Among my many failures was my inability to provide mentorship for junior faculty at Stanford in the early 2000s. My chair, Dr. Ron Pearl, asked that I meet with faculty who were joining our newly launched “clinician and educator” professoriate line. Faculty recruited into our clinician-educator line were outstanding clinicians. They were uniformly eager to establish an academic career at Stanford. I was tasked with providing guidance and montorship.

As a professor in the University Tenure Line, my perspective of scholarship was limited. I understood research, building and running a laboratory, and securing funding from both peer-reviewed and industry sources. I had mentored dozens of my own fellows. I thought I understood mentorship.

I met with every member of our burgeoning clinician-educator faculty, discussed their career goals, and asked them to envision where they wanted to be in 10 years. Most emphasized honing their clinical skills and contributing through education. I explained that Stanford would require evidence of scholarship, a meaningful contribution to knowledge. I told them this would take the form of research and would require training, persistence, and a good question! It would also require time: staying late after a long clinical day to recruit patients for your study or review data with your collaborators. They might need to spend their weekends centrifuging blood samples. They might need an extra day or two for research, requiring a salary cut since they would not bring in a clinical salary on those days. Having done all these things, I offered reassurance that the rewards had been worth the sacrifice.

I also explained that the persistence, the obsession, and the dogged determination needed to answer a question despite endless obstacles and setbacks had to come from the individual. It even required a little insanity to dedicate great chunks of time and energy to a research project that could as easily fail as succeed.∗

I had no takers. Not a single faculty member was interested in what I had proposed. I reported to Dr. Pearl that I had failed. None of the new faculty were interested in pursuing a career in research, the only academic career I understood.

Twenty years later, much has changed. My vision of scholarship was too narrow. As academic anesthesiology departments increasingly emphasize meeting the clinical demands of modern tertiary and quaternary care, those clinicians who dedicate themselves to our most challenging patients and procedures must devote their energies toward developing and maintaining the necessary skills. Fortunately, this focus on advancing clinical care has created new opportunities to demonstrate exceptional scholarship. Traditional hypothesis generating/testing research is now relegated to a small cadre of practicing anesthesiologists, in part because of the requirements for sustained departmental resources.

Scholarship now encompasses advancing patient safety, improving health care efficiency, documenting quality improvement, advancing physician wellness, addressing health care and workplace disparity, and accessing electronic records to generate new insights. It still takes initiative, training, dedication, persistence, and willingness to work hard and fail. However, scholarship has become tractable for those seeking a career as clinicians and educators.

In this issue Drs. Cheng, Nabipour, Strowd, and Wald provide mentorship about negotiation. The article provides excellent guidance on negotiation strategies for faculty (I expect it will help me negotiate my upcoming retirement). However, the article offers more than good advice – it is an example of the academic scholarship that universities seek in their clinician-educator faculty. It is useful both for its content and as an example.

Drs. Nabipour and Cole review the role of networking. They offer sage advice: “Be patient with yourself and others, patient to find similarities, build relationships, trust and create familiarity; but be persistent in your efforts, because connection truly matters.” In my view, networking is the most rewarding part of choosing a life in academia. Over the course of many years, one becomes part of an international community of colleagues, many of whom become close personal friends. Early in my career, my mentor (and life coach) Don Stanski introduced me to senior thought leaders in clinical pharmacology. These introductions wove my career into a network that collectively advanced our understanding of the field, celebrated our shared successes, and supported everyone involved when our efforts failed.

Drs. Deutsch, Nafiu, Lee, and Markowitz address the unique mentorship needs of underrepresented minorities and women. Women face greater hurdles than men in building academic careers, a discrepancy fully exposed by the unequal burden of the COVID-19 epidemic on the academic careers of women (National Bureau of Economic Research Working Paper 28360 January 2021; JAMA Oncol February 2021). The same is true for underrepresented minorities who experience both long-term effects and daily microaggressions from endemic racism (ASA Monitor 2021;84:8-9). As the authors document, women and underrepresented minorities, arguably groups that might benefit the most from coaching and mentoring, “are the least likely to seek and receive it.” We cannot advance diversity, equity, and inclusion in anesthesiology without providing increased mentorship to underrepresented minorities and women.

Drs. Wright, Solomon, and Tollinche address the challenges of cross-cultural mentorship. Because science, medicine, and scholarship readily span cultural boundaries, it is common that individuals from different cultures come together as mentors and mentees. One of my fellows, an exceptionally gifted German pharmacometrician, almost immediately began using four letter words in his interactions with other fellows. I explained that this was not acceptable in U.S. culture. He said I was wrong – he had learned otherwise by watching American movies. (I know it sounds cliché, but this is exactly what happened.) A month later, he used the same coarse language with a patient we were recruiting for a study. Shocked and appalled, I warned him that a second instance would result in immediate termination of his fellowship. He was genuinely confused: he had learned from American movies that coarse language helped people bond. Words that would shock a native English speaker were merely foreign words with him with no emotional impact. This is an extreme example, one where I was obviously right to intervene in this cultural misunderstanding. Because of space limitations I won't share any of the many examples of such misunderstandings where I was equally obviously in the wrong.

Clinicians in private practice might believe that none of this applies to them. Wrong! As Drs. Yost and Tanaka document, there is a role for mentorship for clinicians outside of the university professoriate. Both authors work in private practices that created mentorship programs for new physician recruits. The immediate goal of the mentor is to help the mentees quickly master the ins and outs of providing anesthesia care and “ensuring a smooth entry into our practice.” However, the longer goal is helping new physicians find the right balance between their personal and professional lives. There is a shortage of anesthesiologists. Each recruit represents an investment in the long-term future of the practice. Google, where my son works as a developer, invests an enormous amount of time and money keeping their developers sane, productive, and loyal. If they didn't, the developers would seriously consider the endless entries from Amazon, Microsoft, Apple, and Facebook to jump ship. It's not different for private-practice groups. Career satisfaction is critical to the long-term economic health of private practice groups, and mentorship is essential to any rewarding career. Conversations with close friends who direct private practice groups suggest that they take mentorship and career satisfaction exceptionally seriously, perhaps more so than my colleagues in university practice.

Mentorship can start any time. Many of the authors in this issue have only recently embarked on their own careers. They are providing mentorship while also seeking mentorship. Our first mentors are our parents, followed by older siblings, if we are lucky, and then by our teachers (ASA Monitor 2020;84:8). At the age of 12, my older brother Jim became my mentor. He still is. Mentorship is often a lifetime relationship. Don Stanski and Larry Saidman, mentors over many decades, are providing guidance for my transition over the next few years into a post-Stanford life.

Mentorship is not only essential in building a career – it is among the most rewarding roles in life.

∗ This is also required of entrepreneurs, as Danial Kahneman describes in a section aptly titled “Entrepreneural Delusions” in his classic treatise “Thinking Fast and Slow”: “The chances that a small business will survive for five years in the United States are about 35%. But the individuals who open such businesses do not believe that the statistics apply to them.... Fully 81% of the entrepreneurs put their personal odds of success at 7 out of 10 or higher, and 33% said their chance of failing was zero.” Kahneman D. Thinking Fast and Slow, Chapter 24, Farrar, Straus, and Giroux, New York, 2011.

Steven L. Shafer, MD, Editor-in-Chief, ASA Monitor

Steven L. Shafer, MD, Editor-in-Chief, ASA Monitor