• What are the most important goals for me to
  achieve?

66
Satisfaction and Longevity at Work

• Do I know what is expected of me at work?
• Do I have the materials and equipment I need to
  do my work right?
• At work do I have the opportunity to do what I do
  best every day?
• First, Break All the
  Rules, Buckingham and Coffman, 1999

67
Satisfaction and Longevity at Work

• In the past 7 days have I received recognition or
  praise for doing good work?
• Does my supervisor or someone at work seem to
  care about me as a person?
• Is there someone at work who encourages my
  development?
• First, Break All the Rules,
  Buckingham and Coffman, 1999

68
Satisfaction and Longevity at Work

• At work do my opinions seem to count?
• Does the mission/purpose of my hospital/healthcare
  system make me feel that my job is important?
• Are my co-workers committed to doing quality
  work?
• First, Break All
  the Rules, Buckingham and Coffman, 1999

69
Satisfaction and Longevity at Work

• Do I have a good friend at work?
• In the last 6 months has someone at work talked
  to me about my progress?
• This year have I had the opportunity at work to
  learn and grow?
• First, Break All
  the Rules, Buckingham and Coffman, 1999