Mentoring in action: Mentor Ed Mariano, MD, MAS, FASA, with mentee Felipe Perez, MD, who mentored Natalie Koons, DO, and Tanisha Verneus, MD, both national medical student leaders at the time.

Mentoring in action: Mentor Ed Mariano, MD, MAS, FASA, with mentee Felipe Perez, MD, who mentored Natalie Koons, DO, and Tanisha Verneus, MD, both national medical student leaders at the time.

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Physicians know the sacrifice and devotion needed to excel during college, medical school, and residency. While the path to becoming a physician is defined, the career journey after completing graduate medical education can become unclear. Professional development supplies an ongoing form of education and training after formalized programs are completed (Acad Med 2021;96:1383-8). The groundwork for professional development for the anesthesiologist begins in residency as part of a lifelong journey toward career success. Professional development is personal. Every physician brings their own goals and ambitions, which will change with life and career transitions. Professional development begins with a commitment to continuous learning, the interest in doing so, and the drive to pursue input along the way.

Not every atmosphere is supportive nor equally distributed around opportunity. Many employers, including some academic departments, supply insufficient support for professional development, despite tangible benefits that include higher retention rates, improved talent acquisition, and enhanced productivity (Acad Med 2021;96:1383-8). While employer support is commendable, the responsibility for career development and continuing education remains with the individual. Professional development allows a physician the ability to focus training on personal interests to achieve desired future success, but with multiple paths and resources available, it can be difficult to figure out where to begin.

A solid foundation begins with emotional intelligence. Find mentors and build a professional network for support. Establish a reputation for clinical excellence. Chart a path for success by developing personalized goals and build a professional roadmap. The more difficult choice can be which resources will be of most value on your career journey.

One of the most important steps in career visioning is finding people to provide assistance. Sponsors, coaches, and mentors are all instrumental in career growth. Sponsors are typically highly placed in an organization and carry influence; they advocate and help us establish a new network of connections and remove barriers (Acad Med 2019;94:94-100). For example, they might recommend us for a leadership role in a board meeting where our name may not have been mentioned otherwise. Coaches create a safe, supportive environment in which the coachee is brought to their own answers through reflection. The coach helps the coachee imagine and verbalize an ideal image of self, as well as an action plan with deliverables and a timeline to achieve personal goals. Coaches challenge their clients with powerful questions to create insight and self-reflection (asamonitor.pub/3pmrdCf). Mentorship, as the most traditional relationship in the medical field, still holds immense value today, as it has specifically been linked to accelerated professional growth, increased satisfaction, and greater retention of faculty members (Acad Med 2019;94:94-100).

The first step in identifying a sponsor, coach, or mentor is self-reflection about your target area of interest. Most meaningful success comes from aligning our inner passions with our chosen professional path (Am J Med 2011;124:893-5). Once we have a clear understanding of our values, goals, and desires, the second step is to look for role models who embody these objectives (Am J Med 2011;124:893-5; asamonitor.pub/44EFwT6). Examine a potential mentor's track record. Where have they published? What projects have they successfully completed? Who have they mentored? If possible, speak with past mentees for further insight (Am J Med 2011;124:893-5). Third, arrange for a meeting with the prospective mentor, and be prepared to review both your goals and theirs and mutual expectations for a successful relationship. Gauge the mentor's level of excitement and engagement, and take note of your gut instincts (Am J Med 2011;124:893-5; asamonitor.pub/3VQNLr1). Finally, do not be discouraged if the first meeting does not blossom. Genuine, lifelong human connection takes some searching! We are unique individuals and will need many mentors across the course of our careers. No one individual will fully encapsulate who we aspire to be, but we can find the best guidance if we engage many individuals (asamonitor.pub/44EFwT6; asamonitor.pub/3VQNLr1).

Aspiring physician leaders are often eager to acquire nonclinical responsibilities in administration, quality and safety, education, or other related areas. However, the acquisition of clinical expertise is crucial to the ultimate success of physicians who want to move into positions of leadership. The first years following training are best spent focused primarily on gaining experience in clinical practice. Physicians must become clinically skilled, learning how to manage difficult clinical situations in their chosen specialty and gaining the clinical respect of their colleagues.

Along with skills, knowledge, attitude, and managerial experience, one of the most important aspects of being a successful physician leader is having credibility (PLoS ONE 2017;12:e0184522). Credibility is necessary for the types of roles many physician leaders play in their organizations, driving change in clinical workflows and clinician behavior. However important a title may sound, credibility does not come with a title – without the clinical expertise that comes from experience, it may be difficult to be successful at leading change among clinicians.

