Q&A: What challenges can I expect as a new practitioner establishing myself in a practice site, particularly if I stay at the same institution where I did my training?

This is a very insightful question that pertains to a lot of students, residents, and fellows today. As the job market tightens, centers are looking to retain their in-training members because this often affords the institution increased familiarity with and confidence in the candidate and earlier allocation of the position. Similarly, many residents are staying at the institution where they completed their training because they have existing knowledge of the site and relationships, projects, and life experiences, which makes it a comfortable and natural transition.

Staying at the same institution offers many benefits to residents turned staff or faculty. As an in-training pharmacist, you were given the opportunity to build relationships with intra- and extradepartmental individuals through the unique opportunities that training programs provide. There is no replacement for these relationships in your future endeavors. These connections can be used in both the clinical and leadership aspects of your career. Pharmacotherapy plans tend to be more successful if proposed by a familiar practitioner, and you may more quickly reach leadership roles if you have an established departmental track record. Another benefit of staying at the same institution as a new practitioner is your familiarity with the resources at the site. This may mean you’ve deftly navigated the patient care computer systems, already bookmarked the links to the specialty policies/procedures that have saved you in a pinch, or developed your IRB troubleshooting skills for your next research project. You may also have a clearer sense of the opportunities at your center for future research and projects.

Unfortunately, however, staying at the same institution isn’t all roses, and anticipating the challenges that may arise will help you head them off at the pass. Below, I have listed 3 common challenges you may face and their possible remedies.

1. Shaking the In-training Shell

It is common for people to still see you as a resident or fellow, even well after you’ve transitioned to staff. This can manifest in your relationships with colleagues within your department as well as with members of the multidisciplinary team. However, it can jeopardize your credibility as an independent practitioner because people may not see your recommendations or contributions as independently “sufficient.” Similarly, depending on the situations you encountered during residency, intradepartmental colleagues may perceive your contribution as less valuable than that of someone with the same experience whose development they did not personally witness (ie, a resident in your graduating class at a different center hired by your department). The remedy for this is patience and perseverance; it is largely on your shoulders to change how other people see you. Perhaps engage in didactic and experiential education with the new academic class. This will help you more naturally transition from the learner role to the mentor role, and people will take notice. In addition, work with your multidisciplinary team outside rounding, maybe through participating in a quality improvement project or committee. Make a point of spearheading new projects and displaying your own practice style and clinical approach. Getting to know these individuals in different aspects of your practice will solidify their perception of you as an independent practitioner, not just the resident they rounded with once. Regardless of your strategy, make the extra effort to separate yourself from your in-training role because it will elevate others’ perceptions of you.

2. Developing a Network

This is a 2-part challenge related to developing networks both within and outside your institution.

The first networking challenge when staying at the same institution is the need to establish new connections with other mentors and influential individuals at your center. At the institutional level, as already mentioned, you presumably established great relationships with a lot of different individuals throughout your year(s). Whether these individuals were formally assigned mentors through your program, residency/fellowship directors, or simply people to whom you naturally gravitated because of common interests, they will still be around when you transition to staff. One thing we may forget, however, is that your coveted mentors often get new mentees each academic year. Although this may not devalue the relationships you have forged, your mentor may find it challenging to invest the same amount of time in your growth as a new practitioner as when you were in training. To address this challenge when transitioning from your in-training role to that of a new practitioner, it’s critically important to find at least 1 individual who has the time, energy, and interest in mentoring you in the next steps of your career. Don’t constrain yourself to considering only your previous mentors; as a new practitioner, what you need for growth will differ from what you needed as a resident or fellow. Perhaps engage someone new you’ve gotten to know in your department who has already achieved professional goals similar to yours, or even someone outside the department with expertise in your interest area.

The second networking challenge when staying at the same institution is the need to develop new connections with individuals at other centers. These relationships may be the key to future research endeavors, career path changes, or leadership opportunities at the regional or national level. One strategy to ensure diversity in this aspect of your network is to get involved in professional organizations. Connections through ACCP, state-level societies, or subspecialty organizations may later help you benchmark practice elsewhere, recruit patients with a rare disease for a research study, be offered a formal presentation at the national level, or get external letters of recommendation for academic appointments. Another strategy is to reach out to the alumni of the residency program you just completed. Your shared experiences can provide a familiarity that makes working together more straightforward. In addition, mentoring new trainees through precepting or research will eventually widen your professional network as your trainees go on to become independent practitioners with an indelible connection to you.

3. Setting Goals and Accomplishing Them

As a resident, you found it easy to show up at your quarterly meeting with your program director, click off some boxes in PharmAcademic, and devise a bulleted list of the things you needed to work on for the next 3 months. You were assigned specific tasks that were necessary to fulfill your graduation requirements, and you structured your year(s) to accomplish them. However, when transitioning from in-training to new practitioner, you can quickly lose direction in your career unless you carefully scrutinize your goals. The considerable decrease in oversight relative to the structured residency/fellowship learning experience can leave you at a loss for how to set and reach your professional goals. Moreover, when you’re new, you naturally tend to say “yes” to everything to prove yourself: “Of course, I’ll sit on that committee/give that talk/put together that new order set/lead the task force.” Finally, and perhaps more specific to staying at the same institution, your residency activities often find a way to linger beyond your graduation date. Maybe you haven’t yet presented that MUE to the P&T committee, or your presentation on new updates in a therapeutic area was so popular that you’ve been asked to tailor it to a different audience and give a grand rounds. Although, on the surface, each of these opportunities is valuable, carefully consider whether they will substantially contribute to the attainment of your professional goals. As your residency/fellowship winds down, make a concerted effort to develop a measurable and realistic set of personal career goals. Be honest with yourself; don’t say that you want to do research because that’s what everyone around you is doing. Unlike in a residency, as a practitioner, you can and should tailor your career to your own interests. A narrower focus, albeit uncomfortable at first for new practitioners used to the buffet of options offered in a residency/fellowship, will likely make your career goals more achievable. If, for example, as a long-term goal, you wish to achieve Fellowship in the American College of Clinical Pharmacy, use the evaluation criteria to set up short-term goals for developing your clinical practice, organizational involvement, and scholastic productivity. Write down your short- and long-term goals, and keep a copy of them in a readily accessible location. Share your goals with your mentor(s), and ask those who have achieved similar goals about their experiences in attaining them. Set up check-ins for these goals, maybe through a calendar reminder or a preplanned meeting with your mentor. At these check-ins, reappraise your progress on your existing goals and establish new ones moving forward.

In summary, whether you stay at the same institution or move to a new center after training, each road will offer challenges. The most skillful new practitioners approach this new chapter in their lives with an appreciation for these challenges and a clear plan to prevent them from standing in the path to success.

Erin Frazee Barreto, Pharm.D., PhD, FCCM, FASN

Associate Professor of Pharmacy and Medicine

Mayo Clinic

Rochester, Minnesota