As I begin my career as a neurosurgeon-scientist, I feel incredibly fortunate that I have remained in contact with my senior residents from Ohio State University who have served multiple roles as friends, colleagues and mentors. I reconnected with them recently to garner some of their perspectives on the next stage and wanted to share their thoughts.
Ahmed Mohyeldin, MD, PhD, is an assistant professor of Neurosurgery at the University of California – Irvine, with a focus on skull base pathologies.
Ammar Shaikhouni, MD, PhD, FAANS, is an assistant professor of neurosurgery at the Nationwide Children’s Hospital with a focus on adult and pediatric epilepsy, movement disorders and stereotactic surgery.
Huntoon: What do you wish you would have known prior to becoming an attending?
Shaikhouni: I wish I knew that COVID was going to happen six months after starting my first job! I would have just found another fellowship rather than start my first attending job during this challenging time.
Joking aside, while our residency training was great from a clinical perspective, I think most residents lack training in the daily chores that arise when they become attendings. In residency, we are not trained in coding and billing. On day one of being an attending, you are expected to know how to code and bill, and it becomes an important part of your practice. I noticed my plastic surgery colleagues, for example, were much more facile with coding and billing because they have extensive training during residency.
We are also not well trained on contract negotiation, and most graduating residents don’t understand the different ways contracts can be structured. Senior residents will benefit from education on these issues by lawyers and experienced neurosurgeons from both academic and private practices to help them prepare for their life as attendings.
Finally, in academic practice, it is important to understand that as a neurosurgeon, you will always depend on collaborators as we are way too busy clinically, even at 50% efforts, to be able to manage large research projects without basic science collaboration. It is important to understand how to make connections and understand the strengths and weaknesses of the organization you’re joining and whether it works for you.
Mohyeldin: Although my residency and fellowship prepared me well for the rigors of academic neurosurgery, I would have loved to have more exposure to CPT codes and have a better working command of their use.
Huntoon: How do you balance your clinical and scientific time and energy?
Shaikhouni: This is a challenging problem. I chose to be in an academic setting as I find myself able to use science to break from the monotony and stress of clinical practice. I also find clinical practice always influencing how I approach scientific problems. I typically try to keep at least one day during the week to focus on keeping up-to-date on scientific journals, schedule research meetings and do some writing and data analysis. I also use one weekend day for science. My clinical work consumes most of the week otherwise.
My typical week is: Monday clinic followed by working clinical team meetings, Tuesday is surgery day, Wednesday is a half clinic day followed by research meetings, Thursday is a research day and Friday is an operative day. It needs to be emphasized that many of my research days can be taken over by emergent or urgent clinical cases which makes me fall behind on research work at times. I try to catch up on this during weekend and nights if the family time allows. In tradeoff, there are quiet weeks operatively that I then use to accomplish as much as possible scientifically.
I urge all new attendings to also not forget about their family and personal time. A career in neurosurgery is a marathon and getting out sprinting might burn you out before you can reach the finish line. Everyone will have their own pace, and they need to find a job that meshes with their career path.
Mohyeldin: The way I try to balance my time is to stay focused with the projects and cases that I take on and that fit my area of expertise. This allows me to be efficient with my time and have both my clinical and scientific work inform and synergize to serve one another. I also recognized early from my mentors during training that this is a team effort and to be invested in becoming successful physician scientist, you have to be invested in the development of graduate students, medical students and post-docs. Lastly, I allocate a dedicated amount of time of at least two days a week towards grant writing, lab meetings and running experiments to generate and analyze data. The resources at UCI, starting with the support of my chairman, Dr. Frank Hsu and my Mentor, Dr. Wei Li, has been invaluable in this effort. Their mentorship during the early years of my career has been critical for my development.
Huntoon: What is the biggest benefit/reward of being a newly minted attending?
Shaikhouni: The biggest reward is being able to save lives and making a difference in the lives of patients. It is a privilege that we often don’t get to appreciate as residents since residents don’t often see patients in follow up. I love it when my patients’ families send me cards of kids I operated on who are doing well and thriving. That is the biggest reward that makes me proud and happy to have chosen to be a neurosurgeon.
Mohyeldin: The biggest benefit that comes with being a new attending is that many of the resources are being dedicated to your development and the building of your practice. This allows you to forge new relationships and collaborate with faculty within and outside your department. This compels you to discover new resources within your university that add to your mission. The reward that comes from that is the opening of doors for new projects and new directions to develop your academic and clinic interest. I find it very rewarding when I meet a new faculty member outside of the department who has expertise in a specific area; that collaboration is energized by our mutual interest to serve our patients.
