Mentorship: A Pathway to Succeed in Plastic Surgery

If I have seen further it is by standing on the shoulders of giants. —Isaac Newton As young faculty in the early years of my career at an academic institution, I find myself reflecting on my career choices and what the future holds. What are my short-term and long-term goals and plans? Do they fit with what I want to do in my private and professional life? Am I currently fulfilled in my career? These are questions that we must all answer after honest self-reflection. Although, ideally, the answers should be yes, this is often not the case. This results in many becoming discouraged and unhappy; we leave our current jobs to look for better opportunities; we leave academics altogether. Attrition rates in academia subsequently remain high, and we must address this. We must first answer for ourselves why we have chosen our profession and ensure that our goals align with the job we have chosen. Is it for the prestige, the money, or the job stability, or is it to give back, teach the next generation of surgeons, and provide the best care for our patients? For the senior author, the primary goals have been to be a good doctor and give back, teach the next generation of plastic surgery leaders, continue to improve and impact medicine, and family. That is my goal as well. The answer, however, is different for us all, but the template is similar. Be a good doctor first, give back, be and do your best, and do not be afraid to challenge yourself. Do we need help along this path? Yes! That is the vital role of life mentors and plastic surgery mentors. Often, they are not the same. I would argue that with appropriate mentorship for junior faculty, we can address the problems of job dissatisfaction and attrition. We are very good at providing mentorship to our students and residents, but what happens after? Are we doing a good job at mentoring our young junior faculty or have we failed? Do we prepare plastic surgeons for the business and academic aspect of plastic surgery today? The answer is—it depends! It depends on your mentor, your training, and your mindset to learn these fundamental aspects that are key to success in plastic surgery. We often forget that, as physicians, we have an obligation to give back and teach the next generation so they can be better than we were. We can and must do better! IMPORTANCE OF MENTORS As stated by Rohrich, we must train at the “feet of masters.”1 Mentorship is key to professional development. Mentors provide advice, guidance, and support, fostering qualities that enable a successful career and improve retention.2 Mentorship increases productivity, career advancement, research, and grant funding, and decreases burnout compared with nonmentored peers.3,4 Mentees, in addition, report higher job satisfaction.3 Furthermore, mentors benefit also as they pass on their talents and skills to the next generation.3 Mentorship is important throughout our training and contributes to the success of our profession.4 Eighty percent of recent medical school graduates reported that their mentors influenced their decision to pursue plastic surgery; 40 percent wanted a practice similar to their mentor’s.4 They were also more likely to become academic surgeons according to a survey by DeLong et al.5 Mentorship, however, becomes less formal once training is complete, as 19 to 84 percent of clinical faculty reported working with a mentor.6 This is concerning given the data showing its importance and the high attrition rates seen in academic medicine among faculty. HIGH ATTRITION RATES A survey of academic physicians shows that 14 percent considered leaving within 1 year, whereas 21 percent considered leaving academics altogether because of dissatisfaction.7 In plastic surgery, specifically, only 27 percent of graduates enter academic practice, and an astonishing 40 percent depart within 5 years.8 In a survey performed in 2012, burnout, lack of mentorship, and difficulty with work-life balance were the most important predictors of attrition.8 Inadequate mentorship was noted in 43 percent of respondents in another survey, with the percentage of faculty considering leaving higher in this group.9 Rates of attrition are, unfortunately, higher in female and ethnic minority groups.8,10 A survey of American College of Surgeons members noted that 10 to 20 percent of surgeons consider leaving academia, with women assistant professors contemplating this more commonly.11 WOMEN IN ACADEMIA Women now constitute 50 percent of matriculating medical students, 37 percent of plastic surgery trainees, and 14 percent of board-certified plastic surgeons.12 In fact, plastic surgery maintains the highest percentage of women academicians.13 Although they are more likely to take academic positions, they, on average, tend to be younger and remain at the assistant professor level compared with their male counterparts.14 Women are less likely to be promoted or hold tenure positions, more likely to abandon academics altogether, and reported lower professional satisfaction.10,12 This has been attributed to work culture, barriers to research, lack of engagement, work-life balance, low salary, and poor mentorship and leadership.7,10,15,16 Women remain underrepresented in leadership positions, with 7 percent of plastic surgery chiefs and chairs being female.10,15 There is, consequently, a paucity of female mentors in leadership positions. In a survey performed by Janis and Barker, the majority of mentors were men older than 50 years.17 Same-gender mentors are vital, as women are less likely to seek advice from men regarding gender-related issues, and are less likely to pursue surgery because of a lack of female co-workers and role models.15 Female role models have, in addition, been shown to be the most influential factor for female students interested in surgery.13 RETENTION RATES AND MENTORSHIP An integral part of a successful teaching hospital is the retention of talented faculty. Replacing these surgeons is considerably more costly.10,18 Therefore, we need to stress mentorship especially among young women. A survey conducted at the University of Michigan Medical School reported that faculty with mentors were significantly more satisfied with their job.19 There are data that mentorship programs can improve retention, as seen at the University of California San Diego, whose faculty were more likely to participate in other leadership and professional activities.18 Other institutions, such as the University of Toronto, developed formal career development programs and noted advancement of faculty, whereas the University of Virginia noted increased morale. Formal mentorship correlated with increased productivity and faculty retention.10 It is a vital tool that should be supported by institutions to help recruit and retain talented plastic surgeons.18 Given the importance of mentorship for junior faculty, we must be proactive and seek it out at our own institutions, through professional societies or various networking events. For women specifically, we must be our own advocates, learn to ask for what we want, have confidence in ourselves, and overcome the “confidence gap” that, unfortunately, exists.15,20 In doing so, we can generate excellence in ourselves and in our female colleagues, and together overcome the “glass ceiling effect” that exists.15 The future of our profession relies on this. Although there are many factors involved in job satisfaction, the data are clear, mentorship is vital to faculty success and retention, and we must provide this to our young junior faculty. In addition, we must assess our personal goals and priorities and internally define what success is for us. Only then can we achieve personal and professional satisfaction.21 As for me, I have been so privileged to have trained in an institution where I was able to create mentor-mentee relationships with true masters in plastic surgery. They not only have been my strongest advocates but have taken a vested interest in my personal and professional growth. Going forward, we can no longer have mentorship occur in happenstance, especially with the expanding ethnic diversity and the increasing number of women in our field. We have not done a good job historically in preparing these groups for the rapidly changing environment of medicine. In addition, we need to have specific Residency Review Committee mandates and curriculum to provide a template for ongoing mentorship and learning. This needs to be stressed more at the academic level by making it an achievement and standard for promotion or advancement in both hospital and academic institutions. The delicate balance of mentoring someone is not creating them in your own image, but giving them the opportunity to create themselves. ―Steven Spielberg