If you’re done with your residency or fellowship, you’ve paid your dues. And I am excited for you. Life is about to get better. A lot better. If you read my prior article about going unmatched, you know that things have not always gone smoothly for me. But now, after a reasonably good first year out of training, I feel compelled to reflect on why things are going well, and also—to offer any value I can to other physicians coming out of residency. By no means am I pretending to have the secrets to success. I am still learning every day. The ten points below are a combination of lessons I’ve learned and ideas that people much smarter and more successful than I am have previously shared. 1. Exercise sound clinical judgment. If your specialty involves making a diagnosis, interacting with patients, and initiating treatment, this is critical. There is no substitute for being able to arrive at the correct diagnosis. I try to improve my diagnostic skills in a few different ways: Following difficult cases through the EMR to see if I can learn from the approach of other doctors. Working on diagnostic reasoning using medical education podcasts and the amazing free website The Human Diagnosis Project. Checking in with colleagues to see how they approach the same clinical situations. Learning new things from medical students who rotate with me. 2. Ask for help. In some cases, you may need to request a consult or referral to a specialist. Or you may need to seek guidance from a colleague with expertise in a certain area. I’ve reached out to my residency attendings for their advice (thanks for your help, by the way). Think about it: Would you rather have a doctor who thinks they know everything or a doctor who respects the gaps in their own knowledge and seeks appropriate decision-making support? 3. Know the standard of care. If you know what you are treating, you’ve only come halfway. The standard of care should always be your starting point. A few minutes spent reviewing guidelines, and best practices will pay for itself many times over. 4. Individualize your treatment approach. As doctors, we have the burden of deciding how much of the standard of care applies to our patients. This is where the science of medicine blends into the art of medicine. 5. Communicate with your patients. The doctor-patient relationship is built on explaining things well, understanding how your patient feels, and making them feel heard. This can be difficult within the constraints of practicing modern medicine, but the doctors I respect most still find a way to do this well. 6. Know when to compromise. Just because we recommend a treatment doesn’t mean that it will be followed. Many people aren’t going to do everything we recommend. Recognize how far your patients are willing to go and modify your approach to best meet their needs. In return, you may enjoy more compliance, easier patient visits, and better outcomes. 7. Land softly. You may start your job really wanting to make an impact. Realize that it will take time. At the outset, don’t assume you have the answers to the problems you may see or begin to volunteer ideas about improvement. I would suggest waiting at least six months before offering these types of ideas. In the meantime, keep a personal list of them. That way you’ll get a better sense of how things work, while also allowing time for people to learn who you really are and how your skills fit with the team. 8. Know that you’re not alone. What I noticed after leaving residency and its brutal lifestyle was how much things slowed down. After residency, there is less interaction with other providers. Similarly, people in the military have described the special bond they share with others in the line of duty, and the emptiness that comes with returning to civilian life. If your new workplace has less physician interaction than your residency, and you don’t like how that feels, be proactive before depression sneaks up on you. Feeling depressed after residency can be confusing because you’re finally earning a good income and you feel like you should be happy, but instead, you feel emptiness. Attend conferences or grand round talks. Seek opportunities to connect with colleagues outside of work. Call your closest medical school and offer to take students. Fight loneliness for the sake of your mental health, for the sake of your family and patients. 9. Seek every opportunity to improve. As a new physician, expect daily reminders of how much you don’t know. Some experiences are simply related to a lack of exposure or experience. But an inner drive to be your best and to keep improving will sustain you. I have seen this character in the best doctors that I have worked under. Make sure your approach to medicine doesn’t become stagnant. We’ve likely all met doctors who are not open to learning, those who are basically in a time capsule, held captive by whatever was done at the time of their residency. 10. Take care of yourself. You have worked hard. It’s time to live your best life. Maybe buy the thing, or take the trip that you’ve been saying ‘no’ to for many years. Maybe get that counseling therapy you’ve been putting off because you didn’t have the time or money. From family, to exercise, self-care activities, sleep and travel — taking care of you has to be a priority. Source
