Singers ranging from Kenny Rogers and Gladys Knight to the Backstreet Boys have bemoaned, “If I knew then what I know now.” To help young academic hospitalists avoid that common regret, Bradley Sharpe, MD, offered advice during the SHM Converge session “Things I Wish I Knew Earlier in My Career.” SHM Converge, the annual meeting of the Society of Hospital Medicine, was held online in May.
“I certainly don't have all the answers,” said Dr. Sharpe, division chief of hospital medicine at University of California San Francisco Health. “Some of my success is [being in the] right place at the right time, but it is also doing the things, some of which I'm going to tell you today, that set me up for success.” He offered a dozen of his top tips.
1. Be engaged. “This means when you're starting out in a new job, starting at a new place, you've got to show up: Show up to the faculty meeting, show up to conferences, show up to the morning report. If there's a get-together, a social event, if you can make it, show up,” said Dr. Sharpe.
This advice can improve both enjoyment of work and advancement there, he explained. “This is something we know in health care and outside of health care, that the more connected you feel to the institution and the enterprise, the more satisfied you will be,” said Dr. Sharpe, noting that while showing up has gotten harder during the pandemic, doing so for virtual events is still important. “If you're someone who's not around, then leaders—division chief, section chief—may not think of you when opportunities arise.”
2. Meet people. Showing up will lead to meeting people, but Dr. Sharpe urges junior hospitalists to pursue that goal even more aggressively, by identifying and then emailing potential connections. “Look for people that have shared interests, shared career paths. Maybe they went to the same residency as you,” he said.
Dr. Sharpe even drafted this email for his listeners: “I'm a new academic hospitalist in the division of hospital medicine. I am emailing you because I [saw you at grand rounds, was reading about what you're doing on the website, etc.]. I was hoping we could meet for 30 minutes, so I can hear more about you and your career and we can talk about what I want to do at this institution. Please let me know the best and easiest way for me to arrange a meeting.”
The recipient may not answer, he noted. In that case, it's OK to try again a week later, by resending the email, but Dr. Sharpe recommends against the common technique of speculating that your email wasn't received. “No, no, he got it. That's how email works,” he said. “Say ‘Just following up on the email below, was hoping to find time to meet.’ If they don't respond a second time, then probably let it go.”
If you do get a meeting, begin by asking about the other person's life and career, and then ask for advice about your own plans and interests, including for recommendations of other people to get to know. A few days later, send a thank-you email, in which you can make any follow-up requests, such as a connection to a person or project that interests you.
3. Try new things. New hospitalists should also explore projects that don't focus on their current interests. “Try new things, because you just never know, you could stumble on a career,” said Dr. Sharpe. “You never thought you were interested in QI. Sign up for a QI project, sign up for an informatics seminar, sign up for additional training in diversity, equity, and inclusion.”
He has seen colleagues find unexpected focuses in their careers, for example, a hospitalist with an initial passion for quality improvement who ended up learning to program and specializing in informatics after working on a QI project that involved a lot of data crunching.
4. Teach! “I love the geometric exponential potential; let's imagine you teach an intern something that fundamentally changes how they care for patients,” said Dr. Sharpe. Suppose the intern then applies that lesson with 1,000 patients. “Now, what if that intern teaches five other interns when they're a resident, the very same thing, and they go on [to do the same]? Now you've impacted 50,000. Unbelievable.” Early in an academic career, try as many kinds of teaching as possible—different audiences, formats, and topics—to figure out what you like, he recommended.
Dr. Sharpe offered an example from his own experience. When he had to teach the abdominal exam to first-year medical students, he felt unexcited both before and after. “The next week I was teaching ethics in a small group, and I was really fired up to prepare and get ready and then really excited afterwards. Or when I had an opportunity to do a noon conference on community-acquired pneumonia, I was really jazzed up and fired up.” These experiences taught him which kinds of teaching he prefers.
5. Say yes. “This one's a little controversial, because other people you may have heard will say you need to learn to say no,” said Dr. Sharpe. Saying no is key later in one's career, but at the beginning, it's better to say yes to projects, boards, committees, and other requests whenever possible, he added.
“Here's why: Humans are pretty simple creatures. We need to categorize people into different buckets,” he said. In a big division, leaders might use categories like interest in medical education or informatics to think about their hospitalists. “I also categorize people into ‘Is that a person who says yes or says no?’” said Dr. Sharpe. People in the no category are less likely to be asked when a new opportunity arises. “There is a limit to this,” he added. “Obviously, if you're completely overwhelmed, that's different and just acknowledge that.”
