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How to make the most of transitions
Sharon L. Stein, MD FACS FASCRS
My sister is a trauma surgeon. She loves the fact that each day when she goes to work she has no idea what she will do, who she will operate on, what skills she will need. I am the polar opposite. I like the fact that my patients are neatly organized into my block time, clinic time, and rounds and I can predict what time I can get home most days.
When transitions occur – whether I choose the transition (choosing a new job) or the transition is thrust upon me (my boss changes)- it takes me a bit of time to adapt. I generally proceed through a whirlwind of emotions – fear, anger, bargaining, withdrawal and eventually I proceed to action. I look for the opportunity.
I am not the first to do this. Sun Tzu, a Chinese Military General and Philosopher said “In the midst of chaos, there is also opportunity”. Transitions always create a bit of chaos, and therefore there is a lot of opportunity. The true question is how do you seize and optimize that opportunity.
There are guides to help you. One of my favorites is Michael Watkins, author of The First 90 Days, and writer for Harvard Business Review and expert on transitions. He guides folks at some of the country’s biggest businesses through transitions, so I figure his thoughts (with some adaptations) would work for me.
1- Where are the holes in the situation? Change often leaves a void. Whether there are opportunities to step up and be a leader, to mentor a colleague, or to get more clinically busy – each transition creates a void somewhere. The key is to find that void and identify the opportunity where the void aligns with your goals. This is a great opportunity to take out your written goals (hopefully you have a set filed away, or better yet, prominently posted them by your desk) and figure out how stepping up into one of the voids will get you where you want to go.
2- Who are the players in the situation? How do they work? No matter how intimidating or mighty someone may seem, at the end of the day, they are just a regular person, after all – everyone puts on their shoes the same way. People are motivated by their goals, their ethics, their fears and their insecurities. I like to remember this when walking into meet with a new boss, a disgruntled member of the team, or even a hostile resident. If you can figure out where someone is coming from, you can often find common ground to work together and find mutual goals. Everyone likes a win win.
3- Give it time. I can be very impatient with new situations. I remind myself constantly to be patient. Especially with transitions, taking my time to develop my strategy, thinking before I talk or email, and not saying the first thing that pops into my mind, is almost always the right move. Situations that seem bleak usually get a bit brighter with a bit of time. Opportunities that exist often require some finesse to curate. Maybe stepping up to take over a new role is the right answer, but prior to saying yes, you want to ensure that you understand what the responsibilities are, the resources available. Your best time to secure these resources is when you say yes, not after you have already committed.
Transitions can be tough but with enough finesse, we can use the opportunities they provide to our own advantage.
Sharon L. Stein, MD FACS FASCRS is an associate professor of surgery, program director of colon and rectal surgery residency and leads the University Hospitals Research Consortium. Over the past three years, she has transitioned through four bosses and seven partners. She is still working to find the opportunities in each of those situations.
How to Avoid Troubled Waters
Susan Pories, MD, FACS
Everyone will hit a rough patch now and then. However, even a small problem can seem overwhelming when you are in a high stress profession like surgery. So it can be helpful to be aware of appropriate resources or approaches to problem solving when issues arise.
First, it is important to realize that some problems can be prevented. One of the best ways to avoid problems is by taking good care of yourself. Try to eat a healthy diet, get some exercise on a daily basis, and aim to get enough sleep. Make sure you do something nice for yourself every day and try to build a supportive network of friends. Treat everyone in the hospital with respect and take the time to build friendly relationships with colleagues and co-workers. This will all pay off the next time you are running late or need coverage for example. Try to identify a couple of colleagues that you can really trust with a confidence and feel that you can discuss things openly with. These are precious relationships and should be nurtured. You will also need to find one or more mentors to help you along in your career and to turn to in difficult times.
If you find that you are fatigued or have trouble focusing despite attention to self-care, you may need to stop and take stock. Make an appointment to see your own physician, have a physical and discuss the need for counseling. You could be anemic or hypothyroid. Or you could be depressed or headed for burn out. There is now a tool available that the ACS has developed in collaboration with the Mayo clinic to evaluate burnout. There is one for residents & another for surgeons in practice. It is based on the Maslach scale and is designed to allow you to figure where you are on a regular basis. You need to be an ACS member to use this. Once you sign in, you will receive a code to allow you to complete the survey in confidence. While a heart to heart talk with a trusted friend is helpful, there is no shame in getting outside help when things are overwhelming. If you find your personal life is falling apart and counseling is not enough, then you may need to take a leave of absence to sort things out.
