How to be a Surgical Attending

My mother took me out for pedicures to celebrate my first job. As I leafed through page after page of documents from HR on medical insurance packages, tax deductions, and retirement plan contributions, however, I quickly went from proud to panicked. I had completed 13 years of grade school followed by a 4-year college degree, but nothing had prepared me for this. There was no course in #adulting.

In much the same way, surgical residents are cosseted in the womb of academia for an extra 11 years before they are unceremoniously dumped into the cold world of malpractice insurance and billing codes. Dr. Jim Korndorffer is trying to change that.

In 2019, Dr. Korndorffer began building a curriculum for surgical fellows with the goal of teaching non-clinical business aspects of medicine through a monthly lecture series.

“I met with the outgoing fellows at the end of the 2019 academic year with a large list of topics. We had a working dinner and from that I was able to obtain a consensus of the topics that they deemed important to them,” said Korndorffer.

Topics included: use of the Stanford Library, how to find a job, contract negotiation, and how to set yourself up for academic success.

“The session that really made an impression on me was the career counseling session, regarding job searches. Dr. [Korndorffer] shared his own experience, and that imparted to me that there is no one typical path or career,” said Dr. Michelle Kim, a fellow in the Division of Abdominal Transplantation. “It also stimulated me to think about what I would want in a job after fellowship, and what qualities to look for in an offer and how to go about looking.”

VA MIS fellow Dr. John Mills agreed with Kim and added that he also particularly enjoyed the most recent session on billing and coding.

“Those are topics I feel that aren’t well taught at many residencies including my own, and that knowledge must either be sought out or learned on the fly once you’re employed,” said Mills.

There are more than 60,000 medical diagnoses that can be coded into a patient’s chart from the general “laparoscopic appendectomy” to the oddly-specific “sucked into a jet engine – subsequent encounter.” Incorrectly coding a patient can not only negatively impact reimbursement but also directly harm the patient’s treatment.

“We ignored the ‘business’ side of medicine for a long time, which was fine when there was lots of excess in the system,” said Dr. David Spain, who hosted the session. “With the increased emphasis on cost-effective care and move to more integrated healthcare models, it's crucial for physicians to understand their roles and the value of what they do.”

In addition to the educational aspect, Dr. Korndorffer’s concurrent goal with the lecture series is to provide the fellows with a supportive community.

“Fellows may have limited external support structure beyond their specific surgical section to which they are completing their fellowship. Because of this they rarely know their peer fellows. In fact, I noted one year the MIS fellow at Stanford had not met the MIS fellow at the VA,” said Dr. Korndorffer.

Fellowships are often only one or two years and hold a unique position in the hospital ecosystem as they are no longer residents but also not yet attendings.

“We are in a bit of purgatory in who our true colleagues are. Thus, fellowship can feel isolating at times,” said Kim. She described the fellows’ Balance in Life Retreat, as a turning point. Fellows spent a full day playing team building games and having fun with the other members of their new cohort.

“We've gotten happy hour together, helped each other share resources for oral boards, and a few weeks ago I even went on a ski trip with the HPB fellow (who I met on that initial retreat)! Knowing your colleagues on a personal level definitely makes for more facile collaboration in patient care. I feel more confident and happy knowing that I have allies around me who share similar responsibilities and stressors,” said Kim.

The lectures encourage the fellows to strengthen these relationships by providing them with protected time to engage with their colleagues during the pre-lecture meal and bond through learning.

“The lectures serve as a good meeting point for people who obviously have busy schedules,” said Dr. Mills, who says they’ve also created a WhatsApp group for asynchronous communication between in-person encounters.

Lectures will continue through May when Dr. Korndorffer hopes to close the year with a celebration to give the fellows—especially those leaving for new jobs—one final chance to get together with the support of the department. The format is being developed with the input of the current fellows, who will also have the opportunity to provide feedback so the series can be improved for future generations.