I was fortunate to have great mentors when I finished my fellowship. They were available to field any of my clinical conundrums, and they always had an answer for me. Some of them even gave me sound career advice–there was no reason I would struggle at all loaded with that much support.
But I did.
The first several months were rough, and I chalked up my the highs and lows to simply being the new doctor on the block. As with any painful experience in life, we learn from the pain. After many years of trial and error, I wondered what I could have done to avoid the pain. I realized that we’ve actually heard most of the useful advice to succeed, but sometimes the knowledge doesn’t process. It’s all about the timing, explanations, and triggers that make our brains tick. The following is a list of the most useful tips my trainees have found to be helpful:
The older doctors have more experience.
This sounds obvious, but older doctors have experience you don’t have as a younger doctor. We’ve all seen physicians who might need to brush up on current practice patterns and trial data, but remember that they’ve made it through years of medicine that you haven’t. Look at what they do, and figure out what they do well. Then tailor it to you. This doesn’t even have to be a physician in your department or practice.
Maybe patients love them. Or they have a way to connect with coworkers. Sometimes you will be surprised that they actually know about Clinical Trial RTOG 398263 but chose to treat a different way for a very good practical reason.
The worst thing you can do is dismiss them as someone who doesn’t contribute to your department or situation. Remember that there is always something to be learned from every situation.
Don’t let the Electronic Health Record (EHR) bog you down.
Complaints about EHR inefficiency fill a year’s worth of happy hour drinks, but it doesn’t mean that it should destroy your life. The introduction of EHRs, meaningful use, MIPs, and other annoying acronyms has essentially forced thousands of physicians to early retirement. It doesn’t have to make your life miserable.
The key is to figure out what aspects of charting are consuming your time. Is it the loading of the EHR itself, the clicking, or simply too much to type? There are efficiency measures that could be taken with the EHR charting process or even something you could be doing while your computer is frozen and trying to catch up.
You might also like: Physician Burnout – an alternative analysis
The solution isn’t always to rely on technology. I’ve seen many physicians transition to dictation software, because they think that the typing is slowing them down. In fact, loading up the dictation software and correcting the errors may consume even more time than supercharging your smart phrases and finding efficient uses of your time for certain computer-related delays.
Gauge your support
You are surrounded by medical assistants, nurses, front desk people, and coworkers during the workday. They are there for a reason, and it is your job to find ways for each member of the team to work efficiently. We all will encounter coworkers who don’t work to our liking, seem incompetent, or plain lazy (yes, I just said it all), but surprisingly there are ways to still enforce accountability without appearing like a slave driver. This can take work, but you have a career to solve the problem.
Each one of us will have a different methodology to work with others. For some of us, it may require frequent huddles and departmental meetings. Other times, it may simply mean individual chats to find personalize solutions.
Think like a leader(becoming a superstar)
Developing insight into yourself and your department is the key to becoming a superstar. It’s easy to have opinions on others, but the hardest part about our jobs is knowing how our actions impact those around us and how to change the offenders. I’ve seen physicians who are comfortable with their workplace, and openly vent when things don’t go their way. Some of these frustrations are clearly harmless and directed at the wind, but there is always a reaction.
One key overlooked aspect of medical practice is that each coworker in our workplace is in a different position and situation in life. Some will end up being a career worker in the same job. Others may have aspirations to move elsewhere. Your actions as a physician can impact your coworkers’ perception of the workplace, their job stability, and even what you think of them.
Remember that there are ways to help those who surround you succeed. There are ways to make those successes shine. In return, some of those successes will return to you.
Show up on time
This is another obvious action, but it is easy to lose sight of how important it can be. We often let our guard down on timing when we become more comfortable with our jobs, maybe 6 months or a year into it. Sometimes we realize that grand rounds never starts on time, or our patients are never ready in an exam room when the clock starts.
The natural reaction is to mold ourselves into the system. Why show up on time when I’m not productive when I’m there? Guess what? People notice when you’re not there. You’re the doctor, and arguably the most important part of the group. And the reaction of others goes back to point #4 of becoming a leader. You (for better or worse) have to be a role model for others to aspire to.
You might also like: Doctors working in tech cities are losing the rat race
Whether or not you show up on time as the physician actually isn’t the sole issue; doing so actually encourages your coworkers to test the tolerance of the system. We see this in kindergarten, where the kids extrapolate what is acceptable and see what they can get away with. In a way our workplace is like a kindergarten, wouldn’t you agree? 😉
Wrapping up…
These are five quick tips that new attending physicians can implement quickly, including one that can help you shine throughout your career. Remember that there are many aspects of medical practice that are out of our control. The key is to focus on the parts that we can control. That is the secret to maintaining longevity in medicine.
What other suggestions do you have for the younger physicians and what hurdles have/did you face as a young attending?
Nice post. Here are a few other things I would add:
1. In the beginning your goal should really be to focus on the clinical aspects of your job AND pass your boards if they are being offered that year (in my field peds critical care it’s every 2 years).
2. Realize there’s more than one way to do things. In fellowship training you work in a really big center with national experts so you feel that the way you learned is the “right way” to do things especially if you end up working in a less academic place. However, you will find that there’s a lot of inter-institutional variation in how care is delivered.
3. Develop a nonclinical niche. Many people are the clinical workhorses for their group and are happy in that role. However, the majority of people need something in addition to clinical work to be fulfilled. This serves two purposes. It gives you an alternate path if you get burned out from clinical work. Also, it gives you value to the organization as a whole and improves your position there.
Great additions!
The number one that you listed is one of my pet peeves–maybe I’m showing my age, but it seems to me that many young physicians (first 5 years out of training) really think that they are at the top of the game even though they are not. What sometimes happens is that their clinical decision making isn’t as sound yet but their egos get in the way. For others, I see a little bit excessive side hustling outside of the profession to make an extra buck or get out of debt. Over time it seems that they end up being a mediocre to subpar doctor (it’s easy to settle in a groove after a while as you know) and many a successful real estate investor. Who would we want to take care of us in the hospital when we need it?