Leadership and professional development: PAUSE to sustain career flourishing

It is when we are in transition that we are most completely alive. Mid-career hospitalists are particularly prone to burnout, given the increasing clinical, nonclinical, and personal demands and insufficient career mentorship opportunities they may face.1 While the mid-career transition poses challenges for hospitalists, it also provides an opportunity for reflection on career trajectory. As such, the early- to mid-career transition represents a key crossroads, requiring one to pause and focus on the roles and projects that will mitigate burnout and sustain flourishing. Grounded in positive psychology principles, PAUSE, is a framework for mid-career hospitalists to sustain career flourishing. PAUSE stands for Process, Align, Uncommit, Slow, and Elevate. Using this framework, hospitalists can transition into this new phase and continue the career flourishing achieved through our CORE2 framework.2 Process: Look backwards—reflect on your early-career experience and consider how you've added value to your hospital medicine group. What were your major successes? Appreciative inquiry encourages us to shift our focus from “what is going wrong” to “what is going well,” and its application can empower mid-career hospitalists to lead strengths-based collaborations.3 You've likely identified colleagues with similar career interests—lean on this network and apply the “5D Cycle: Define, Discover, Dream, Design, and Deliver” to collaborate on initiatives.3 Align: Now, look forward—revisit and refine your professional vision statement, ensuring it orients your career path.2 Consider how your current roles and projects align with your professional vision. Which evoke positive emotions and support engagement, relationships, meaning, and accomplishment—the key elements of flourishing?3 What are your future desired roles and projects? Alignment focuses on these important questions. Uncommit: Alignment not only clarifies which roles and projects are value-added to your career trajectory but also identifies opportunities to uncommit. As early-career hospitalists, we are encouraged to “say yes” to help establish a positive reputation and identify a niche. Consequently, you've likely invested effort into projects and commitments that did not align with your professional vision. Now is the time to uncommit. Identify an early-career colleague you could suggest to assume this responsibility and offer to provide guidance, ensuring a successful transition. Slow: Now that you've aligned and refined your value-added roles, slow your project work to extract maximum benefit. As Cal Newport advocates in “Slow Productivity,” when we do fewer things, work at a natural pace, and obsess over quality, we can achieve accomplishment without burnout.4 Consider 2 project tanks: an active tank for projects in progress and a holding tank for future projects. Limit the active tank to 3 projects and “pull” a new project from the holding tank only when an active project is completed.4 Mitigate the “push” of outside project requests with an email response that enumerates your active and future project load and provides an estimate for outside project completion. Elevate: The mid-career transition often marks a shift for hospitalists from mentee and sponsee to mentor and sponsor. Mentorship networks help you identify early-career colleagues with similar interests and facilitate scholarly collaborations where you assume the senior author role. Consider available local leadership positions and sponsor a colleague. As a mid-career hospitalist, become a force that elevates others, as service beyond self is a powerful accelerant for flourishing.3 With a mid-career PAUSE, you purposely slow down and give yourself permission to prioritize your needs and focus your career path. Through strengths-based collaborations, tailoring your roles and projects to your professional vision, slowing project work, and elevating early-career colleagues you sustain career flourishing. The authors declare no conflicts of interest.