Secondly, plan ahead for day-to-day challenges. Yes it will cost more, but having a backup sitter on retainer for those days when the daycare is closed, the nanny is sick or there is a snow day is priceless. Hire a housekeeper who is willing to walk the dog, run, errands, and even make meals if needed. If you don’t have children or pets, you still need and deserve help as a busy surgeon – and that is what money is for! Your housekeeper can grocery shop for you, pack your lunches, pick up dry-cleaning and so forth.
When you are looking for housing, try to find a place that is fairly close to the hospital to cut down on commuting time, and buy or rent an affordable place. It is important to stay within a budget so you can start paying off any loans from medical school. Overspending on high mortgages or expensive cars can cause considerable worry and also takes away from resources that you need for support of your household as mentioned above. It’s also important to make sure you have some money left over for vacations and travel to help sustain joy and balance.
Third, pick your battles. If the anesthesiologist snaps at you once for being late, ask yourself if it is worth responding in kind or better just to let it go. Apologize politely and move on. She is likely having a bad day. On the other hand, if she denigrates you every time she sees you, it’s time for a more meaningful conversation. Ask her if you can talk privately and calmly address the situation, first trying to frame the conversation about how you feel rather than attacking her.
Similarly, if the person who makes the call up schedule expects you to cover more than your share of holidays or weekends once or twice, that is one thing, but if this is a pattern then a conversation is in order. This can be an issue for pregnant surgeons. In some cases your partners may expect you to take call up until delivery, cover all office costs while you are on unpaid maternity leave, and take every other night call when you are back from leave to make up for time lost. Clearly, this is unreasonable. If your pregnancy is planned, work out a compromise with your partners ahead of time. If your pregnancy is unplanned, then let your partners know as soon as possible so that schedules can be adjusted accordingly. If you are single or not planning a family, you may be asked to provide extra coverage and it is important that you negotiate time off for your own priorities in return. Everyone needs time off and accommodations should be worked out fairly across the board.
One common cause of stress early in a surgical career is the need to take boards, both written and oral. Despite your stellar surgical skills and wonderful way with patients, most hospitals will not credential you without board certification. Making sure that you have the time to study adequately is important and should likely be part of your negotiations. The Board of Surgery allows a finite number of attempts to pass the boards within a few years of finishing training, so this should be a top priority and your practice should allow you at least a month to study if at all possible. If a block of time off is not an option in the practice you joined, then try to negotiate this before you actually start working, or ask for less call and a shorter work week for the month before the boards. Studying SESAP, practicing oral boards with a friend can help, as well as listening to review tapes in the car. Taking a review course is well worth the investment.
A common refrain is always being passed over for opportunities of advancement. Be sure to speak up when there is a leadership opportunity in the department or the practice or an organization you want to join – otherwise those in charge may not know you are interested and may not even consider you. For instance, if the residency director is leaving and you always wanted that job, then make an appointment with the Chair and let them know about your interest. Bring your updated CV along and be prepared to state your case about why you are a good choice for the job and what your strengths are. Even if you don’t get the job, you will have put the Chair on notice that you are interested in advancing. Be sure to follow up and find out what else you need to secure the next position of interest.
One of the most devastating issues is finding out you are paid less than a male colleague. This cannot be overlooked. It is very important that you work to correct a situation like this. The first step is to gather data to carefully compare your jobs and responsibilities. If you do have equivalent jobs and experience, then ask your mentor for advice and practice for a conversation with your Chair or Practice leader. While it may just be a matter of asking for what you want and deserve, this could be a difficult conversation and will require preparation. Your colleague likely negotiated a higher salary at the time of hire as is often the case. I suggest practicing with your mentor and also reading the book Difficult Conversations by Stone et al before meeting with the Chair. There are also helpful chapters in the AWS Career Resource; Navigating Your Surgical Career.
