If you ask 100 business, government, military, or academic leaders what are the most important factors in successful career development, 99 of them will include identifying a good mentor. For medicine in general and for academic medicine especially, mentors are essential in order to achieve one’s maximum potential. The reality is that most of us will have many mentors that each guide us through different facets of our careers. But there is usually one person who we can look back on and say that that individual had the biggest impact on helping us realize our career success.
The best mentors are not those who you model your own behavior from, but are those who actively guide you and advocate for you. The mentor’s actions should be with the mentee’s best interest in mind and not the best interest of the mentor. In other words, the mentor should act in a fiduciary manner.
When mentors do not act as fiduciaries
I’ve seen a lot of people who thought of themselves as mentors but were actually using those junior to them to advance their own careers rather than the junior colleagues’ careers. Here are some examples.
25 years ago, I was on a search committee for a new division director. We had narrowed the search to three finalists and invited each of them for a formal visit that included interviews with various hospital and college of medicine leaders. During my interview with him, he asked me if he was selected, whether he would be able to put his name on all manuscripts written by the members of the division. At the time, this included about 20 physicians and PhDs who collectively wrote dozens if not hundreds of papers a year. It was clear that he wanted to use the position of division director to advance his own career rather than to advance the careers of the members of the division. Needless to say, we didn’t offer him the job.
Our hospital had a quality director who always had a junior physician functioning as a quality intern. The junior physician spent months and countless hours reviewing patient charts in the analysis of a particular quality issue and then analyzing the data. The director had the junior physician prepare a PowerPoint presentation and then the director presented the findings to the medical staff leadership committee, to the Dean, and ultimately to the hospital’s Board of Trustees. In none of these presentations did the director mention the name of the physician who did all of the work and ultimately, the junior physician decided to leave academic medicine and go into a private clinical practice.
As a resident, there was an attending cardiologist whose main interest was his research laboratory. However, he was required to attend on the inpatient cardiology service 3 months a year in order to earn enough clinical income to cover his salary. He viewed the residents on the cardiology service as indentured servants whose main role was to do H&Ps, write progress notes, collect data, and put in orders. To him, residents were a tool for him to use to earn clinical income. He would show up for an hour a day to round on patients and then would go back to his research lab for the rest of the day. His belief was that residents were responsible for their own education and did little to no teaching.
When my own mentors acted at fiduciaries
As a third year medical student, I spent the month of December at a community hospital in Columbus on a general surgery rotation. At the time, students on surgery rotations were pretty low in the pecking order and were generally relegated to doing history and physical exams, collecting lab results, and performing general scut work. If a student was lucky, he or she might be granted the opportunity to stand in the corner of the operating room and watch the attending surgeon and residents perform an operation. But on the first day of December, my attending told me that he and the resident would do the H&Ps and that his nurse would collect labs and do scut. He said that I could learn the most about general surgery from being in the operating room. His goal for me was for me to scrub in on 100 surgeries during the month. He told all of the other surgeons at the hospital the plan and I held retractors during a Whipple procedure, made an incision to remove a lipoma, stood by the operating table during heart and brain surgeries, and helped suture abdominal surgery closures. I still rounded with the attending and resident every day but by the end of the month, I had been in on 100 procedures and learned more than any other month of my medical school clinical rotations.
During my first year of pulmonary/critical care fellowship, we had a weird case in our ICU of a college student who developed respiratory failure with diffuse pulmonary infiltrates and a large number of lung eosinophils found during bronchoscopy. We soon identified 3 other cases of a previously undescribed disease that we called “acute eosinophilic pneumonia”. One of my attending physicians suggested that I write it up and send it to the New England Journal of Medicine. It took me 35 drafts with the attending physician finding something to change in the first 34 but eventually we sent it in and it was accepted. The attending physician told me to put my name first on the article, rather than his name – and it launched my academic clinical career.
During the second and third years of my fellowship, I was assigned to do research with a different attending physician who specialized in the role of interleukins in lung disease. He had seen an article that suggested that some interleukins were bound to microtubules, the intracellular scaffolding that gives cells their shapes. He had me do a few experiments that supported the role of microtubules with interleukin production by a type of lung cells called alveolar macrophages. He then anointed me as the alveolar macrophage microtubule guy. That became the basis of grants I received from the National Institutes of Health and the American Lung Association – it launched my academic research career and for a few years, I was the world’s leading expert in the very obscure and esoteric field of the role of human alveolar macrophage microtubules during inflammation (mainly because no one else was doing research on it).
Fiduciary mentors put the mentee’s interests first
As a species, we physicians often have big egos that need to be constantly stroked. We have spent 15 to 20 years of training after high school competing to get into the best colleges, medical schools, residencies, and fellowships. Success in that competition usually means trying to make ourselves look better than everyone else – better test scores, better grades, more publications, more grant money, and more leadership appointments. So it is the rare physician who can step away from making themselves successful and famous to making a trainee or junior colleague successful and famous. Here are some of the specific actions that a fiduciary mentor can take for their mentees. Although these are derived from my experiences and observations as an academic physician, they can be generalized to most professions.