6. Be great. Of course, being great all the time is ideal, but there are times when making an effort to excel is particularly important, explained Dr. Sharpe. “This specifically means be great when you're engaged in activities that are highly visible, and highly visible to people that have control over roles.”
For example, as a second-year faculty member, Dr. Sharpe was invited to give a lecture to the entire first-year medical school class. “I was like, ‘I'm going to make this lecture awesome.’ I spent six months. I reviewed the literature. I contacted people at 10 other places, put together this talk. … I spent an undue amount of time, and it went really, really well.” This success then led to multiple later invitations to speak.
7. Get paid. There are four means by which academic hospitalists typically get paid, Dr. Sharpe said. “One, you get paid to see patients, and we all get some of our salary from this awesome part of the job.” The second is grants, a big source for researchers, and a small one for nonresearchers. “You might write a small grant—10% of your salary—or get included on someone else's grant,” he said. No. 3 is to have a wealthy philanthropist endow your position. “He's like, ‘You cured my pneumonia, I want to support you,’” said Dr. Sharpe. “There are a couple of those in the country.” The final option is to get paid to be in charge of something, whether it's a clerkship, QI, or patient safety.
“As you think about your career advancement … look around your organization and say, ‘Who has roles that I could see myself in and I might enjoy?’” he said. Junior hospitalists should be constantly scanning the horizon for roles that might interest them and then talking to their seniors about how they ended up in those positions.
8. Take three to four years to explore. “Sometimes I hear from junior faculty, ‘I've got to find my niche. I've got to find my niche.’ You've got time,” said Dr. Sharpe. “In my experience, it takes three to four years as a faculty member to figure out who you are and what you want to do.” During that time, let the experience of being an academic hospitalist wash over you and figure out which parts of your work get you excited and which do not, he advised.
9. Refine clinical skills. “Spend time becoming a better health care provider,” said Dr. Sharpe. This is a good project to work on during those first three to four years, he noted, and it entails not just reading and learning but also more active pursuits, such as “going to conferences, going down to neuroradiology to look at that MRI, calling the cardiology consult, ‘Hey, can we go over this EKG?’”
10. Find mentors. “This may be the most important,” said Dr. Sharpe. The goal is to find a career mentor, not just a project mentor who leads you on a specific effort, like a quality initiative, he clarified. “Having someone who's helping you think about your career and your path—career mentors are key to success. The literature is so clear on this,” he said. “Those that have a mentor are more satisfied, less burned out, less likely to leave an institution, more likely to get a leadership role, more likely to publish, more likely to present at a national meeting. The list goes on and on.”
How to find a compatible mentor is a topic big enough for a whole other lecture, Dr. Sharpe noted, but he encouraged any hospitalists in need to ask their division chief for advice.
11. Get help, or don't let yourself burn out. Hospitalists should watch for symptoms of burnout, which include depersonalization. “You stop caring about patients,” explained Dr. Sharpe. “Like you don't call the daughter back. You've gotten the message from the nurses that the daughter called, wants you to call, but you're like, ‘Enh, no.’” Other symptoms include feeling exhausted and doubting the meaning and quality of your work. “If you feel any of those even starting, get help. Help is often from your supervisor. Or you go to your mentor or go to a friend and say, ‘Hey, can I talk about this?’” he said.
Dr. Sharpe noted that he has struggled with this issue himself. “I wish someone would have told me this. I do believe three separate times in my career I let myself get burned out before I asked for help. … By the time I went to the supervisor and said, ‘I don't think I can do this,’ I was probably six to nine months over,” he said. “The reason is that I love my job, but it just got too busy and overwhelming. Every time, my supervisor got me help, helped me figure out the path forward.”
Following this advice provides important benefits not just for yourself but for patients and the hospital, since burnout is associated with lower patient satisfaction, more medical errors, and higher costs, Dr. Sharpe noted.
12. Aim for the sweet spot. For his final tip, Dr. Sharpe presented a Venn diagram with four circles representing things you love, things you are good at, things you get paid for, and things that advance your career. Often, these areas will naturally overlap, but not always, he said. “A senior resident had a passion for palliative care, but their communication style was not going to work well with that. … The opposite is also true. A friend of mine who's an emergency medicine provider hates doing the schedule, but he's really good at it and he gets paid to do it.”
Like that clinician, you might find that you are OK with some work that doesn't meet all four categories, especially if it fits within the broader context of your life, such as family responsibilities and preferred location. But the goal should be to find a spot in academic hospital medicine that covers all four, Dr. Sharpe recommended. “We're going to try to hit that sweet spot right in the middle,” he said.