Membership and participation in the Association of Women Surgeons is a great way to make friends, start building your networks, and learn about the skills you need to sustain your career.
Breast surgeon and surgical educator, Susan Pories, MD, is an Associate Professor of Surgery at Harvard Medical School, the Chief of Breast Surgery and the Director of the Hoffman Breast Center at Mount Auburn Hospital. She is currently the Vice President of Mount Auburn Hospital Medical Staff and a Past President of the Association of Women’s Surgeons. Dr. Pories also serves as the Vice Chair of the American College of Surgeons Women in Surgery Committee. Special thanks to Hilary Sanfey for her assistance with this article.
Sharon L. Stein, MD, FACS, FASCRS
When I was finishing fellowship, I accepted a job at my home institution. Although the basics of the job were worked out, we didn’t talk salary until late in the year. At that point, I was already committed to staying where I was. The conversation went something like this:
Boss: Sharon, we are very excited that you will be joining us. We would like to offer you a starting salary of $180,000.
Me: Gosh, Dr. Boss-man, that is quite a bit lower than I was expecting.
Boss: What were you expecting?
Me: Something in the nature of $225,000.
Boss: That is quite high.
Me: I have spoken to several colleagues, who have accepted positions with similar training at other institutions, and that seems to be a
Boss: What institutions?
Me: Prestigious University #1 (in my own city) Prestigious University #2 (in another city)
Boss: Well, those are world class institutions.
Me: Dr. Boss, I thought that I was negotiating with a world class institution.
Boss: Ok, $225,000.
Most of us don’t like negotiating. We feel like we should be offered the salary we deserve without having to negotiate. After all, we are good people, we work hard and we should be rewarded. The reality is that only 37% of people always negotiate their salary, and 18% never do.
Those numbers are even worse among women – 46% of men, but only 30% of women always negotiate. It is important to remember that the hospital, department, partnership (whomever you are negotiating with) has to make money to stay afloat. They are in business. And they make more money by paying you less. But that doesn’t mean that you have to accept it.
What difference does a few dollars make? By negotiating, the average earner’s starting salary is 7% more than someone who doesn’t negotiate. It isn’t just that 7% once – the salary of your next job has a lot to do with your prior salary. Over the course of a professional career, that may add up to over $500,000 (which is enough to pay for most medical school expenses).
There are keys to negotiating. Here are a few of my favorites:
- Ask: If you don’t ask the answer is always no. Just start by asking.
- Keep your cool. Getting excited, emotional, angry just won’t help. And don’t take it personally.
- Do your homework. It helps to be prepared when you are trying to keep your cool. The more you know about what other people are making, the more you will feel comfortable asking for what you deserve.
- Use numbers. I purposely left the numbers in the scenario above. If we don’t talk about how much we make, how will we know what we should be making? If you are comfortable asking your colleagues about their salary, we can be better informed and ensure that we are appropriately compensated.
- Make your priority list. Know what your bottom line is – how much are you willing to accept? What is too little? What is worth walking away from?
- There is more to negotiate than money. At the time that I negotiated my first job, I was also negotiating support for a master’s degree – time off to work for Medecins sans Frontiers. Perhaps you need a nurse practitioner, or new equipment. The money may matter less than some of the other negotiables that you can request.
- A little flattery doesn’t hurt. One of the keys to successful negotiation is making the other party feel good. If you can get what you want, and they leave happy as well – that’s a win–win.
- Practice – have friends or family walk you through mock negotiations to help prepare for the meeting. The more questions they ask, the better prepared you will be.
My mother used to tell me, “If you don’t ask, the answer is always no.” Learning negotiation skills can go a long way toward making you more. More comfortable, more prepared, and more money. Here are some recommendations of interesting reading on negotiations.
How to Negotiate Salary: 37 Tips You Need to Know | The Daily Muse Editor
Negotiating in Academic Medicine: A Necessary Career Skill | Journal of Women’s Health
Nine Words And Phrases To Avoid When You’re Negotiating A Salary | Amy Elisa Jackson, Glassdoor
Sharon L. Stein is an Associate Professor of Surgery at the University Hospitals/Cleveland Medical Center and Secretary of the Association of Women Surgeons. By no means is she an expert at negotiation, but is trying to learn to do better. Tips and tricks warmly received. @slsteinmd1
How to Eat Healthy at Home with Minimal Effort
Chantal Reyna, M.D.
