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Maintaining Wellness in Mid-career

Maintaining Wellness in Mid-careerMid-career faculty often constitute the largest and most productive segment of faculty members. However, they are also reported to have the highest rates of burnout, emotional exhaustion, and low vitality. Common themes among mid-career faculty members related to overall burnout include feelings of neglect and decreased opportunities for mentoring and career development. These findings are especially troubling since the mid-career faculty period has been described as “the keystone of academic enterprise”. This period in career development is also one of dynamic career change where many faculty members are reaching either a professional cross-roads, crisis, or apex of their career. It is during this time period that many mid-career faculty members make institutional changes, or may leave academia or the active practice of medicine all together. Some of the challenges encountered during the mid-career are nicely highlighted in the paper by Golper and Feldman. Select topics relevant to necessary skills and knowledge to successfully navigate a career in medicine, especially during the mid-career period, are further discussed. Knowledge and resources in these areas may help to mitigate burnout experienced during this career period.

https://cjasn.asnjournals.org/content/3/6/1870

Navigating the Political Landscape of Academic Institutions
Simone’s Maxims published in 1999 is still very relevant to the political landscape of academic institutions today. Understanding the academic environment and the drivers of decision making and priorities within institutions is important to understand early in your career, but becomes fundamental knowledge required to navigate the challenges of the mid-career period.

https://clincancerres.aacrjournals.org/content/5/9/2281

Some selected take-home messages include:  
-    “Institutions don’t love you back”: The relationship between an employee or faculty member and the institution is contractual. Decisions must often be made within institutions without consideration for personal feelings. Loyalty to an institution does not typically buy you special treatment or consideration when tough decisions must be made.  

-    “One should consider an academic move only for an improvement in anticipated opportunity and environment of 50% or more”: The grass is often not greener on the other side. When deciphering as to whether to move institutions or workplaces consider that the reality of a new environment is often less desirable than the initial perception. Although the environment may indeed be a better fit for your career goals and may provide better support and opportunities, you must be aware that the “real” environment will only be revealed once you are there. You must be ready for some challenges that you did not expect. The “50% or more” cushion is needed because the true environment and opportunity almost always end up being less, and the difficulties always turn out to be more than one thought. It is in the nature of changes that the grass always looks greener, and it may be, but just not as green as it looked.

If you are having difficulty in a current environment, be sure to ask around with other colleagues to determine if what you are experiencing is true dysfunction at your institution or part of the norm of the current medical environment overall. For example, due to the current financial climate of medical care many institutions have implemented more strict production (e.g. RVU) goals for their staff. Often issues experienced at your institution are not unique.

Mid-career Mentor and Support Relationships/Mentorship Versus Sponsorship
Mentorship, which describes a more passive role of the mentor in providing overall guidance in making career decisions, is essential during the earlier part of your career. At this time, one may have just finished medical training and may be contemplating which type of medical position to pursue (e.g. academia vs. private medical group) or whether to focus one’s academic career on teaching as opposed to scientific research. At this stage the mentee is often looking for guidance in making critical decisions.

However, as one progresses within a career the mentor may also start to take on more of a role of sponsor. Sponsorship describes an active role as the sponsor will provide not only guidance or advice, but will provide opportunities for the mentee in reaching their career goals (e.g. introduction to a research collaborator). A good sponsor will often expand the horizons of what the mentee may believe that they are capable of (e.g. nomination for a committee chair position within a national organization, suggestion to administrative leaders that the mentee should be considered for a specific leadership position) and is an active advocate for another’s success.

Some mentors may naturally take on a sponsorship role. However, other mentors may continue to see their role as only providing guidance. It is important for one to recognize the difference. If all your mentors are only providing the more passive role of providing guidance, it is critical for the mentee to recognize this and to also seek those who will provide sponsorship. It is not to suggest that continued guidance from the mentor is unnecessary, but sponsorship is essential to continue an upward trajectory in one’s career. Sponsorship is also especially important for women and under-represented groups in medicine to seek out, as sponsorship may not develop naturally from relationships with mentors or senior colleagues.  
Please see these resources regarding the sponsorship versus mentorship role.

https://inclusion.slac.stanford.edu/sites/inclusion.slac.stanford.edu/files/The_Key_Role_of_a_Sponsorship_for_Diverse_Talent.pdf

Becoming a Leader: Tools for Success
During the transition from an early career faculty member, physician leadership development becomes of paramount importance to continued career success. Although physicians are often viewed as “natural leaders” especially among the medical team, leadership skills are not routinely included in the medical school or medical training curriculum. With increasing complexities within medicine, strong leadership skills among physicians are an essential component in navigating institutions  and medical settings and in being the most effective advocate for physician needs. As physicians transition into the mid-career, they are often sought after to lead teams or groups. However, this transition may be difficult and be met with failure without adequate leadership training.

Below are recommended readings and resources regarding leadership development:      
-    Leading through change or implementing change within a medical organization is a necessary skillset among medical leaders. Successful strategies to leading change have been described by John P. Kotter in the Harvard Business Review.  
-    
https://hbr.org/1995/05/leading-change-why-transformation-efforts-fail-2

-    Within the medical environment “grit” has been described as one trait which distinguishes successful research scientists, effective clinicians, and medical leaders. Grit predicts who will accomplish challenging goals. Grit has been described by Angela Duckworth as “a special blend of passion and persistence”. Please see author and psychologist Dr. Duckworth’s inspiring TED talk on the topic.
-    
https://www.ted.com/talks/angela_lee_duckworth_grit_the_power_of_passion_and_perseverance?language=en  

-    As institutions are now recognizing the need to develop strong physician leaders, they may offer leadership training for faculty/staff. If such training is not offered at your institution (or if training provided is not adequate to meet your needs specific to your career goals) you should seek leadership training outside of your hospital/institution. The American Association of Medical Colleges (AAMC) is one resource for medical leadership training. A variety of AAMC Leadership Development courses are available.

-    Although mid-career is a time for transitioning into leadership roles for many physicians, women and those who are under-represented in medicine (URM) (e.g. African American, Hispanic) physicians are faced with barriers to leadership attainment that other groups do not face. Therefore, women and URM physicians are poorly represented in medical leadership. The challenges experienced among women and under-represented minorities are highlighted in the following articles.
-    
https://www.acponline.org/meetings-courses/acp-courses-recordings/acp-leadership-academy/acp-leadership-academy-webinars/leadership-principles-for-women-in-medicine

https://annals.org/aim/fullarticle/2678630/achieving-gender-equity-physician-compensation-career-advancement-position-paper-american

-    AAMC recognizes the unique barriers that women and URM physicians face in leadership development and offers courses that are specific to the needs of these groups. The AAMC Leadership Development courses for women and URM:
•    Early Career Women Faculty Leadership Development Seminar
•    Mid-Career Minority Faculty Leadership Development Seminar
•    Mid-Career Women Faculty Leadership Development Seminar
•    Minority Faculty Leadership Development Seminar

-    The Executive Leadership in Academic Medicine (ELAM) program has been in existence for over 20 years and is a competitive selection program for women who are well into their mid-career and have begun a trajectory towards leadership but desire further and more intensive training. ELAM offers an intensive one-year fellowship of leadership training with extensive coaching, networking and mentoring opportunities aimed at expanding the national pool of qualified women candidates for leadership in academic medicine, dentistry, public health and pharmacy. 

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