Holding the Course or Moving on from Your First Job

By Gabriel Loor, MD

July 23, 2019

Starting your first job as a cardiothoracic surgeon is exhilarating. Yet only 60% of graduates report being satisfied with their first job and more than 70% leave their first jobs within 5 years. This blog post addresses potential reasons for job changes, the value of persevering before leaving too soon, and the benefits of moving on when it’s time.

When you start your first practice, you are finally doing what you love and what you trained endless hours to do. It is scary as you perform your first cases independently, but gradually you gain confidence. Your employer courted you from your fellowship and is excited to work with you. You seek mentorship, get support, and define your goals in alignment with your boss and hospital. You have a substantial impact on patients’ lives. The families appreciate you, and the staff is thrilled to work with you. You develop new ideas and initiatives and introduce cutting-edge techniques to your practice. Residents and support staff look up to you. You are in a new city making a real income for what may be the first time. It is a unique and rewarding experience.

Over time, however, certain realities may start to crystallize. You are a new graduate who is performing difficult procedures with no room for error, but referring providers favor sending cases to your senior partners. These partners may or may not be as committed to developing your career as you would have hoped. You find that you are lacking the instruments and resources you requested. You have few patients in your clinic. Residents and PAs second-guess you and defer to your partners. It is challenging to initiate research projects and recruit a research team due to lack of time and resources. You tend to perform cases at odd hours with a limited block time. The hospital isn’t supportive of your initiatives. You long for the efficient, high-volume, surgical fellowship experience in which you had limited responsibility and liability. Essentially, what began as a new and exciting adventure is now quickly fading into a humbling experience that takes resilience, purpose, and integrity to overcome. 

Guess what? You are not alone! Developing a new practice is and always has been challenging for surgeons—from Harvey Cushing to Michael DeBakey. This is because few fellowships are able to prepare residents for these “work-related” obstacles, given the limited time and requirement for focusing on technical skill and clinical management.

Essentially, what began as a new and exciting adventure is now quickly fading into a humbling experience that takes resilience, purpose, and integrity to overcome. 

As a new surgeon, the stress levels rise fast, and by the end of your first year and beginning of the second year in practice, you can start developing signs of burnout due to long (often self-imposed) hours, a heavy workload, and numerous personnel, infrastructure, and resource challenges. 

How to Handle First Job Challenges 

Challenges like these are part of life as an early careerist, and by overcoming them, you become stronger and more adept for the future. Yet it is tempting to think you can recreate that initial exhilarating experience by switching jobs and moving to a new organization. Almost daily, postings show up about exciting opportunities at new facilities in different towns. Moving on might be a good idea in some cases, but how can you be sure? 

Consider two things when deciding to leave your first paid position: 

  1. How your current employer will view you?
  2. How your future employers will view you?  

For the first, you can rest assured they will be resentful if they invested in you and you crumbled under the least bit of stress. Future employers will sense this as well.

The best advice and critical first steps are to seek help, develop your leadership skills and maturity, and reassess your expectations. You must learn quickly that social interactions with staff, peers, and patients are just as important as your surgical results. Take apart your challenges in discrete portions and develop strategies to address each one. Focus on what you can do and what is possible. For example, you can increase your consistency in rounding, communication, and teaching your staff. You can embrace the established culture while incorporating new ways of doing things. You can bolster up your research team. You can get more cases by collaborating with your peers to double scrub and learn from them. Make an effort to be compassionate, understanding, and tolerant of your nursing staff and trainees; trust will follow. 

What you will quickly realize is that your approach is key. Focus on the positives—your success, your family, and all of your wins in clinical and research endeavors. Slow down and prioritize. Alter your expectations to align yourself with the system better. If you want more volume, first break it down and address the elements needed to build and sustain that volume before setting your goal on volume alone. If applying for three grants is your goal, consider changing it to one so that you can actually enjoy the team relationships you develop along the way. Read as much as you can on self-development and stay in shape both physically and mentally. Shift your focus to what really matters and clarify your purpose. At times, just knowing that you are here to care for another human life can give you a profound satisfaction that goes beyond meeting your artificial goal of 300+ pump cases. 

Once you have done these things, you are likely to gain a newfound appreciation for your environment. Your current employer and future employers will see significant value in you. 

At times, just knowing that you are here to care for another human life can give you a profound satisfaction that goes beyond meeting your artificial goal of 300+ pump cases. 

When to Move On

It is rarely, if ever, advisable to move on before 3 years. There are some exceptions such as family, health, or personal issues, but disillusionment with your current system is not a good reason to abandon ship. 

If you do decide to move on, make sure your new opportunity aligns better with your goals and objectives, but rest assured, there always will be challenges. This is why it helps to develop resiliency and positive methods for dealing with challenges in your first practice. 

There are pros and cons to any decision, and you must be very realistic and honest about both. For example, changing jobs comes at a cost. You incur high costs in moving, selling your home, losing research momentum, and having to rebuild a clinical practice. At the same time, the opportunities of relocating can also be very good, including better support, a promotion, higher volume, or more resources. Moving somewhere new broadens your horizons, increases your challenges, and forces you to work outside your comfort zone. 

If you decide to move, you need enough bargaining power that the opportunities offset the risks in loss of practice and professional momentum. The only way to get that bargaining power is by increasing your net value, and the only way to do that is to stick around long enough in your original position to make a noticeable impact. Typically, when this occurs, you will leave in amicable terms, as your program will appreciate that you weathered challenges, built opportunities, focused on the program, and gave them a significant return on their investment. 

If you decide to move, you need enough bargaining power that the opportunities offset the risks in loss of practice and professional momentum. The only way to get that bargaining power is by increasing your net value, and the only way to do that is to stick around long enough in your original position to make a noticeable impact.

Whether You Stay or Go

Integrity, resilience, and perseverance are key attributes that employers look for and expect in their new employees. Although most of us receive no formal training on how to develop these attributes, they are almost innate to trainees completing an arduous 7 to 10 years of surgical training. So if you are in doubt about your current position, be aware that you already have these attributes within you. Know that your new practice and newfound expectations will increasingly test you. Be patient and learn from your challenges. Seek mentorship from inside and outside the institution. Help your patients and the broader surgical community through clinical excellence and leadership. Others will notice and value this and, gradually, the right opportunity and right time to move on will materialize. Alternatively, you may find newfound purpose and excitement in your current position and continue to build your net value for the benefit of your patients, your organization, and the broader medical world. 

The opinions expressed in this article are those of the author and do not necessarily reflect the views of The Society of Thoracic Surgeons.


Read more career development blog posts >