Dear Graduating Residents,
It is now May, which means you have somehow survived (almost) 4 years of residency. Congratulations! You have all come out of the other side with your humanism and humanity intact, even if it doesn't feel that way every day. Your dedication to patient care and equity is impressive - don't ever lose that! You have survived the year down a person and you all covered the work so beautifully and effortlessly that it is downright jaw-dropping.
I wanted to just offer my congratulations and best wishes as you all continue on your journeys and just offer some jumping-off points for things to consider as you transition from residency > beyond. Obviously, this is a biased view of my brief throughts which I perceive to be relatively universal truths as you jump into attending-life.
# Resident > Attending (fellow) - Clinic Woes
You will not know everything ever. That is okay! Clinic is going to have a significant learning curve and everyone will have different patient populations, styles, cultures, niches, etc. There are couple things to keep in mind:
* People want doctors to be thoughtful, caring, empathetic, active listeners, and run on time. They will sacrifice the latter for the former.
* Think about how to work best within your own style. Can't prep charts? Make sure you have smart phrases to pull in all the shit you need to know. Take too long in clinic with people? Ask your medical assistant to knock on your door and interrupt you after 10 minutes. Set up systems to make you successful.
* Nothing is forever. Try something out for 6 weeks, evaluate it, then get rid of it or keep it. This is your time to figure out what works
* If you can't get to ALL the things in the same day, just have patients come back. They won't disappear. When people feel cared for, they typically will return when you ask them to.
* DO NOT BOOK FOLLOW UP TOO CLOSE TOGETHER. Someone has abnormal bleeding and you want them to try OCPs? Have them come back AT LEAST 3-6 months later. Pace yourself. If they need to come back sooner they will call.
* Know who to "curbside consult". They can be in the form of text messages, other attendings in clinic, etc.
* When in doubt either a) biopsy or b) treat for PID
* Strip charting of its emotional value and even if you had a terrible clinic day, remember that documentation is just documentation. Close your charts. Some amazing resources include the charting coach (podcast!) and weight loss for physicians (the podcast episodes re: closing charts!)
#Attending Life - Complications
Complications happen. A complication does not mean that you are a bad surgeon or a bad doctor. Yet, you will feel like complications means that you are a bad doctor. Make sure you have other people that understand this (usually that means other surgeon-types) and can help support you when this happens. Notice, I did not say "if" this happens. I said "when".
* Of course, my catchphrase: trust no one and expect sabotage. Round on your patients in the morning and before you go home. It is worth it to detect bad things before they become disasters.
#Attending Life - Education
No one cares if attendings stay up to date. As long as you're not doing crazy medicine and not hurting people, there is really no incentive (other than board certification) to keep up to date. Figure out ways to stay current in a low-barrier-to-entry way. Highly recommend medtwitter, social media, podcasts like the Green Journal. The NEJM has weekly emails with the newest journal entries and interesting articles so that you can skim the headlines while you're commuting, bored and scrollign twitter on the weekends, etc.
* Lower the barrier to entry
* It is easy to learn from "bad cases" or when "things go wrong" but much harder to actively engage when thigns go right. Sometomes, you can learn even more from when things went right. What happened? WHy did it go so smoothly? What can be simulated again in the future to keep it running smoothly?
#Attending Life - Finances/Burnout
Doctors have a high likelihood of experiencing burnout. I think it is because we get caught up in the "golden handcuffs" i.e. all of a sudden make a ton of money, end up with lifestyle creep (expand yoru lifestyle to correspond to new paycheck) and end up having to work to support the lifestyle. You then get asked to do all these extra things that create moral injury and lead to burnout. Fix this by setting yourself up with a great financial plan so that you feel empowered to say no to doing things you do not want to do. Unfortunately, most of the time that requires a financial cushion to be at that point, so start right out of residency.
* I love the white coat investor and basically any blog on the FIRE movement (financial independence, retirement early) because I think financial independence is crucial to being able to withstand the increasing administrative burden.
* If you have not done so yet, max out a ROTH IRA this year if you are income-eligible.
* We spent a lot of time learning to be doctors and not a lot of time learning how to be good business people. Either spend time learning the basics OR pay someone else to set you up with the basics. Money can be a useful tool to keep you excited about the type of medicine you want to do
* One useful tool I heard was to increase your lifestyle by 10% as an attending and then use all that extra income to go towards savings/loan/house etc
#Attending Life - Career Choices and your first job
Your first job will not be your forever job and *that is okay*.
What you want right out of residency will be different than what you want in 3-5 years. And it will be different from what you want in 10 years. Thats okay! Prepare for what you want right now and when it no longer meets your needs, look for another job.
#Back2Basics - Some basic general reminders:
* The institution does not care about you. If you quit, get injured, or leave you will be replaced. and quickly. Your friends & family do care about you - so make sure you prioritize correctly.
* Only do things that benefit you and your career. Consider your trajectory like an NIH biosketch - what are your 3 ares of "niche/interest" and only say yes to things that fall within those categories.
* Some people say "just say yes to everything" but I do not recommend this strategy which seems insane. Instead, please spent the first 1-2 years learning how to be a badass attending, which you all will be anyway. Then, see bullet above in terms of your big 3 overarching areas as if you are describing your NIH biosketch and only say yes to something that falls within those areas.
* Pay it forward. Provide sponsorship & mentorship when possible. Stay transparent and open.
* For those of you staying in academics: medical students pay the bills. Residents do not. For promotion, be very aware of this dynamic.
#The Boards - ObGyn edition
Written boards: just do Walls questions
Oral boards:
* Case lists. Send them to friends early.
* When studying, the practice bulletins have those stupid Q&A's at the end which are supported to be formatted to help you study for the oral boards (who knew? it makes so much sense in retrospect...). Enlist people to just ask you those questions. Sign up grandma, etc. They just need to read the question and the answer is right there in there paragraph so they can gauge if you know your stuff.
I know this has been a novel, but actually it could probably be distilled into a couple TL;DR:
1. Curate a group of people that understand when you're having a shitty day so that you can vent. They can be your co-residents, former residents, former attendings, whatever. Just make sure you know who to call after that terribly and shitty call or after that terrible OR case etc. Bad complication does not equal bad doctor, as long as you thoughtfully reflect and learn from it.
2. Stay curious about everything and make it easy to learn and stay curious - patient care, standards of care, why things went well/smoothly, and reflections both when things go right and wrong
3. Your first job is not your last job and the institution does not care about you, but your friends and family will so prioritize accordingly.
Good luck!
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