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Supplement Article

Building Your Career After Fellowship

Tejwani, Nirmal C. MD

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Journal of Orthopaedic Trauma: September 2014 - Volume 28 - Issue - p S26-S28
doi: 10.1097/BOT.0000000000000183
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As you start your career and move up the ranks, one must consider variables that will allow you to attain your goals while maintaining your work–life balance. This article explores and suggests strategies and coping mechanisms as you begin the beginning of your working life and most of them may apply beyond this time interval as well.

So, now that you are done with your fellowship and are full-fledged attending surgeon, working at a place you chose and colleagues who chose you; how are you going to proceed from here? This is a question that we ask often much later than we should. With your first new job, the focus is on developing a practice and working hard to settle yourself and your family in a new environment both professionally and personally.

The question is how to achieve the goals that you may have set yourself, which should include advancement in your surgical skills and patient care, practice growth, and participation in local, regional, and national organizations as you desire. Perhaps, you want to be more involved in teaching or research or to be politically active? Once you have thought about and decided on what the priority should be, you can then start focusing on working toward a plan to help achieve your goals.

At present, we have a system in which an individual a week before graduation is unfit and unable to see a patient unsupervised in the office, but the day after graduation can perform surgery of any level of complexity with little or no oversight. This is unfortunately true for all our commitments and can be a potential problem if one does not recognize that the first few years in practice are “learning years” and honing your surgical and interpersonal skills in your new role should be one of your most important and primary tasks.

Do you need a personal trainer? A mentor is important both to guide you and help you in reaching closer and attaining your goals. He/she can help you crystallize your thought process while introducing you to hierarchy of organizations both at your institution and professional societies. This mentor could be someone from your training program, your fellowship, or maybe at your new place of work. Stay in touch with those who were your mentors and residents who trained with you.

Based on your career stage, some of the following “pearls” may not be applicable or needed; however, some of them are crucial throughout, no matter where you have reached. The following sections while separately discussed are often intertwined and will significantly overlap and affect your ability to do each to the best of your abilities and within the time constraints you will have.


It is difficult to move to a new place and start fresh as an attending, having to relocate from your residency and then fellowship, and starting a new practice. Although you are coping with the patients, some important things to keep in mind are the people who are important in your life.

Start off with one of the most important people you know; yourself! When is your protected time for yourself and your family? This may seem almost facetious, but taking time to exercise/play instruments or doing whatever you do for pleasure to unwind is important to a long working life. Carve out time in your schedule and spend some time decompressing from the pressures of work with physical activity. This will not only allow you to be fit but also keep your sanity and prevent “burn out.” Another advantage of exercise is to keep physically healthy and fit so as to avoid work-related injuries. In 1 study, 84% of surgeons experienced discomfort or pain while performing surgery. As a result, 33% of these surgeons took pain relievers and/or sought physical therapy for the pain.1

Similarly, family time becomes equally important; your partner/spouse and the children (if any) are integral to your well-being. The old saying, “happy wife, happy life” is true for your life partner (even though only wife rhymes with life here!). As you and your practice mature, having this time or hobby or activity outside of work will be helpful in maintaining your equilibrium. Looking back, no one had ever regretted spending more time with family or friends instead of being at work. Try not to forget your friends and you should meet your neighbors and try and spend time with people who are in professions other than medicine or Orthopaedic Surgery. This will prevent you from discussing “shop” all the time and also widen your horizons, almost like crosstraining of the mind. Thus, it helps in making you a much more interesting person to those around you. It may even allow you to develop a new hobby or interest!


It is important in this age of specialization to find a niche in the first 5 years if you can. This will help build a referral base, both in the community and among your colleagues, as well as help your requests to get the specialized equipment if any is needed as you build up volume. The first few years are also critical in establishing lifelong learning habits; the field of Orthopaedics is constantly evolving. Even though the human anatomy or the basics of surgery do not change, technological advances are constantly occurring and keeping up to date in the entire field of Orthopaedics is impossible. Once you have established your field of expertise, you can then focus on learning and evolving in that particular area while maintaining your primary skill sets. This will involve learning not only in the class room but also cadaver laboratories, online forums, webinars, visiting other surgeons to observe and learn, and finally scrubbing with a more experienced colleague.

Similarly, once you are settled into your practice and have an organized schedule, you can spend some time acquiring new skills or learning new techniques. Keeping up with the latest updates and your Continued Medical Education at the same time will be helpful to keep your career on track.

Some of you have chosen to be in academic practice and you need to learn and improve on how to be an effective teacher in teaching students, residents, and fellows, and you have to do this while learning everything we said earlier yourself. Additional information can be found within this supplement in the article “Tips for Being an Effective Teacher.” In addition, you may be expected to do research, produce scientific publications and presentations so as to get promoted to higher levels. The key here is not to lose sight of your goals and ask for help from your department or university. Most academic institutions already have programs for faculty development in place, be sure to find these and use them to help you reach your goals. As you are more senior, you will be expected to help and mentor your junior colleagues and partners; at this time, remind yourself of who you were at that stage.


