Making the Leap from Trainee to Staff Surgeon

27 May 2020

By Lakho Sandhu

‘The more I read, the more I acquire, the more certain I am that I know nothing.’ –Voltaire

The moment you’ve dreamt about for years finally arrives. You pack up your belongings and move across the country or perhaps just down the hall, to start a new journey as a staff surgeon. Without a doubt, it’s an exciting moment the culmination of years of dedication, hard work and sacrifice. It’s also a significant transition into a new role that can stir feelings of doubt and anxiety. A sense of imposter syndrome can make even the most confident among us start to second guess themselves. During my first 18 months of practice, I received many pearls of wisdom from colleagues and mentors that have eased my transition from trainee to staff surgeon. What follows is by no means an exhaustive list but just a few lessons that I hope will help you on your journey.

Set yourself up for clinical success by being selective about your early case-mix

A colorectal surgeon I admire did not tackle recurrent rectal cancer referrals during her first six months of practice. She knew how important it was to have good clinical outcomes to build her own confidence and to gain the respect of her colleagues. This was especially true given she was working at an institution where she had not previously trained. By taking a graduated approach, she wanted to have a few “wins” under her belt before tackling the tougher cases that inevitably would come her way. I acknowledge that not everyone can be this selective when starting out, but if you can, avail yourself of the opportunity.

Be prepared to come across the weird and wonderful

There will be moments when you encounter disease processes and presentations that you have never heard of let alone cared for before. This is not only to be expected, but this appears to be a rite of passage.

Reach out to others who are also starting out

Several of my closest friends are also early career surgeons, and we are an unofficial support group for one another. We run cases and complications by each other, discuss billing strategies, and share plenty of laughs along the way. Hearing my friends confirm that they share many of my concerns has made me feel far less alone.

Negotiate for leeway in hiring administrative assistants

You will spend a significant amount of time working with your administrative assistant. Patients and other clinicians will often interact with this person before they have ever met you. Hiring someone you can see yourself getting along with can make all the difference.

Find a financial planner, accountant, and insurance specialist

Many of us have accumulated a fair amount of debt throughout the course of our training, so we become focused on debt reduction when earning a staff salary.  This is an opportunity to tackle this as well other financial goals.If possible, find experts who do not receive a commission from specific financial institutions for selling their products.

Setting expectations with trainees

Before every case, I take a moment to ask the senior and junior residents what part of the case they are especially excited to perform. I let them know that if we are failing to progress, I’ll particularly give them extra time when working on these portions of the case. I will also openly acknowledge that as a newer staff, my threshold for taking over may be different than others, but this too will evolve with time.

Find yourself different mentors for the various aspects of your career

A recent population-based study found that increasing surgeon age was associated with decreasing rates of postoperative death, readmission, and complications in almost a linear fashion. Finding a senior colleague who is both approachable and highly skilled provides you an opportunity to benefit from the breadth of their experience. Your clinical mentor, however, may not be the person you turn to for advice regarding grant writing. Identify those who can help you and don’t be shy about reaching out. 

Set realistic goals

A few years ago, I saw an early career surgeon leave his first job in academia for private practice after he was asked to take on an unrealistic number of educational and research projects. While some of these goals he cared about deeply, others simply did not provide him with meaning. Only you know what matters most to you, so protect yourself and set realistic goals whenever possible to ensure your success.

Cut yourself some slack

Remember that you are a well-trained surgeon who has spent years refining your judgement and technical skills. Take the opportunity to be kind and reward yourself for your hard work. Hire a cleaning service, get a meal delivery plan, or work with a personal trainer if these changes add to your quality of life.




Lakhbir “Lakho” Sandhu, MD PhD FRCSC is a surgical oncologist and general surgeon in Hamilton, Canada. After obtaining her medical degree from McGill University, Lakho completed a general surgery residency at the University of Toronto. During her residency, she obtained a PhD in clinical epidemiology from the Institute of Health Policy, Management and Evaluation at the University of Toronto. She completed her training in surgical oncology at MD Anderson Cancer Centre in Houston, Texas. In her free time, she enjoys traveling and biking. You can follow her on Twitter @Lakho_Sandhu.

Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.

2 Replies to “Making the Leap from Trainee to Staff Surgeon”

  1. that’s really beautifully wrote mam..for a budding obstetrics surgeons like me who has just come out of medical school it seems like own story.
    Just want to share one more thing mam what I experienced in few months of practice.. none female wants to be treated by or being operated by young surgeons.. this sometimes is painful..but I guess that’s when senior mentors like you step up
    thanks for sharing mam.. really enjoyed

  2. Thank you very much for your great advice. Actually i feel every word you wrote and i am sure it is a very loyal and sincere advice for every woman in surgery. 🙏🙏🙏🙏🙏🌹

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