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Tuesday Aug 09, 2016

What You Need to Know on Path Through Residency and Beyond

During the transition from second-year to third-year resident -- or from resident to new physician -- many may find themselves questioning their methods and motives. Becoming a practicing physician brings many pitfalls and changes, and they're often not discussed during residency.

I recently received a question via email from someone I was precepting that led to another interesting question among some of the writers of this blog (all of whom are new physicians with varying levels of experience): What would be your No. 1 piece of advice for a third-year family medicine resident?

Several of the Fresh Perspectives bloggers answer that question in this post, drawing from our collective experience about this challenging transition. We come from different backgrounds and different practice settings, so it's not surprising that five of us came up with five different answers. Below, we offer advice on several topics that may help as you think about, or actively undergo, transition from resident to new physician. Honestly, most of it applies to all of us even later in our careers, so feel free to share.

My advice? Focus on the patient in front of you. When it comes to scheduling, there's no more important lesson a clinician should learn. As physicians, our task is to make every person with whom we interact understand that they have our full and undivided attention. I'm horrible at it, but when I do well, people feel important -- and more important, they feel listened to.

I confess that I am sometimes distracted by other things. It's something I struggle with daily. But if a patient calls on the phone or sends a message -- no matter how insistent they are (unless it's life threatening) -- the patient in front of you in the exam room or hospital bed takes precedence. The phone, the letter, the email, the front desk, the refill, the old overdue note -- they all can wait a bit longer until you finish the task that is directly before you.

That mantra singlehandedly keeps me on task in the clinic. If I deviate, time catches me. The same is true at home and everywhere else. When my kids are in front of me, they get my attention. When they leave, I can catch up on the other things. And when other things are in front of me, everything else can wait, too. Choose one thing and finish it.

Gerry Tolbert, M.D.

Have Multiple Sources of Income

Most third-year residents will be searching for a single full-time job shortly after graduation. Although the demand for family physicians has never been higher, entering the employment market for the first time can be perilous for many reasons. Even if an initial job seems perfect, many physicians will discover that their employment isn't everything they envisioned.

Starting a new practice out of residency can be equally challenging, and it poses much bigger financial risks and sacrifice for several years.

Whether employed or taking an entrepreneurial path, it's advisable for new physicians to consider finding additional sources of income such as moonlighting, administration or telemedicine until they are confident and stable in their main position and income. The worst situation for a new physician is feeling like they are trapped in a job due to financial obligations. Having another income source can allow for more flexibility in career choices should the need arise.

Ryan Neuhofel, D.O., M.P.H.

Culture is Critical

Create a positive, collaborative culture of success. Whether they join an existing practice or start their own, physicians naturally shape the culture of an office. The most minuscule behaviors contribute to this. For example, will staff be on a first-name basis with you? Will you eat lunch with your colleagues daily? Will the environment be light-hearted and filled with jokes, or more serious? How will you recognize team members' birthdays? There are bigger aspects to culture as well, such as creating a mission-driven focus and defining teams.

Setting the culture should be an intentional development, one that requires careful forethought. If you don't deliberately shape a positive culture, the existing culture will shape you.

Natasha Bhuyan, M.D.

Know What You Want (and What You Don't)

When it comes to your first job, considering what you want your practice to look like is of utmost importance. You need to know what your deal breakers are. Maybe it is overnight or weekend call, late clinic hours or amount of vacation. And you also should identify your must-have items. If you are a parent of small children, a four-day work week might be what you are looking for; if you are someone who loves to do international missions, it might be the ability to take a month at a time out of clinic.

It is easy to be wooed by a high salary, but is it high only for the first year before changing to a low base salary that's weighted for productivity? The physician recruiter is going to make the job sound great, but are the people who work there actually happy? Do your research, talk to other people in the practice, spend a day there and get a feel for it.

If you decide to hang up your own shingle, as my husband and I did, make sure you have people available to serve as mentors when the multitude of things you don't know you don't know come up. Investing time in determining what is right for you at the front end will save you vast amounts of time, heartache and job changes on the back end.

And if that first job isn't right, if the product that was sold was not what was actually inside the box, don't be afraid to change and find what is right for you.

Beth Oller, M.D.

Phone a Friend

We spend seven years during our training getting to know other physicians. Our medical school classmates don't all grow up to be family physicians, and even many who do focus on different areas of medicine. Throughout our training we learn from other physicians, we read articles written by other physicians, go to lectures taught by physicians, and spend countless hours in the hospital managing patients as a team. It's that spirit of learning from one another that helped me the most in my first few years out of residency.  

My office partner (and fellow med school classmate and resident) and I ask one another questions all the time. But when we feel like we need to phone a friend, so to speak, we call on our former colleagues, senior residents or faculty. We may be separated by hours or even state lines, but all those amazing teachers we meet along the way are just a phone call, email, or text away. Use your network. You wouldn't hesitate to do it in the hospital, so don't be scared when you need to run a case by someone and know exactly who has your answer. 

Kimberly Becher, M.D.

Posted at 10:09AM Aug 09, 2016 by Gerry Tolbert, M.D.

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