In the middle of the COVID-19 pandemic, after moving to a new city in a new medical system, I (JXO) finally became a new attending psychiatrist. Despite the well-traveled road from medical student to faculty, the day-to-day adjustments required as a new faculty member in academic medicine were challenging to me. I was surprised, but relieved, when my mentor (MTR) expressed similar feelings of unpreparedness when he made his first transition. The following is a starting compilation of shared and remarkably similar reflections to help others beginning their own new roles to adapt more comfortably and thrive.

Avoid taking workplace disagreements and “unreasonable” requests personally; instead, pause, and use “wise mind” [1]. Do not be surprised if you are asked to perform a series of tasks outside of your skillset and role. It may even be instinctive to feel confused and irritated. However, stepping back to ask, “What is the goal of the request?” is necessary. People with whom you may disagree still have a need to be seen, heard, and understood by you. In fact, they are your partners in problem-solving. By being curious about the end goal, we can get into collaborative problem-solving mode. Here are examples of gracious responses: “It sounds like there is a need for additional support in this area of the project. Taking this on would make it hard for me to accomplish [list duties] our team needs. How about I help to brainstorm a better solution?” or “That sounds interesting. Let me think about it some more and come back to this at the next meeting.” Reframing the goal of the original request can bring out a more collaborative resolution and is a critical skill to develop at any institution. Unfortunately, it will not develop overnight, but practice will lead to more satisfying results.

Boundaries involving personal limitations and skillset limitations are important to reconcile to help define your scope of work and appropriate your time properly. In other words, know what should and should not be asked of you. This can be tricky, especially as a new attending who is still building a reputation, but having defined boundaries is vital for the longevity and work satisfaction of the new attending physician. There is a culture in academics of saying yes to everything, for that is the “can-do” and “team player” attitude that everyone is seeking. If you say yes to everything and do not respect or enforce your boundaries, your burnout might actually be your problem. Agreeableness and collegiality are not the same as saying yes and then becoming overwhelmed; being resentful does not help anyone. Having mentors and other supportive relationships will be invaluable here.

Camaraderie and relationship development require effort and time to be cultivated. Intentionality is necessary to create your community when it is not built-in. Consider these practical steps: First, take advantage of what exists. Join the mentoring initiative or early career group from a professional organization or your institution. Second, invest in your peers (e.g., five psychiatrists were hired around the same time during the pandemic, and a peer group for supervision and community was born). Third, know your interests outside of your job and use them to build comradery with colleagues. Finally, maintain your connections with loved ones, because not only will this help you stay resilient but also these communities are your roots. Remind the people from whose relationships you derive joy and life that they are important, and show them that it is true.

Discover yourself, your purpose, and your needs as you transition. Caring for your whole person may mean sometimes challenging conventional medicine with “You are not only a physical being, but emotional, intellectual, social, and spiritual; all these areas need nurturing. What is going well in these areas, and what do you need to work on?” But we as physicians often neglect to care for one or more domains of our personhood. For us, a daily spiritual practice is a need to remind us of our purposes. Needs are different from wants: “I want to binge Netflix, but I need to sleep. I want to distract my conflicts away, but I need to confront and resolve them.” Being honest and reflective is an invaluable routine that has helped us win battles with not only ourselves but the struggles against broken systems and difficult encounters. For only when we are filled can we pour out to others.

Email management is a major task that all faculty face. Try to schedule email catchup times. Emails may contain hidden gems (particularly those from the faculty development office) like invitations to events or unique opportunities.

Find and review your contract and benefits a few months in, because your understanding of what you signed and what you want is much better than when you first signed it. You will be glad you did; I learned that part of my pre-tax dollars can fund public transportation and that employees receive free coaching.

Growth in your new position does not require perfection, but it does require self-awareness and intentionality. David Steindl-Rast, a Jesuit priest, said, “It is not joy that makes us grateful; it is gratitude that makes us joyful” [2]. During overwhelming and confusing times, it was almost certain I had forgotten to practice gratitude, rushing and thinking “I’m getting behind!” Yet it is when I slow down to re-ground myself, in and with my purpose, my relationships, and gratitude practice, I am the least frantic and the most joyful in my work.

In closing, these reflections and lessons we learned are our attempt to begin to give language to the unwritten curriculum from some real-world classes. The materials and learning methods will vary in this next series of experiences post training, but we hope that the ideas described herein can spark a greater conversation in remembering our humanity as we go onto the next phase of the adventure.