Editor’s note: The Young Fellows Association (YFA) of the American College of Surgeons (ACS) Communications Committee recently held an essay contest. Young surgeons were challenged to write an essay on the theme Transitioning to Mid-Practice, and the winning essay was written by Sameh M. Said, MBBCh, MD, FACS.
Finally, I can say the statement, “I have been doing this for a while,” that I’ve heard so many times from other mid-career and senior surgeons during my training and early career. But is this really true? When I am entering my mid-career as a surgeon, do I not need guidance or support anymore? Let us think about this for a little bit.
I find those in early career actually lucky. They have plenty of resources and support to help their transition from years of residency and fellowship training to become independent. I was one of them. I will tell you the expectations in general are not that high and if you excel, you are great, and if not, someone will help you, and you will learn.
But, how about later, like now? It is totally the opposite; the expectations are high from both patients and colleagues, but we still need guidance and support. It may be different based on your specialty, but it is definitely needed in mine. Pediatric cardiovascular surgery is one of the most challenging specialties out there.
“Doctor, how many times have you done this operation before?” This is, in my mind, one of the scariest questions that a patient or parent can ask an early-career surgeon and it always scared me. I never knew how to answer that question and I am not sure I ever will know. Not because I have never done the procedure they are asking about, but because in cardiac surgery, and in congenital cardiac surgery in particular, when you start to feel confident and you think you have done enough, that is when you start making mistakes. It is a fair and unfair question at the same time. No one understands that we cannot give guarantees at any time in our specialty. Experience, for sure, matters, but it is not everything. Attention to details is more important in my line of work, and treating every case as the first case is my own personal rule and one of the key things I learned in my early career. I have had difficulties and troubles in the easiest cases, and not the hardest, perhaps because I was better prepared mentally and paid attention to all details. As Benjamin Franklin has been quoted as saying, “By failing to prepare, you are preparing to fail….”
There is no doubt you learn a lot in your early career and you bring this experience into the next phase, which eases that transition, but also you need continued guidance and support.
I think the focus of the two phases are different. In early career, you focus on doing more (quantity) and learning more. While in mid-career, your focus is on quality and trying to apply what you learned in your early career. I will tell what I have learned so far:
- I learned the importance of mentorship and collegiality. To be among a supportive group and team is more important than being able to do the most difficult cases out there.
- I learned to aim for perfection at all levels: preoperative, intraoperative, and postoperative. This may come across as highly demanding but this what my subspecialty needs, and that is what I have seen great surgeons do. We are invested in our patients to the extreme. We take it personally and I do not think this can easily change.
- I learned how to speak to parents and patients. I always thought I knew how to talk to parents when their kids were about to have a major surgery, but actually it is one of the most difficult skills to learn. I have seen very senior surgeons who lack this skill. I think this is a skill that continues to develop and mature over time, and it may take an entire career to master.
- I learned that the loss of a patient is like losing a family member. It can be very difficult to handle. I remember crying for a child’s death after a long battle in a complex case. It is difficult because we care and we treat them as family. This is the most difficult scenario to discuss with parents and families. They do not teach this during training; you are on your own.
- You also start paying attention to things you heard about, but you did not care too much about previously, such as work-life balance. I still do not believe in this, and I do not think I ever will. It is easy to talk about it. But, are we, as surgeons in a very demanding specialty, really balancing work and life? No, we are not, so we should stop saying this. Stop making things harder. The best approach is to find harmony between both work and life and establish a rhythm between both; find what works for you. As Simon Sinek said, “The goal is not simply to ‘work hard, play hard,’ the goal is to make our work and our play indistinguishable.”*
- Finally, a dream does not become reality through magic. It takes sweat, determination, and hard work.
I hope I am personally prepared for the next phase of my professional journey, but the bottom line is that mid-career is when you realize that operating is the easiest part of your career.
*Sinek S. Quotes Wiki. Available at: https://www.quotes.wiki/the-goal- is-not-simply-to-work-hard-play-hard/. Accessed August 20, 2020.