Mentoring is widely established as a means of professional development. The term originates from the Greek language and translates as “enduring.” In Greek mythology, upon embarking on an epic voyage for the Trojan War, Odysseus entrusted his son Telemachus to the care and direction of his trusted friend, Mentor, who was regarded as a wise counselor.
Research in academic medicine, law, business, and nursing has shown that mentoring leads to higher levels of career satisfaction and a higher rate of promotion. This effect is also greater if it begins early in a person's career. Mentoring in private practice anesthesiology groups is not as well described in the literature as mentoring in an academic practice. However, it exists in many forms and serves many purposes.
Mentoring serves as an opportunity for the private practice group to introduce new physicians to the culture and unique aspects of the practice while providing a supportive resource to help the new physician succeed. Most groups choose their recruits carefully and have a vested interest in their new physicians becoming excellent, productive, and happy members of their team.
In our private practice group, we routinely assign a mentor to new physicians, whether they are fresh out of residency or experienced anesthesiologists. We select mentors based on interest, demographics, experience, and sometimes personal factors in the hope of fostering a good relationship. Each practice is different, and while the practice of anesthesiology is consistent, the system processes of the groups, the practice environment, and the preferences of the surgeons vary greatly. For example, one practice doing total knee arthroplasties may use shorter-acting local anesthetics as part of their spinal and supplement with general anesthesia and a supra-glottic airway, while other practices use a denser spinal anesthetic with sedation, and conversion to general anesthesia is viewed as a failure. Some practices do adductor canal blocks at the end of the surgery and some at the beginning, some place a catheter and some use liposomal bupivacaine. Some practices do IPAK blocks, and in some cases, surgeons inject the posterior capsule of the knee during surgery. In our practice, an anesthetic for the same procedure is done differently at different hospitals. Having a mentor to guide new physicians is critical in ensuring a smooth entry into our practice.
New residents entering private practice for the first time can have a difficult time adjusting to the differences between academia and the private practice world. Cases in the private practice world tend to be faster and the relationships with our surgical colleagues tend to be more cooperative. For example, in our pediatric practice, if an anesthesiologist uses a non-depolarizing muscle relaxant to intubate a tonsillectomy patient, the surgeon will be done before you can chart and reach for sugammadex. Most of us just use a small dose of propofol after a standard inhalational induction to facilitate intubation. The general feeling in private practice is one of cooperation and getting cases done quickly, smoothly, and with minimal recovery time for the patient whenever possible. There is a strong sense of collegiality coalescing around optimization of medical care under sometimes immense production pressures.
Different practices use different methods of charting and handling controlled substances. In our practice, we go to several different hospitals and surgery centers and use everything from paper to Cerner, to PICIS, Meditech, and Epic. Losing one's iPhone with all of one's stored passwords can be a metaphorical disaster. Each facility has a different way of accounting for controlled substances; in one location, we waste unused drugs with the nurse, in others, we return unused medications to the pharmacy in secure bags. Some of our locations use Pyxis, some Omnicell, and some a good old-fashioned pharmacist! Mentors can really smooth out the process and help keep the mentee out of trouble with medical records.
Mentoring can also serve as a form of proctoring. Although it is exceedingly rare in our practice, occasionally a new physician is just not a good match for our practice, and it is in everyone's best interest to part ways. Sometimes it is the speed and acuity of the cases, and sometimes the culture is just not a good fit. Having an empathetic mentor who has established a trusted relationship with the new physician can help fix the issue or to navigate these difficult decisions.
Mentoring is not just for new resident graduates, either. After practicing with the same group for almost 30 years, the author (Paul Yost) decided to spend some time in another part of the state where he enjoys having a beach home and practices part time. (He is not ready to retire and still loves administering anesthesia!) He felt very fortunate to have a wonderful mentor who helped him navigate a new practice and to help him fit seamlessly into their world. This mentor helped with surgeon preferences, culture, electronic charting, and billing. He made Dr. Yost look great and even taught him a new kind of regional block. As his mentee, he cannot thank him enough!
When co-author Vivian Tanaka, fresh out of residency, first interviewed for multiple positions at various practices, she was surprised to be repeatedly asked about her future family plans. While the group had almost no women when she first joined, she found the group very supportive and was never once asked about her personal plans. She was able to form multiple peer-type mentoring relationships, which was very encouraging and made being part of a large group rewarding. In addition, when she and others developed an interest in organized medicine, they could always rely on Dr. Yost for meaningful guidance and support. It is very inspirational when leaders take it upon themselves to educate and encourage the next generation.
Mentoring is not without its challenges. It can be a significant time commitment. There can be role confusion and bias. Mentoring can mean different things to different people. As mentoring is very much an informal relationship, communication can be difficult if both parties have little in common. It is therefore desirable to pair a mentee with someone they may share common interests with. As a concept, mentoring is difficult to standardize, evaluate, and monitor. It would be wonderful to see more formalized mentoring training programs developed, as has become the standard in many other industries.
Mentoring relationships are known to be prevalent in academic medicine. There is evidence to show that faculty members who can identify a mentor feel more confident than their peers, are more likely to have a productive research career, and have greater career satisfaction. There is also evidence to show that mentoring seems to occur less frequently with women and members of minority groups. This gap seems especially poignant as mentoring also seems to have a greater influence on them. Women often perceive that they have more difficulty finding mentors than their male colleagues. While there is little research on this subject for private practice settings, it does not seem unreasonable that the same occurs in private practice. Issues based on diversity of race, gender, gender identity, gender preference, and culture are significant for many doctors. Having a trusted mentor to help a physician navigate these challenging issues can make a huge difference.
Mentorship can have an important and profound influence on both personal and professional development. While not formally researched or frequently described, mentoring in private practice also occurs in many forms and serves many purposes. There are many advantages to adopting mentoring relationships. It can help both parties understand and change personal and professional attitudes. It is a wonderful opportunity for both self-reflection and self-renewal. We'll end with a quote often attributed to Shakespeare: “The meaning of life is to find your gift. The purpose of life is to give it away.”