By providing direct clinical care and working in the environments where care is delivered, aspiring leaders will gain the experience necessary to better understand the nuances of clinical care delivery. Working within the systems that exist and with the resources available allows aspiring leaders to understand where processes are working well and where they need improvement. Using the electronic medical record to provide clinical care will help individuals recognize the challenges that may come from existing workflows. Perhaps most importantly, gaining the respect and trust of anesthesiologist, surgeon, and nursing colleagues will enable anesthesiologist leaders to be more successful at implementing and sustaining viable change, even when that change may be initially difficult.

Regardless of specific roles, physician leaders often serve as a key link between front-line clinical staff and administrative leaders. Clinical staff look to leaders with clinical expertise to represent and advocate for them and will expect their clinical leaders to understand the pressures they face in their daily work. The time and dedication required to develop a reputation for clinical excellence will not only benefit the aspiring physician leader's clinical career, but it can be crucially important to success in the nonclinical aspects of one's career.

Developing leadership skills is an ongoing process that requires intentional effort and a growth mindset. One effective way to start developing leadership skills is by focusing on five specific competencies: Strong ethics and safety, self-organization, efficient learning, nurturing growth, and belonging (asamonitor.pub/3VGbvhy). Active learning programs are not required but can be implemented as you develop as a clinician. To begin this process, it's important to take an inventory of your strengths, weaknesses, values, and aspirations. This requires a willingness to be open to new experiences and take on new challenges. By being playful with your own identity, letting go of performance goals that limit risk-taking, and exploring different versions of your personal narrative, you can expand your self-concept and become a more effective leader.

As you progress in your clinical career, it's important to prioritize skill-building as a key aspect of your leadership development. This involves identifying areas of weakness or areas where you would like to improve, and actively working to develop new skills or build on existing ones. Such efforts may mean taking on new responsibilities or seeking out opportunities for training or mentorship outside of the clinical sphere. To become a more versatile and adaptable leader, it's crucial to allocate less time to what you already do well and more time to learning new things (asamonitor.pub/3nLp3f3). There are many programs sponsored by ASA that can help you achieve this. For those who are early in their careers, programs like the ASA Leadership Academy and ASA ADVANCE conference are excellent resources for introducing core concepts around leadership and health care management that can easily translate into your clinical practice.

Networking is a crucial aspect of leadership development that should not be overlooked. By connecting with people from diverse backgrounds and industries, you can gain new perspectives and insights into your own leadership style. In the field of anesthesiology, attending annual meetings and conferences is an excellent way to network with other professionals and learn about new developments and trends. Moreover, serving on committees on a regional or national level can provide unique opportunities to showcase your leadership potential and gain valuable experience. By incorporating an annual meeting into your development pathway, you can markedly enhance your networking skills and expand your leadership potential.

Finally, once you have established yourself as a leader in your respective organization, it's vital to uphold core principles of effective leadership when managing your team and resources. Adaptability allows you to adjust your approach with changing circumstances and pivot to new strategies. Being proficient in contextual problem-solving means better decision-making through integration of information from across your system landscape, while empathy allows you to better understand and respond to the needs of your colleagues and patients, creating a supportive and inclusive work environment.

Health care is undergoing a rapid transformation. Uncertainty exists about what future care delivery systems will look like, but physicians must be among the architects of that change. Anesthesiologists lead the care delivery of patients every day. Successful anesthesiologists use informal leadership skills to build relationships and influence to accomplish goals (Clin Colon Rectal Surg 2020;33:225-7). Emotional intelligence (self-awareness, empathy, and positive social skills) is foundational to informal leadership (Anesth Analg 2017;124:359-61). Informal leadership is the establishment of professional reputation, clinical credibility, and maturity to align with organizational goals. Informal leaders are highly regarded by front-line caregivers and are critical to organizational success (Clin Colon Rectal Surg 2020;33:225-7).

After developing the skills as an informal leader, some physicians choose to move on to formal leadership. The formal leadership path involves the identification of an individual as an acknowledged organizational leader, usually bearing a title. Identification of formal leaders often occurs when informal leaders signal a willingness and bring forth ideas to propel organizational goals. The ability to lead change and positively influence colleagues, especially with quality initiatives and critical programs such as enhanced recovery after surgery, demonstrates high individual value to an organization (ASA Monitor 2022;86:37-8).

