Bill asked me to talk about making effective change because what's going to happen to most of you over the next couple of years is you're going to make this huge change from residency to your first job. And the statistics are that I think up to 50 percent of people change jobs within their first two years out of practice. Is that the statistics you know, Bill? So it's very likely that you will land a job and decide to make another change in terms of your overall job and if not maybe some kind of minor change within your job. So learning to deal with change I think is important. And before I came here, my junior partner is about two years out in practice and so I ran some of my thoughts by him because I'm now 20 years out in practice and he kind of confirmed that I was pretty much on target on this. So I'll first share with you, you know, this quote that I used in a recent address that I used by Wayne Gretzky. He says that a good hockey player plays where the puck is and a great hockey player skates to where the puck is going to be. And I think that this is really the crux of what change is. Is you want your life to always be looking ahead, not kind of, you know, if you're constantly focused on exactly what you're doing today and not thinking about where you're going and where you want to be, then a change is going to hit you in a bad way as opposed to you managing the change. There are many reasons why you or I or any of us in this room may have to change. Some of them are because the global healthcare system is changing. There may be changes in your local environment. Your hospitals may merge or be acquired by a bigger system. And there may be family or personal reasons why you need to change. An illness of a child, a disabled child, a disabled parent, a disabled spouse or friend. And so there are many reasons why we are confronted with change as we enter into our practice. Right now, one of the things that may concern you all is that there's this perfect storm going on in terms of changes in the healthcare community. And this relates to a whole confluence of things. This is Libby Zion. She's the one who is responsible in part for changing the work hour regulations. There's the reports by the IOM, the financial crisis, some of the global things going on, and the advent of technology have all caused these changes that Katie Arrico was referring to, and I'm glad she came before me. So there's an increase in people working in the hospitals. There's changes in the regulations from the ACGME. We talked about accountable care organizations yesterday and the IPAP. So all of these things are really going to impact your practice and you don't really know how that change is going to affect you. So the one way of approaching this is to say that these are desperate times. The other way is to say that this is an opportunity for you and for all of us. Neurosurgeons remain in demand. The salaries are still very high and our lifestyle is still pretty good. And as I said yesterday, we're all still smiling around this room. So what are the roles of engagement? Change is really part of your life and it shouldn't be something that you fear, loathe, or otherwise. And you need to embrace a process that is proactive in terms of change. So always be thinking about what can happen next and what your strategies will be. Don't fear change just because it's something different and this is something that's very hard for most of us to accept. And I would say that in my career I've changed my practice many, many times and if I'd look back and say what was the biggest mistake that I made, it was that I waited too long to get out of a bad situation. So don't let yourself get trapped and think that it's going to get better when all of the signs point that it's not going to. So this is unfortunately what happens a lot of time. A whole group of people say we're going to change and then nobody really does anything. So how can you be proactive about this? I think first and foremost you have to find a mentor. And I was pleased that my junior faculty member sort of said that he agreed completely. He said that me forcing him to establish three, six, twelve, and twenty-four month goals and actually write them down and he and I agreed on them when he started working with me was the best thing that I made him do. Some of my fellow colleagues accused me of mothering him and sometimes speaking to him in that motherly way, but he will tell you if you ask him privately that it's the best thing. It made him really sit down and think about what did he want to accomplish? What were his strengths and weaknesses? And every time he knew he was due to come up to a meeting with me, suddenly all of those things that he hadn't done for the first two months, he found a way to get them done. So having the deadlines really helped him to focus on making sure that he was meeting the goals that he had set for himself. And so he said that was very useful. But you have to have a mentor that you or somebody who you trust and feel comfortable with. And it may or may not be somebody that you work with immediately. And the NNS can help you find a mentor or some of your other colleagues may help you find a mentor if you don't have somebody where you're working. And it may take you one or two tries to actually hook yourself up to a mentor that you feel can do this for you, because it's got to be a give and take and it has to be very honest. And then you want to revisit and you revise these on a constant basis. And that's what I've done with him at his regular meetings. Now obviously I operate with him, I see him, we discuss patients, but we set aside special time that's uninterrupted at these different intervals. And they become longer and longer because as he gets more established, then our need to do this is a little bit less. But you should be doing that for your life as well. In this proactive process, you want to be realistic and you want to be your own harshest critic and recognize that perfection really doesn't exist. Just a couple more quotes to keep things lively. When you're finished changing, you're finished. And everyone thinks of changing the world, but no one thinks of changing themselves. One of the things that you have to always have prepared is your resume. And this was discussed yesterday a little bit. Your resume should reflect who you are, where you came from, what you have accomplished, and where you want to go. I think these days the notion of having just a comprehensive CV is probably not what you want to have. I mean, you want to kind of keep that on the side, but you actually want a resume that more accurately reflects these elements of yourself. If you're really proud of your teaching, then you really want to list the people who you have mentored or the research people who you've directed, what their projects were, what happened to those projects, and how you helped propel them along. That, to me, is much more meaningful than having you list 20 people who you've been involved in mentoring but having no idea what actually happened to any of those individuals. So it's