Being An Attending: What No One Tells You In Residency And Medical School

For most of us, medical training through all the pains of medical school and residency is often bearable when we fantasize about life on the other side of all of this. Life as an attending physician, when the sky suddenly turns all rainbow, when the money starts to fall from those skies — we’re finally our own bosses, and then we’re supposed to live happily ever after. The reality, however, is often far from this fantasy.

While being done with residency and becoming an attending physician has its perks, it is important not to overestimate your expectations of happiness and peace of mind. Because with every new stage in life, as you are now aware, comes with its challenges. However, I do not intend to scare anyone by the premise of doom after finishing medical training. Rather I hope to share a realistic take on what to expect and achieve a more meaningful experience working as an attending.

When I think of advising on preparing for the “attending life,” the question that often comes to mind is what one needs to become an attending or rather what it takes to become an attending. This is also the question I am most often asked by junior colleagues who hope to see through my eyes what life may entail for them in their not so distant attending future. While I cannot say I have truly figured anything out in this position, the answer that I can usually give is in these four words: knowledge, knowledge, knowledge, and composure. In that order, I find it to be the most important tool in navigating this new life as an independent clinician.

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Because as an attending physician, you are often the leader of a patient’s care team, everyone on that care team looks to you, the attending, as a last resort for help on whatever may go wrong with the patient. Even when you must involve other specialties, the care team looks to you to make that decision expectedly from your knowledge and experience. And even though you may have a senior colleague who you’re able to discuss the cases and seek help, the acuity and rapidity of these events do not allow the time it takes to have an academic discussion. For example, you’re expected to act and act now as another human being’s life is on the brink. The work obviously starts in training, whether in medical school or residency. One must take personal responsibility for these things early enough to prepare for attending life properly.

I have also found that financial issues can also be an avenue for suffering as an attending if not responsibly managed. We can all agree that working as an attending is the first time as a medical professional you feel you’re actually getting paid for the work you do, although varyingly depending on your specialty or location. So, no doubt, making that money truly feels gratifying. But while it is gratifying, it is not unusual to find attending physicians still struggling financially or, simply put, broke.

For me, the lesson here is simple. Do not overblow your expenses because you now suddenly make quadruple of what you made as a resident. I always remind myself of some of the basic rules around money even though I still struggle to follow them to the letter.

1. Have a budget.
2. Spend less than what you earn.
3. Get out of debt as fast as possible (whether student loan or credit card debt, the faster you get out always, the better).
4. Save some money and invest while saving.
5. Finally, please be as generous as you can within your limits.

Finally, I find that it is also crucial to ensure a work/life balance. While it is certainly true that different people have different capacities for work and balancing life, it is equally true that most of us are susceptible to burn out. Know what you can cope with and do work within those limits. You will be doing this most likely for the rest of your working life, which will be an average of 30 years, so it’s essential to make sure you can keep things fresh and pace yourself.

We chose medicine, which is often not an easy job regardless of specialty, work structure, or environment. However, we have a responsibility to choose to work in a space that allows us to remain energized and motivated. This begins by limiting your chances of burn out. Take rest when you can and find something meaningful to do on your days off. It’s quite tempting to want to work those extra days for that extra money. If it impacts your ability to love what you do and remain energized and motivated, you should definitely consider limiting that extra hustle. It is a marathon and not a sprint.

Finishing residency and becoming an attending is never a blank check used to purchase happiness. You must define what is meaningful to you and structure your life around that. Figure out what makes you suffer and fix it. If you can’t fix it, get away from it, and if you can’t get away from it, learn to live with it without complaining. For the resident or medical student reading this: You don’t have to wait until you’re an attending to find happiness. Find it now by applying some of these lessons, and most importantly, find it in what you have in front of you right now, everything you’ve been blessed with that you never had to beg for. Those are the most important things. Gratitude is vital.

Fatai Oluyadi is a hospitalist and can be reached on Twitter @FataiMd.

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