If you lucky enough to join a department with an established research division, you can use those resources to your benefit. Writing an IRB or for grants is another skill that you may have to learn, if not already done as a resident. Joining a regional or national research consortium will be beneficial to you because you are unlikely to have enough of your own patients in the first decade or so. In addition, you will learn valuable skills that can be applied to your future studies. At present, there are multiple research groups in different parts of the country, ask your colleagues or use the OTA Web site. Even in private practice, you can undertake research. Key elements of a successful “nonacademic” physician in the research realm require that individual to be creative in the design and financing of clinically relevant pursuits, a multitasker, and a good leader/communicator for the research team.2


It is always a good idea to participate actively in committees that are formed in your department, hospital, or university. This gives you a voice in decision making on matters that affect your practice or patients. If you are just a complainer, your ability to affect change is limited. If you find something that could be done better, provide a solution to the problem. Do not just talk about the problem. Remember, as you increase your contribution to the department, your value in it will increase as will your chances of advancement. Develop a reputation as someone who can be counted on. Say yes to opportunities that interest you, and then be sure to follow through and meet the deadlines that you commit to. This will hold you in good stead throughout your career and follow you across different jobs.3

Private Practice

“What role am I going to play in my practice?” is a question a young practitioner ponders. This is a question you need to ask when you join and continue to ask as you grow your practice. Develop your interests and practice niche within the first 3–5 years and grow from there. Usually, your practice patterns are well established in the first 5–6 years, as is your referral pattern. Engage in community outreach efforts with local and regional providers, even setting up meetings. This provides an excellent means to get to know one another and discuss your cases and highlight your areas of interest. By 10–12 years, you will have a mature practice and unless you have a life-changing event, you will likely continue with that pattern.


Finally, you have to think about what you want to do outside your work place. Do you want to be part of your local, regional, or national organization? My recommendation is that you carve out some time quarterly to strategize and participate in activities. If interested you should apply to be on committees at the national level. The AAOS has a Committee Appointment Program (CAP) that you are free to apply online. Do not get discouraged if you are not selected the first time. Continue to apply and make contacts at meetings to help you. Fortunately, there are a lot of surgeons like you who are willing to volunteer their time to their specialty organizations.

You should develop a 5-year plan with your goals, stretch goals, and strategies and how to achieve them. These will be clinical (patients, office space, OR commitments), research (publications, presentations), committees (hospital, local, national), education (resident, allied health, student teaching) or even philanthropy (fund raising either for your institution or a favorite cause), and finally personal goals (climbing Mt Everest?).

As Albert Einstein famously said: “Try not to become a man of success, but rather try to become a man of value.” Think beyond your person, involve others in your life and career and you will have far more success than possible to attain alone.


Burn out,” a condition described as “an erosion of the soul that results from the dislocation between what people are doing and what they are expected to do.”4 Exercise, eating well, sleeping when we can, cultivating interests outside of medicine, spending time with family and friends, laughing, and being still are all important components of treating the disease of compassion fatigue. When these treatments fail, for us or our colleagues, it is important to seek professional help to avoid the tragedy of careers or lives undone by compassion fatigue.5 These 2 articles quoted in this paragraph are a useful tool to read and remind us as surgeons to stop and smell the roses!

To conclude, some summary suggestions and pearls that apply to all stages of your career are given below.

What to Do

  1. You need to have the 3 A's: Available, Affable, and Able
  2. Be involved in teaching: residents, Physician Assistants, Nurse Practitioners, etc.
  3. Always welcome input of your partners: you have a lot to learn: Be Humble
  4. Reach out to your senior colleagues and offer to help with committee/courses for teaching locally
  5. Be friendly and respect your colleagues
  6. Be involved in research if you wish
  7. Start with being part of local organizations; hospital, and department committees
  8. Develop a mentor–mentee relationship. This could be someone you have worked with or are working with
  9. Say “yes” to any opportunity that interests you, whether a lecture, case presentation, or membership and then deliver on the appropriate deadlines

Do Not

  1. Forget that you have a family with a spouse and children. Nobody on their deathbed ever said, I wish I had spent more time at the hospital
  2. Treat people with disrespect, especially those whom you have power over (nurses, Physician Assistant, Nurse Practitioners, janitors, secretarial staff)
  3. Make derogatory remarks about colleagues or publicly disagree with a senior attending (do so privately with the relevant person)
  4. Back out of commitments you made at the last minute. Give advance notice if you cannot make it or preferably only commit when sure
  5. Be afraid to help another surgeon in surgery or clinic
  6. Be the first out of the door


Over the course of your 30–35 years of career, you will look back and consider what you could have, should have done and either laud yourself or regret some of your choices. The ideal would be to achieve an idealistic and perfect work life and personal life balance. The hope is that using some of the ideas or suggestions in this article will help you take some concrete steps in achieving your idea of success.

In summary, be yourself, set yourself realistic goals, pay attention to your colleagues and family, and finally “check” on yourself periodically to ascertain that you are doing what you want to.


1. Matern U, Koneczny S. Safety, hazards and ergonomics in the operating room. Surg Endosc. 2007;21:1965–1969.
2. Lebus GF, Collinge CA. Research in a non-academic setting: it can be done. J Orthop Trauma. 2011;25:S128–S130.
3. Schmidt AH. Preparing for the road ahead. J Orthop Trauma. 2012;26:S21–S22.
4. Orrom WJ. Achieving balance in a surgical life: a personal perspective on a Sisyphean task. Am J Surg. 2008;195:557–564.
5. Brandt ML. The Claude Organ Memorial Lecture: the practice of surgery: surgery as practice. Am J Surg. 2009;198:742–747.

career after fellowship; personal fulfillment; burn out; professional achievements

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