Throughout our training, we spend the majority of our time rounding, operating, and occasionally eating and sleeping. By the time we leave work, the choice comes down to buying fast food, going to the gym, seeing the family or catching up on some much needed sleep. For me, sleep won more times than the gym (and occasionally still does). Not many of us are up for the task of making dinner upon arriving home after 12 hours of work. However, it is important to make yourself a priority, and proper nourishment is critical. But trying to make that happen can be difficult.
As someone who never learned the “joy” of cooking, and especially not the art of it, this concept was a challenge for me. I had to find a way to combine my limited skills and maximize the results. It turns out preparation and efficiency are the key ingredients. Here are some ways to eat at home with minimal effort.
Tips and Tricks for Tasty Treats
- Fast food is not your friend. Yes, it’s quick, easy, and portable, but not as healthy as it seems to be. Even salads available at most fast food restaurants are loaded with fat and calories. The occasional visit to your favorite place is fine, but if you end up making the drive-through worker your maid of honor, you may have gone there too often.
- Join the Snack Pack. There are veggie packs, fruit packs, protein packs, and more. These are good items to keep at the house to eat immediately upon arrival to stave off hunger while preparing your meal. Most of the time, we arrive home hungry and end up binging on chips, crackers, whatever is out and ready to eat. By eating a small snack, the binging may be controlled (albeit not completely eliminated).
- Prepacked food can be fast and healthy. More focus has been placed on grocery stores have pre-packaged, calorie proportioned foods. Many stores now have prepacked salads or individual meals that can be heated in the oven and ready to eat. These are usually kept in the refrigerated area as they are fresh and ready to go.
- Push button and eat. For those of us who are impatient and need instant gratification, which applies to many surgeons, there are healthy microwave options that are not frozen foods. A few of these (Snap Kitchen, My Fit Foods, Nutrisystem or Weight Watchers) can be found in the grocery store or delivered to your house. These typically require two minutes in the microwave (and thank goodness most microwaves have one touch buttons for this occasion). Push the button and get ready to eat…Don’t burn your tongue.
- Make it yourself. For those who does not have an inner chef but want to try, several food delivery services are a good start. Hello Fresh and Blue Apron send individual ingredients with easy step by step directions on how to make a meal. When you are brave, you can go rogue and add your own spices. These deliveries can be two or four person meals. For those single young surgeons, like yours truly, the second half can be saved for left overs, saving time and money.
- Pick up and pay. The part of cooking dinner which can take a while is grocery shopping. In order to increase efficiency, certain grocery stores will allow online ordering with pick up which can save lots of time and prevent some impulse buy which helps the budget (Did I really need this three pack of Chapstick? I could have put that money towards shoes).
- Delivery is delicious. No, I am not talking about pizza, although that is tasty. Some grocery stores will deliver, i.e. Peapod. Recently on certain delivery services such as Grub Hub and Door Dash fresh healthy options have been included, i.e. MyFitFoods and Snap Kitchen. Also, Amazon pantry allows for many items to be delivered to your house, making it another good way to obtain snacks.
Overall, the important thing is your health. Make yourself a priority. Make eating at home easier by preparing and being efficient. Save time from shopping with pick-up and delivery options. Make extra food for future meals on days you have less time at home. Have a variety of healthy quick snacks available to prevent binge eating and poor food choices. Good luck. Get out there and feed your face!
Chantal Reyna, M.D. is an Assistant Professor at the The University of Texas, M.D. Anderson Cancer Center in the Department of Breast Surgical Oncology
HOW TO DRESS FOR SUCCESS: FASHION STRATEGIES
Nancy Gantt, MD, FACS
Fashion is an interesting topic for women surgeons. We spend the majority of our working hours in anonymous, unisex, often ill-fitting apparel, but who has time to reconfigure her wardrobe? How we feel and how others perceive us IS important. A well-fitting white lab coat goes a long way at work but more traditional business clothing can give that extra bump in confidence and authority to help us get the job done. Though perhaps clichéd, “Dress for the job you want” should be our mantra.
