Congratulations on finishing your training and stepping into your first clinical role! You are about to enter into the absolute best season of medicine. Caring for patients, creating relationships, having more time off with the people you love, discovering your hobbies again… all of it. I’m so thrilled for you.
Of all the transitions in medicine, starting your first clinical role as staff is the most exciting (and the most terrifying). Making decisions without supervision, navigating the workplace, and handling challenging patient interactions were some of the hardest parts of my first year in practice. Hopefully, this will make it easier for you. You will make it through.
1. Adjusting to your new role
Whether you’re a physician, nurse practitioner, physician’s assistant, dentist, or pharmacist, your first year in practice will be a huge adjustment. It certainly was for me. I went from oncology fellow one day to oncologist the next, ordering chemotherapy, managing side effects, and making complex decisions for patient care.
It was overwhelming at first. All new things are.
It wasn’t just patient care or learning the names of my colleagues in multiple disciplines that was overwhelming. It was learning all the logistics of patient care. How do I request an add-on for pathology? How do I get outside images pushed to the cloud? What is my workplace tax ID for a peer-to-peer? What clinical trials are available at our center? How do I conduct a virtual visit?
What helped? Resetting my expectations to know it would be a lot. Asking a lot of questions to the people I work with. Eventually, I created a document in my Notes app on my phone called “Job Stuff.” Whenever I learned an answer I didn’t know, it went in that folder.
Remember that an adjustment to a new practice setting will be a transition. You’ll get through it. Hopefully, there will be kind people around you to help answer your questions, and in turn, you’ll be one of those kind faces willing to help someone else.
2. Sharing your personal contact information with patients
As a new attending, I had a few patients with more needs and questions than I had time to answer in clinic. I ended up sharing my cell phone and email with many of them. Most (99%) respected this personal information and only used it under urgent circumstances or not at all. I did have a couple of patients who called very late at night or very early in the morning for non-urgent issues.
I also had a couple of patients who sent emails with many itemized questions (up to 30 questions or more at one time), along with the expectation that such questions be answered within a few hours. Not only was this distressing to my team and me but emails are also not connected to patients’ electronic medical records, which made it more difficult for my team when orders or follow-ups were needed.
These experiences shaped my policy to provide clear contact information for our clinic and nursing team, a pathway to send messages through the EMR, and an after-hours number for the physician on call. However, I no longer give patients my cell phone or email.
Thankfully, this new policy has worked well. Patients have their concerns addressed in a timely fashion, which helps protect my time off and time with my family.
3. Negative patient reviews & requests for a provider switch
If you are practicing medicine and entangling your life with other people, at some point, you will not be able to please everyone, no matter how hard you try. This was a hard pill for me to swallow. I assumed that my patients would all be satisfied if I showed up, was kind and respectful, and provided thorough and honest care.
For the most part, this has been the case. However, especially if you are delivering hard news or cannot prescribe a particular medication due to state law, prescription regulations, or practice preferences, you will have people get upset.
Sometimes, this will happen directly, with a patient sharing it clearly to your face, or sometimes, it will seem like a perfectly normal encounter, and then it will show up weeks later on a review. Both have happened to me.
When (not if) this happens to you, know that you are not alone. This happens to my partners, too, and they are exceptional in what they do. This has happened to every physician I know. Take a breath. Keep doing your best and move forward in kindness toward the patients you have.
Also know that at some point, you will also have a patient request a different doctor, and you likely won’t know the reason. This has happened to me, and I’ve also had my partners’ patients transition to my care. Again, take a breath, move past it, and do your best.
4. When a patient is disrespectful to you or your staff
I am fortunate to have incredibly kind patients. They are also going through a diagnosis of cancer, and this (understandably) can be very stressful. Within the limits of our flawed healthcare system, we do the absolute best we can to provide them with evidence-based, timely care.
This is sometimes impossible, given insurance denials, delays, or other factors. When your patients are dissatisfied with their care for whatever reason or angry, frustrated, or stressed about their diagnosis, you may experience anger or disrespectful words from them or their families.
Know that you are not alone.