Many resources are available to physicians to improve their leadership skills and manage the transition from informal to formal leadership roles. Some physicians find value in pursuing graduate coursework such as in a Master of Business Administration (MBA), Master of Healthcare Administration or Management (MHA/MHM), or Master of Public Health (MPH). These programs teach foundational concepts and leadership skills that fill the void of traditional medical education in finance, operations, and value creation (ASA Monitor 2022;86:37-8). While these degrees are not required for leadership advancement, they certainly can be of value.

Professional societies also serve as valuable resources for physicians, offering greater flexibility than graduate degree programs. The American College of Healthcare Executives (ACHE) offers physicians the ability to interact with health care leaders from diverse backgrounds and provides robust educational content. Interested members can pursue fellowship (FACHE) and board certification in health care management. The American Association of Physician Leadership also offers board certification in health care management through its Certified Physician Executive (CPE) program. A key advantage of the content and curriculum is that the material is specifically geared toward topics relevant to physician leaders. ASA also offers comprehensive leadership training for all phases of career development, including leadership in clinical, research, graduate medical education, and administrative/executive paths.

A multitude of approaches to professional development exist and are not limited to the continued acquisition of clinical skills and knowledge. Depending on one's career stage, professional development can and should take many forms. As most anesthesiologists do not receive formal training in effective communication, self-awareness, conflict management, or emotional intelligence, finding opportunities to develop these competencies can be critical for achieving success as either a clinical or administrative leader. The use of a trusted accountability partner or 360° reviews can aid in creating awareness of areas for personal growth.

Professional development is a lifelong journey, often without an easily defined destination. Achieving clarity about what matters most is essential when navigating the inevitable changes and transitions that occur over the course of a career. Identifying one's personal values and definition of career and life success is an important step, and it should also be recognized that these will evolve over time. The definition of success, in the end, will always be a personal one.

Disclosure: Dr. Hill holds stock in Hemaptics, LLC.

James L. Hill Jr., MD, MBA, CPE, FASA, FACHE, ASA Committee on Professional Development, Chief Operating Officer, University Hospitals Parma Medical Center, and Assistant Professor of Anesthesiology and Perioperative Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio.

James L. Hill Jr., MD, MBA, CPE, FASA, FACHE, ASA Committee on Professional Development, Chief Operating Officer, University Hospitals Parma Medical Center, and Assistant Professor of Anesthesiology and Perioperative Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio.

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Mada F. Helou, MD, FASA, ASA Committee on Professional Development, Program Director for Anesthesiology, and Associate Professor of Anesthesiology, Case Western Reserve University School of Medicine, University Hospitals Cleveland Medical Center, Cleveland, Ohio.

Mada F. Helou, MD, FASA, ASA Committee on Professional Development, Program Director for Anesthesiology, and Associate Professor of Anesthesiology, Case Western Reserve University School of Medicine, University Hospitals Cleveland Medical Center, Cleveland, Ohio.

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Aalok V. Agarwala, MD, MBA, FASA, ASA Committee on Practice Management, Chief Medical Officer, Massachusetts Eye and Ear, and Assistant Professor, Harvard Medical School, Boston, Massachusetts.

Aalok V. Agarwala, MD, MBA, FASA, ASA Committee on Practice Management, Chief Medical Officer, Massachusetts Eye and Ear, and Assistant Professor, Harvard Medical School, Boston, Massachusetts.

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Chris D. Glover, MD, MBA, ASA Committee on Professional Development, Professor of Anesthesiology and Pediatrics, and Vice Chair for Clinical Affairs, Texas Children's Hospital System, Department of Anesthesiology, Perioperative, and Pain Medicine, Baylor College of Medicine, Houston, Texas.

Chris D. Glover, MD, MBA, ASA Committee on Professional Development, Professor of Anesthesiology and Pediatrics, and Vice Chair for Clinical Affairs, Texas Children's Hospital System, Department of Anesthesiology, Perioperative, and Pain Medicine, Baylor College of Medicine, Houston, Texas.

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Laura K. Berenstain, MD, FASA, ACC, ASA Committee on Professional Development, ASA Ad Hoc Committee on Mentorship, and Professional Leadership Coach, Berenstain Coaching & Consulting, Philadelphia, Pennsylvania.

Laura K. Berenstain, MD, FASA, ACC, ASA Committee on Professional Development, ASA Ad Hoc Committee on Mentorship, and Professional Leadership Coach, Berenstain Coaching & Consulting, Philadelphia, Pennsylvania.

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