I remember it like it was yesterday.  It was an afternoon in early April—like every good post-doctoral fellow I was sitting in my office working hard and pondering my future.  Or, maybe you could say I was catastrophizing my future. 

 

I had been blessed with a wonderful pre-doctoral internship and post-doctoral fellowship within a leading medical university—I was happy and I was comfortable.  To think about the familiar ending in just two and a half short months was overwhelming.  Don’t get me wrong, I was preparing for the transition from fellow to early career professional feverishly.  I spent hours scanning available positions, throughout the country, and was consistently sending letters of interest and my curriculum vitae. 

 

However, there were times, like this particular afternoon, when vivid visions of my fellowship ending, and a one-way ticket to New Hampshire being purchased to return to my parent’s home in order to reside in their unfinished basement plagued my mind.  Granted, my parents would have been thrilled to give me back my childhood bedroom, but the thought of the basement seemed much bleaker; it matched my mood.

 

You see, I knew I was qualified.  I knew I had an impeccably comprehensive training in integrated healthcare and I knew my supervisors had spent endless hours investing in me and my future, but what I hadn’t found was that dream job.  I wanted to be a director of behavioral health, and the idea of any other position lacked satisfaction.  Perhaps this is why many letters of interest went unanswered and why some employers responded by saying my ambitions were beyond the scope of the posted position—readers could sense a strong desire for directorship regardless of the position being applied to. 

 

Then, they came, first one, then two, then three dream positions.  My letter of interest spoke to the current directors of these programs and I had interviews, fully funded interviews!  I have to admit that after being a graduate student for what seemed ages and spending a plethora of money to fly from interview to interview for different doctoral programs, pre-doctoral internships, and post-doctoral fellowships, I felt like a bit of a celebrity having all my interview trips arranged and paid for, as custom.  There was also a feeling of exuberance, as I met an array of dynamic professionals and could conceptualize my role in their programs and ways in which I could aid in enhancing these programs.  The idea of not knowing what part of the country I would end up in also energized me, testament to my adventurous personality!

 

As I was offered positions, and I chose the best position based on overall fit, negotiation came in to play.  Also a new feeling, as I had only experienced the thrill of acceptance prior.  Negotiation was an empowering experience as it continued to affirm my knowledge, skill base, and work related value.  In just days, negotiation was completed and contracts were signed. It was happening!

 

Like with every move and new position, there was a whirlwind of activities.  From apartment shopping and packing, to shot records and eye exams, it was all happening quickly.  Wrapping up my post-doctoral fellowship and training my successor proved challenging while I simultaneously planned for my position to come.  

 

Then the time came for me to embark in my professional career as director of behavioral health.  The first week was filled with orientations, meets and greets, and organization of my office, the second week work began.  I remember sitting in my office, staring at my computer screen, like every good director does, and it all of a sudden hit me…I was responsible for the maintenance and the development of this behavioral health program!  I could no longer walk across the hall to my supervisor’s office for her expert opinion anytime I needed, the responsibility was on me.  My immediate thought, “what were they thinking hiring me?”  Imposture syndrome had set in.  I somehow regrouped within the following minutes and began feverishly working on my first-hand initiatives.  I wanted to prove myself and prove myself quickly.

 

Over the next weeks, my feelings of imposture syndrome continued to dissipate.  My knowledge and hard work was allowing for my initiatives to align as I had hoped.  I was recruiting for four pre-master’s level medical family therapy interns from a local university’s marriage and family therapy program. Within just months of becoming director, we would have a fully integrated behavioral health program within our two clinics.  I was also in the process of piloting pre-clinic huddles, and anticipating another implementation victory.   However, implementation didn’t go quite as perfectly as my visions had.  On match day, I was incredibly fortunate to receive two marriage and family therapy interns, but this was not the sum of four I needed for full behavioral health coverage at each clinic.  I had failed, I had aimed for full coverage of an integrated behavioral health program and now I was not able to fulfill that.  To add to my dismay, not all faculty and residents were as excited about pre-clinic huddles as I was. Defeat! 

 

This time I stared at my computer screen thinking I had failed in my role as director, my thoughts simultaneously turned to my previous supervisor…I needed to e-mail her immediately to ask what she would do in this situation. I needed her immediate affirmation, or did I?  I took a minute, and then I took a couple more to breathe and reflect.  My thoughts shifted from what I hadn’t yet accomplished to everything I had accomplished.  In just a few short months, I had single handedly created a pre-master’s level behavioral health internship, was in the process of implementing pre-clinic huddles, and had increased my teaching responsibilities by nearly double; not to mention I had kept abreast of research efforts and fulfilled my clinical responsibilities. 

 

Why was I being so hard on myself?  Yes, my ideal plan and efforts had not been one-hundred percent fulfilled, but I had accomplished a lot.  This was not the time to succumb to defeat. This was the time to recognize my efforts and then strategize how to make this first internship year a success and to move forward developing a relationship with a nearby psychology program to expand recruitment for the following year, better ensuring a behavioral health intern cohort of four.  It was also the time to focus on providing further education to faculty as to why pre-clinic huddles would be invaluable.

 

I share these personally professional anecdotes to normalize and humanize the experience of being an early career professional.  Although different in nature, early career, mid-career, and maybe even late-career professionals alike face the highs and lows of leadership, sometimes winning and sometimes seemingly failing.  What I have learned and will continue to learn is that when challenges arise, as they will, we must allow ourselves to feel disheartened when things do not first go as plan, reflect on what still needs to be accomplished, and then re-strategize.  If you’re anything like me, cranking Sia’s “The Greatest” will cure any self-deprecation you may have and get you ready to conquer the world, or the workplace, all over again. 

Ruth Nutting, PhD, LCFMT, is the Director of Behavioral Health at the Via Christi Family Medicine Residency, and Clinical Instructor  at the University of Kansas School of Medicine.  She teaches a behavioral medicine curriculum to 54 family medicine residents, facilitates resident wellness initiatives, oversees the functioning and supervision of a pre-master’s level medical family therapy internship, provides integrated and traditional therapeutic care to the underserved population, and continues her research on Chronic Illness and its Effects on Young Adult Populations.