When this happens, it can be highly distressing. In my first year of practice, one of my colleagues had a very helpful phrase he’d say to patients who were being rude or disrespectful to him or his staff:
“We understand this is a difficult time for you and your family. However, if you continue to speak to me or my staff this way, we can no longer continue this therapeutic relationship, and you will need to find another medical team.”
As a new attending staff member, you will be expected to provide guidance, leadership, and support to your other staff. We must support our team members and ensure they are respected.
5. Medical errors
If you practice medicine long enough, you will make a mistake. This is not an “if” situation but a “when” situation. Every clinician I know has made a mistake at some point, worsened by factors such as sleep deprivation, burnout, busy clinic schedules, and constant interruptions.
Unfortunately, this will happen to you. You will want to crawl into a hole and never emerge, and you will think about stepping away from clinical practice. But know that you will come through this. You will heal. You will find a way to make amends.
Do all you can to protect your health, slow down, enter orders, and do procedures without distractions or interruptions. Know you aren’t alone in this. Talking with a trusted colleague or therapist can help.
6. Ask for advice for complex patients
When I entered my first year of practice, I didn’t realize how frequently attending physicians ask their colleagues questions. It’s a daily occurrence. What are your thoughts on this new data? What would you do in this situation?
I’m grateful to have smart people around me, plus three tumor boards a week where I continually see physicians with 20+ years of practice asking each other questions. This has normalized it for me.
Keep asking questions. Text or call your mentor if they live in another city. Reach out to a friend who practices in that specialty. Be willing to answer questions from your peers.
Keep learning, and keep asking questions. Your colleagues and mentors are much more willing to help than you imagine.
7. Connecting with your peers in the office and making friends
Many people reach out to me feeling out of place during their first year of practice, especially if they’re moving to a new town or working for a big center. You might not immediately connect with your colleagues and office staff. That’s okay. Relationships take time.
Here are some things that can help:
- Introduce yourself (often multiple times) to your colleagues and other specialists, especially if you’re in an extensive practice
- Turn your camera on for Zoom meetings, if only for a few minutes
- Go to social events like fundraisers and club mixers on campus. If you’re a woman, consider attending the Women in Medicine mixers. You can even host an event or social gathering. My family and I try to attend the holiday/social events and bring our daughter. I also try to attend meetings in person when possible, which helps.
- Consider holiday gifts for your staff (we do this every year)
- Consider bringing in coffee, breakfast items, or other snacks for your team
- Give it time. Showing up, being kind, and being willing to help goes a long way. It takes years to develop these relationships and keep at it.
8. Setting boundaries and saying no
As a new staff member, you will likely be asked to serve on several committees (often unpaid) and do other uncompensated work. There is a balance between wanting to be a team player and protecting time for my priorities. It helps to clarify what matters to you, what my mentor calls your “buckets.”
It helps to have two or three buckets of interest at work. Mine are GI oncology, humanism in medicine/clinician wellbeing, and narrative writing. If asked to be on a committee or do something that fits within one of those buckets, I’m more likely to say yes. If it clearly does not fall within one of those buckets, I’m more able to decline politely, saying something like:
“I really appreciate you considering me for this opportunity. However, I am currently spending my time doing (XYZ – fill in the work you’re already doing) and respectfully decline at this time.” If I have a colleague who may be interested in that opportunity and it fits within their bucket, I will consider mentioning their name.
There is also a great book called “F*ck No” by Sarah Knight that gives practical strategies (and verbiage) to say no when you want to say no.
9. Imposter Syndrome
This guide would not be complete without mentioning imposter syndrome. All of my friends who have transitioned to staff roles at some point felt that they weren’t good enough to be there or weren't ready for their roles.
That’s the tricky thing about medicine. You can see, learn, and do so much in training, yet there will be things you have not learned. We will be continually learning throughout our careers.
Ideally, your practice would start slowly to build your confidence. This would allow you ample time to spend with patients, review their charts and data, and get comfortable with your new practice setting. You can even run patients by a mentor or colleague those first few weeks to help build your confidence.
The confidence will come. It will take time, but it will slowly build the more familiar you are with your patients and your role.
Trust that you belong here as much as anyone else.