Traditional business attire advice – find the perfect tailored suit and LBD (little black dress) to accessorize as appropriate – applies to women surgeons with a few caveats. We have little time to peruse fashion magazines or the racks at the mall, much less regularly organize our closets. Our free time often falls well after stores are closed, or we have more important and valuable things to attend to. We work hard for our living and abhor throwing money away on a trendy but useless fashion item. We get pregnant-and after a long day of surgery, we are very tired even when not pregnant. We regularly attend professional meetings with conservative dress codes-simple for our male colleagues, but less so for us after an overscheduled week at work.
Shoes, of course, can’t be left out of the equation. Seldom does the after-hours gathering of women surgeons NOT involve cocktails and discussion of footwear. The health and comfort of our feet is paramount, but that doesn’t have to mean dowdy style. Find the brands that fit YOUR foot and invest in them. Splurge on a provocative pair once in a while to make that LBD sizzle!
With all that in mind, here are a few tips to simplify and feel organized on the fashion front:
Top 10 (or so) Fashion Strategies
- Find “your” uniform – what works for you on a day-to-day basis that isn’t scrubs. Comfort is essential. Think dress yoga pants/tailored no-iron shirts/Dansko Mary Janes; easy dress/tights/boots. Employ the idea of a “capsule wardrobe”: a few well-fitting and interchangeable items. Dress for your day-what’s important is that you feel good in your clothes. This includes workout clothes-which should be in your car and ready to go!
- Keep a few clean pressed lab coats and a jacket/suit/heels/accessories at work to throw on if the situation calls for it. Don’t miss the opportunity to feel and look great when something important arises, at work or socially.
- Identify the brands/styles that work for you that are of good quality and require minimal alterations. Get on their mailing list, keep your eye out for sales. Have a passion for fabulous vintage? E-bay even has Chanel!
- Consider borrowing from friends or renting, either locally or on-line such as Rent the Runway for special occasions. Focus on quality, not quantity for your business purchases (suits, dresses) and……
- Find a good tailor! Many great stores, such as Nordstrom, include free alterations if you use their credit card.
- Find a dry cleaner that picks-up and delivers. You don’t have time to iron your lab coats.
- To keep up-to-date, patronize local shops that can keep you apprised of style updates that work for you. Follow a fashion blog or two that offers specific advice for busy professionals. Consider a clothing subscription/delivery service that lets you order and try on at home on your schedule. Again, high end stores like Nordstrom and many online retailers make the most of your time by offering generous return and shipping policies of items that don’t suit your needs. For shoes, it’s hard to beat Zappos. I follow my beautiful nieces on Pinterest-they are always styled up to the minute.
- Patronize friends who represent jewelry/accessory lines. They can be great sources of style advice and loaners. It is easy to update your classics with accessories.
- Check out store stylists/personal shoppers, like JCrew and Nordstrom. Set clear expectations so the relationship is on your terms. Look for upscale consignment stores and have them call you when that St. John suit in your size comes in. (Just sayin!)
- Keep your closet organized as time allows–sort by item and color. If possible, keep all your clothes in one large closet so seasonal changes and travel to other climates involves less leg work. Turn all your hangers around on New Year’s Day and considering editing out anything not worn that year. if you aren’t wearing it, donate it to someone who will!
Would love to hear from other women surgeons about their fashion strategies!
Nancy Gantt, MD, FACS is the Past-President of the Association of Women Surgeons and the Ohio Chapter of the American College of Surgeons and an At-Large Governor of the ACS. She is Professor of Surgery, Northeast Ohio Medical University (NEOMED) and serves as the SIG Advisor and AWS Medical Student Chapter Advisor. At Mercy St. Elizabeth Youngstown Hospital she is Co-Medical Director, Joanie Abdu Comprehensive Breast Care Center, Associate Director of Resident Education and the ACS COC Cancer Liaison Physician. Dr. Gantt is a Chicago native and earned her medical degree from the University of Chicago Pritzker School of Medicine. She completed an internship, research and general surgery residency at University of Pittsburgh Hospitals and Clinics.