What I know now that I wish I knew then

"Most people overestimate what they can do in one year and underestimate what they can do in 10 years." – Bill Gates

The time it takes to arrive as an independent plastic surgeon following medical school graduation is anywhere from six to 11 years. During this time, I've seen individuals be highly productive – and those who've been less productive. The following is what I've learned from both.

Master operative technique

When you start as a plastic surgery staff member, it's very important that you can efficiently and effectively perform the surgical procedures assigned to you. This can be incredibly stressful for the first few cases – this is the first time you independently make decisions, and you hold complete responsibility. Obviously, if you fail in the first few cases, this can have an adverse effect on your career and self-confidence. It takes an entire career to master surgery – and even those at the end of their careers continue to learn and refine technique.

In my years training residents, the transition to becoming a staff member is very stressful; many struggle with the change. There does not seem to be a solid correlation between how good you are as a resident and how easy this transition will be. I've seen many in this transition act out, berate others when things go wrong and make bad decisions in the O.R. I have found that those who struggle with this transition often lack confidence in their operative skills and decision making.

Former residents often call me for advice on a particular or challenging case. Most of the time this involves a decision about what operation to do or how to manage a postoperative complication. These types of requests are easy for me to manage, and I hopefully give some helpful advice. In contrast, if someone calls and doesn't actually know how to do the surgery required, this is something that can't be conveyed over the phone. During their training, I encourage our residents to take advantage of every case they do – and to think of each case as if all the decisions were theirs alone to make.

Because of increasing hospital regulation, learning independence as a resident or Fellow can be challenging. My advice is to try to do even simple cases independently with the attending looking over your shoulder. See patients before and after the operation in order to learn the nuances of patient care. And don't be afraid to ask for help.

Make innovation a part of life

This specialty is constantly evolving, and operations and procedures that we design today will naturally and eventually be performed by individuals in other disciplines. It's incumbent that we continue to innovate to preserve our profession. Innovation can come in a variety of forms – including basic or clinical research, device development and collaboration with people of other disciplines. It certainly isn't restricted to academic medical centers, as many of our most important innovations have come from private practice.

To be successful with innovation requires outstanding time management. We now have the ability to do our work anywhere in the world with an internet connection. Try to use down time – such as when you're waiting for a case to start – to write, answer emails and phone calls that foster innovation. As Bill Gates suggested, using this time wisely can be quite rewarding over the long term. Make time in your lives each day to read and learn new things that foster innovation.

Build strong relationships

Plastic surgery has become a team effort, and building the best team possible will make your career fulfilling. Hire the smartest people to work with you – and people who will be kind to your patients. I've been fortunate in my career to be in an institution that attracts the best residents and researchers from around the globe. Working with them has allowed me to make innovation a priority. Similarly, having outstanding nurses, administrative support, physician assistants and others can allow us to focus on surgery and leave nonsurgical tasks to others, who generally will do them better than if we attempted to do them ourselves.

Building strong relationships with your patients will allow them to be some of your best supporters. Of course, taking time to support your family and the loved ones in your life is why we all go to work each day. Those who have children will find that the years when they are home are busy but can be quite rewarding, and that these children can be of great support later in life. Those who neglect family relationships can end up feeling lonely and unfulfilled in the later parts of their careers.

Wellness has become increasingly recognized as an important area – it's incumbent upon us to avoid burnout and maximize the time that we can be productive. I've seen far too many physicians not take care of themselves, a few of whom have had issues with drugs or alcohol – which can be tragic. Early in careers, surgeons are under intense pressure to perform, and it becomes easy to neglect nutrition and exercise. We don't know the optimal way to do this, but certainly taking time each day to be active, watching our diets and avoiding alcohol are methods that will improve wellness.

Plastic surgery is a special field that has great opportunities as we move into the next few decades. I can't imagine a field with more opportunities and the ability for the vast majority of plastic surgeons to do substantial good in the world. As we move forward, we will see larger numbers of challenging patients to treat – but through our combined efforts and collaboration, we should be able to greatly improve the quality of their lives.

Dr. Orgill is a professor of surgery and the Wound Healing & Tissue Engineering Laboratory principal investigator at Brigham & Women's Health at Harvard Medical School, and medical director of the Wound Care Center at Brigham & Women's Hospital.