really quality over quantity. Keep your resume up to date. It's much easier to do that than to go back and remember all the things you did two and three years ago. Have others review it on a regular basis, and this was mentioned by somebody else. And prioritize it to make your accomplishments obvious to other people. So if you put a whole lot of hospital committees that you've served on and done nothing on above some really critical project that you headed up that netted profits for your hospital to the tune of $2 million or something like that, that whole list is somebody's going to start falling asleep before they've read through that and not gotten to some of the projects or programs that you may be most proud of. In terms of promotions, and Bill alluded to this the other day, understand what the rules are. They're going to be slightly different at every institution. And make this a priority if you are in an academic setting because your promotions will help with your job security, and they also will make you a more attractive candidate if you need to change jobs or if you decide that you want to change jobs for some reason. So you really have to keep on top of this, and again, your mentor should be able to help you do that, or you may need another individual at your academic institution who can help facilitate this for you. I can share with you that when Bill came as my chair, at that point I had all these projects underway, but I was failing at actually getting them published. And he kind of, you know, said to me, Deb, you know, it's great that you're doing these, but if you don't publish them, then no one else is going to be able to acknowledge them. And, you know, I got that message loud and clear. And that's the same sort of thing that your mentor should help you do so that you can fill in all the boxes you need to in the promotion scheme of things. This may seem obvious, but never burn your bridges. Allies are good and enemies can block your way. I think it's important to understand that relationships and positions shift over time. So your general surgery colleague who is always harassing you in the trauma rooms right now, you know, five years from now you may land at an institution where they're the chief of general surgery. And if you piss them off, you know, in the trauma rooms while you are a resident, and then later on they're chief of surgery and your neurosurgery is a division and not a department, you may find that you're their boss even though they're your boss even though you're their contemporary. And this is very true within hospitals where people move into administrative positions and assume new roles. So try whenever you can not to burn these bridges. On the other hand, you should learn to say no and find ways of saying no. One of the classic ones is serving on the medical school admissions panel. This is something they like to hand out to junior faculty. It is enormously time consuming and offers very little reward. That's something I think you should always say no to. But make sure that if you're signing up for a committee or your chair or your division chief or whatever asks you to do something that it fits in with the scheme of where you want to go. And if not, you know, discuss with them why that is and why they've asked you to do it and whether it really fits in with what your priorities are and what their priorities are for you. A corollary to all of this is that beware when negotiations start. And when I talk about negotiations, it may be that you want a promotion or you want to change jobs. Sometimes people don't know that what they say at cocktail parties or social events may later impact their negotiations. The head of my current multi-specialty group, I actually met first at a cocktail party. And if I had said the wrong thing, it may have impacted whether they ultimately hired me. You may be serving on a hospital committee where somebody who's going to make a decision about your promotion or whether you're going to get named chief of a division or something like that is on that hospital committee. So how you behave generally and how you behave towards them may be the start of your negotiations for one of those sort of things. It's also true of when you attend annual meetings or a meeting such as this. I mean, I try to always introduce my residents as I've walked around to people that might be of interest to them. If they want to do a pediatric fellowship, I sort of go out of my way to introduce them to other pediatric neurosurgeons that I encounter at the meeting. And likewise, as you wander through those meetings or do your presentations, remember that those are sometimes the first impressions that you're going to make of people who may later hire you or be involved in your promotion. There is a strategy called the Blue Ocean Strategy, and it's basically finding a path that's less travel instead of trying to involve yourself in the shark-filled red waters. It's to find a place where you can do what you want to do without having to fight those daily battles. And there's a lot of ways to accomplish this, and there's a whole book and strategy written about it. But I would encourage you to be creative and to find ways, instead of feeling like you're fighting every day, to find a path that what you're doing is in much calmer waters so that you can be more effective. Perfection is a myth in your job, in your relationships, in your accomplishments. But you need to accept the fact that while perfection is a myth, you have to fight for the good things. And my final talk today will be about balancing your life and those sorts of things. But I'll just say now that you can change, but that you will never find perfection. And change is really an incremental process. I mean, Willis Harman said that fundamental changes have come about through vast numbers of people changing their minds, sometimes a little bit at a time. And I think the same is true for us as individuals, that we end up making global changes in our life because we've made sequential changes as we reviewed and revised what's important to us, and that it changes over time. And when my kids were little, my priorities were more focused towards my young kids. And now my kids are grown and out of the house, and the way that I deal with them is obviously very different. So these things all change over time. I think we're running behind, so I won't play You Might Think Different. But if you haven't seen that commercial, please Google it and listen to it. It should inspire you. So in summary, your change in your life is going to be constant. You think that you're making this big change in the next couple of years, and it's going to be the last one you're ever going to make, and that's not the case. Think of your life as ever-changing and ever-evolving. Be very proactive, and therefore be prepared for the changes that you may want to make or that you may need to make, and think differently so that you can create opportunities for yourself. Thank you.

managing change

embracing change

professional life

transitioning from residency

first job