- Trainees are there to be trained. Whether the trainee is a resident, a PhD post-doc, or a business intern, the reason they are there is to learn. At that level, learning is by a combination of the learning triad: (1) observation of experts performing their skills, (2) practice performing those skills themselves, and (3) didactic training. A fiduciary mentor ensures that the mentee has the opportunity to do all three. The trainee is not there to simply do the senior colleague’s work for them.
- Nominate for or appoint to committees. A common warning given to junior professionals is to “protect your time” and this often translates to avoiding committee work. But whether the committee is at the hospital, university, corporate, or professional society level, committee membership can expose the junior professional to other organizational or national leaders and can be a vehicle for invaluable career networking.
- The person who does the work should be the first name on the manuscript. Too many tenured professors put their name first on any research papers that come out of their lab. This is self-promotion at the cost of their junior colleagues’ reputation building.
- Credit earned is credit due. When a medical resident is the one who figures out the perplexing rare diagnosis, the attending should publicly credit the resident with the diagnosis rather than taking credit themselves. Same with the committee chairman when a committee member performs some cost savings analysis of hospital operations. Or the research lab director when a PhD student makes some new scientific discovery.
- Share lectureships. When the fiduciary mentor is asked to give a grand rounds or other lecture, invite the mentee to be a co-presenter for the lecture. It sends the world the message that this mentee is an expert and what they have to say has value.
- Nominate the mentee for local and national presentations. Professional societies all have their own annual national or regional meetings. The fiduciary mentor nominates mentees to give presentations. For 25 years, I hosted the OSU MedNet continuing medical education webcast and I invited junior faculty physicians to be guest presenters in their chosen area of sub specialization in order to get their name out as emerging experts.
- Tailor the degree of autonomy to the level of experience of the mentee. In my outpatient clinic, I had medical students, internal medicine residents, and pulmonary fellows who rotated to work with me. Each of these three types of trainees came with different degrees of experience and required different degrees of supervision. The fiduciary mentor neither sets the mentee up for failure by giving them too much autonomy nor holds them back by not giving them enough autonomy.
- Prepare the mentee for where the field is going to be in the future, not just where it is today. Hockey legend Wayne Gretzky famously said: “I skate to where the puck is going to be, not where it has been.” This is a great lesson in any career, not just hockey. The fiduciary mentor identifies the future needs and demands in the field and prepares mentees to be the experts in those needs and demands. When our hospital was considering purchasing our first surgical robot for the operating room, our Chief of Surgery sent one of the junior general surgeons to spend a couple of weeks at a hospital that had already acquired a surgical robot. When he came back, he instantly became the go-to surgeon for robotic herniorrhaphies and cholecystectomies. Pretty soon, he was giving regional and national lectures in the then-new field of general surgery robotics.
- Foster expertise. In the research lab, the lab director should identify new side areas of research that the research fellows and doctoral students can explore and develop in order to create new areas of research that they can claim as their own in order to launch their own careers. If a junior physician has an interest in pulmonary vasculitis and there is no current expert in pulmonary vasculitis on the faculty, then figure out how to direct all of the pulmonary vasculitis consults to that junior physician’s clinic. And be sure that the physician is assigned to give pulmonary vasculitis lectures to fellows and residents.
- Listen. Too many people who think they are mentors ascribe to the old saying that “Children should be seen and not heard.” A mentor cannot be a fiduciary unless he/she listens to the mentee in order to determine what it is that they really want. 90% of internal medicine residents who apply to cardiology fellowships will say that they want to be teachers and researchers – that is what it takes in order to get into a cardiology fellowship. But most cardiology fellows eventually change their mind and actually go into private practice. And when they do change their mind, their future careers would benefit more by additional clinical training and business training rather than performing experiments in a research lab. The fiduciary mentor listens to what the mentee really wants rather than what the mentee thinks the mentor wants to hear.
- A mentor’s most valuable gift is his or her time. Few things are more impactful to a mentee than one-on-one time with their mentor. Whether that be time spent teaching a laboratory technique, demonstrating a physical examination technique, or reviewing a business document prepared by the mentee, when a mentor gives their time purely for the benefit of the mentee, a true fiduciary role is established.
The legacy of a mentor is the mentee
I carry with me a little piece of every mentor I ever had. I’ve incorporated all of their behaviors, phrases, priorities, and skills into my own persona. And I’ve passed them on to my own mentees over the course of my career. Human civilization has been built by mentors passing on knowledge and skills to their mentees and by doing so, fiduciary mentors create their true legacies.
December 1, 2025
