SGO Wellness: I Am a New Gynecologic Oncology Attending–Am I Well? | Sarah Huepenbecker, MD, MPH

I’m a new gynecologic oncology attending, and I’m five months into a dream job with supportive partners, wonderful trainees, and protected research time. Am I well?

On one hand, I feel immense happiness and pride when my patients do well, a family member thanks me, or I get to tell someone they are cancer-free. Compared to fellowship when I was beholden to others’ schedules, I now have autonomy and stability. It feels revelatory to be able to count on set clinic and OR days, to round on my own schedule, and to use research time to ponder questions I care about. It provides the sense of control that fellowship never allowed and allows more balance into my life.

On the other hand, being an attending is scary. The sense of responsibility that now hangs over every decision I make can feel panic inducing. I perseverate about and second guess decisions that I previously made without question as a fellow. I wonder if I will live up to the high expectations of someone who received superlative training and wants to positively influence the field and my patients.

What is driving this feeling? I felt prepared (for the most part) upon graduating fellowship. This is in line with my peers; among SGO members who graduated between 2015-2020, 94% felt prepared for independent practice despite discomfort with ultraradical debulking and urologic procedures (same),¹ similar to recent Complex General Surgical Oncology fellowship graduates.² Outside of clinical practice, I lack knowledge surrounding the business practice of medicine echoed by others in and out of our field^3,4 and the learning curve of administrative tasks, RVU numbers, and Epic inbasket management is daunting. However, my current hesitations revolve less around unpreparedness and more around a desire to ensure that I am always making the optimal decision.

In opening up about this topic to peers and esteemed mentors, I feel reassured that this is a normal transition. My former co-fellows and I keep up a steady text conversation regarding surgical management, counseling, and chemotherapy, and this comradeship bolsters my confidence. When I talk to attendings a few years out of training, I am heartened that they too must sometimes look up chemo doses, brush up on rare surgical procedures, and work through doubt. And I look to people I respect within our field and feel comforted knowing that they, too, had to learn how to be attendings.

So in considering the question of wellness, the answer remains elusive. Compared to fellowship, my work life balance is better in terms of hours spent at the hospital, but the mental and emotional toll feels heavier. I am trying to embrace this transition as I grow into the gynecologic oncologist I want to be for my patients and trainees, with others (especially my fellow new attendings) around me to lean on and learn from. Ultimately, I appreciate how my life has changed for the better post-training as I continue to navigate towards the career wellness that will come with time, patience, and practice.

Sarah Huepenbecker, MD, MPH, is a Gynecologic Oncologist at St. Luke’s University Hospital Network in Boise, ID.

References

1. Nguyen NT, Jang AM, Pomerantz T, Zavorsky GS, Leiserowitz G, Brooks RA. Perspectives of gynecologic oncology fellowship training and preparedness for practice. Gynecol Oncol Rep. 2023 Dec 20;51:101319. doi: 10.1016/j.gore.2023.101319. PMID: 38223656; PMCID: PMC10787252.
2. Behrens S, Lillemoe HA, Dineen SP, Russell MC, Visser B, Berman RS, Farma JM, Grubbs E, Davis JL. Perceptions of Readiness for Practice After Complex General Surgical Oncology Fellowship: A Survey Study. Ann Surg Oncol. 2024 Jan;31(1):31-41. doi: 10.1245/s10434-023-14524-x. Epub 2023 Nov 7. PMID: 37936022; PMCID: PMC10695882.
3. Dholakia J, Boyd LR, Agarwal R, Moss H, Ko EM, Aviki E, Liang MI. Early-career and fellow gynecologic oncologists perceive underpreparedness for the business of medicine: A Society of gynecologic oncology survey study. Gynecol Oncol Rep. 2024 Sep 21;55:101501. doi: 10.1016/j.gore.2024.101501. PMID: 39376710; PMCID: PMC11456887.
4. Huckaby LV, Cyr AR, Lee K, Steiman JG. The Life After Surgical Residency (LASR) Curriculum for Surgical Residents: Addressing the Nonclinical Barriers to Preparedness for Independent Practice. J Surg Educ. 2020 Mar-Apr;77(2):254-259. doi: 10.1016/j.jsurg.2019.09.017. Epub 2019 Nov 11. PMID: 31722845; PMCID: PMC9057454.