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Kickstarting your academic hospital medicine career

Successful hospitalists offer advice for new docs

From the October ACP Hospitalist, copyright © 2013 by the American College of Physicians

By Charlotte Huff

Working alongside students and residents keeps medical practice fresh for Angela Johnson, MD, FACP, even if she's treated a particular diagnosis countless times.

“It's hard for it to get old when it's always something new for someone I'm teaching,” said Dr. Johnson, an associate professor of clinical medicine at Louisiana State University (LSU) Health Sciences Center in New Orleans, and chair of ACP's Council of Early Career Physicians.

Image from Thinkstock.

Image from Thinkstock.



But as satisfied as she is now, Dr. Johnson faced a challenge early in her career. Having trained in the LSU health system from medical school through chief residency, she wondered how she could clearly establish her position once she became a faculty member.

One step she took was to become the physician champion for a heart failure improvement effort. She also got involved in institutional preparations for an upcoming reaccreditation of the internal medicine program. “That let my program director know that I had an interest in not just in the day-to-day work, but also the administration side of the program,” Dr. Johnson said.

Building networks, finding mentors and staying open to new experiences and opportunities are just some of the ways successful hospitalists have shaped the early years of their post-residency careers in academia. At the same time, veterans caution that hospitalists shouldn't overcommit themselves or get diverted from their clinical passions.

Tapping mentors

Hospitalists who are just getting started in academic medicine have a lot of skills that can benefit not only their institutions, but the evolution of the relatively young specialty, said Moises Auron, MD, FACP, a staff hospitalist and assistant professor of medicine and pediatrics at The Cleveland Clinic in Ohio.

“As a young physician, you bring energy, you bring enthusiasm, you bring the desire to excel, you bring an incredible desire to learn new things, and an incredible desire for innovation,” he said.

But early on, hospitalists should think hard about how they want to position themselves, in terms of where they prefer to spend the bulk of their time and energy moving forward, Dr. Auron said. Do they want to devote themselves primarily to teaching, or to research, or to a specific institutional area like quality improvement or cost control?

To discuss and weigh these various paths, mentor feedback is crucial, he said.

“I think mentorship is the single most important component for anybody's career,” Dr. Auron said. “Mentors can help to strategize, to be more efficient. Mentors can provide a different insight into things.”

It's important to soak up as much input and as many ideas as possible by, for example, meeting with the department's chairman as well as any hospitalist with more than five years' experience, he added. “Ask them, ‘What's the best way to make my entrance a success?’”

Dr. Auron credits a mentor with encouraging him to pursue quality improvement, now one of his driving interests. Julie C. Nguyen, MD, MBA, FACP, an academic hospitalist at Houston Methodist in Texas since 2009, has a long-term goal of one day running a hospital, and she counts a hospital administrator among her key mentors. Another mentor suggested she get an MBA; she recently completed that degree.

Mentorships can't be forced, but they can be fostered, Dr. Nguyen said. “If there is anybody I admire, and I want to be like them, I usually approach them and set up a meeting to talk to them,” she said.

Her MBA program also alerted Dr. Nguyen to the importance of networking, including online. While she spends little time on Facebook, other than keeping in touch with groups like ACP, Dr. Nguyen recommends LinkedIn.com as a good way to keep in touch professionally and stay on colleagues' radar for professional job opportunities in the years ahead.

Drs. Nguyen and Auron recommend becoming active in medical organizations and societies; both belong to several, including ACP's Council of Early Career Physicians.

“Health care in the United States is changing dramatically. And the societies right now are in the midst of the change,” Dr. Auron said.

Be selective

One potential pitfall early-career hospitalists may encounter is tackling too many projects at once. Developing a career requires a constant balance between staying open to new possibilities, and not getting overloaded or closing off other intriguing options, hospitalists said.

“If I could go back, I would have learned how to say no,” Dr. Nguyen said. She moved quickly to join initiatives as a new hospitalist and today is part of several quality-related committees, one of her primary interests. She added that she wishes she'd been a bit more selective, in order to better fast-track her career. “This field is so young that if you begin to do it early, you will get to where you want at an earlier age,” she said.

But a young physician who narrows focus too early on may also risk missing out on career options. Only five years ago, for example, Dr. Nguyen was still thinking about working at an outpatient clinic, until she got hooked on hospital medicine.

Looking back, Dr. Johnson wishes she had reached out earlier for guidance on fitting research projects into the swirl of faculty responsibilities. “It sometimes can be difficult to start developing the research side,” she said. “It tends to hit the back burner, because you are so involved with the patient care responsibility side and the direct teaching side.”

Dr. Johnson also echoed Dr. Nguyen's suggestion that new academic hospitalists try to resist “the overwhelming push” early on to shoulder too many committees, projects and other roles. “Try as best as you can to choose something you really feel passionate about,” she said.

Otherwise, a hospitalist risks not performing as well, she said. Plus, if the hospitalist is not careful, he or she may get pigeonholed into an area that is not a driving passion and may not be approached later with an opportunity that is a better fit.

“You can't sit back and wait too long for that perfect opportunity, because those don't always come along,” Dr. Johnson said. “But you have to make sure you have enough interest in [a subject] to sustain it, and actually want to excel in that particular area.”

Charlotte Huff is a freelance writer in Fort Worth, Texas.

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