Advice going into first attending job

[Buckeye1992]

With my final ITE being done and all of my graduation requirements being finished it is starting to get real. Is there any advice you would give to residents who will be starting their first attending jobs this summer?

With COVID effecting things this past year no one in my residency class has been able to moonlight. While I essentially practice on my own at this point and do all of my own work ups I haven’t had the opportunity to not having someone there to back me up if needed. What is the best way to bridge the transition?

Also any advice for working with APPs?
Is it cool to bounce things off of the other attendings I will be working with or is this seen as annoying? Advice on how to spend my cme I have left while I can still get resident discounts?

Really I think I am just reaching the point where I am excited but also terrified lol. I think that I am ready but hard to know until I am actually out there doing it.

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[cyanide12345678]

moonlight at a sightly slower pace and get comfortable with being an attending.

Always okay to bounce ideas with other attendings.

Some APPs are really bad. Go see their patients if they have real chief complaints or at least see what's ordered and what the results are, especially if you're signing their note.

 

[namethatsmell]

If you’re on the fence about ordering a test or admitting somebody just do it and move on.

Don’t call consultants overnight if it can wait for 6am.

Say thank you to your staff and everyone else you encounter who gives you a reason to. On top of the fact it’s the right thing to do, showing appreciation is among the lowest hanging fruit to improve morale when you’re around and develop a team who has your back when the going gets tough.

 

[bravotwozero]

very important to get a feel for the c suite culture at your place.

 

[Birdstrike]

With my final ITE being done and all of my graduation requirements being finished it is starting to get real. Is there any advice you would give to residents who will be starting their first attending jobs this summer?

With COVID effecting things this past year no one in my residency class has been able to moonlight. While I essentially practice on my own at this point and do all of my own work ups I haven’t had the opportunity to not having someone there to back me up if needed. What is the best way to bridge the transition?

Also any advice for working with APPs?
Is it cool to bounce things off of the other attendings I will be working with or is this seen as annoying? Advice on how to spend my cme I have left while I can still get resident discounts?

Really I think I am just reaching the point where I am excited but also terrified lol. I think that I am ready but hard to know until I am actually out there doing it.

I remember this time well.

Just realize you've been trained well, it's now ingrained in you and will get you through the transition. And yes, it's okay to run things by other attendings if you have a question or a difficult case. They were there once, too.

Also, realize new-attending jitters are normal in the initial transition period. It will go away. Keep in mind that in the first 6 months to a year the learning process continues to be rapid and that works to your advantage every week that goes by.

 

[dadaddadaBATMAN]

Don’t call consultants overnight if it can wait for 6am.

I agree with everything else you said but I think consults overnight depends on context. If it’s just to “get them on board” that’s bulls*it and obviously you don’t do it.

If it’s for a legitimate question like “are we capable of handling this sub specialty problem in this hospital” or “I’m considering discharge for this time sensitive or other high risk diagnosis” then you should absolutely call, just know exactly what your question/concern is and be ready to present it in a single line, with context if needed.

Frankly, if you’re new and don’t know if you should call or not you should definitely call. Especially because the attitude towards consults in academics vs private life is night and day.

The only way I’ve gotten in “trouble“ as an attending was by not calling because I wouldn’t have in residency. No bad outcomes but a few raised eyebrows from consultants who I now get along with well.

 

[namethatsmell]

I agree with everything else you said but I think consults overnight depends on context. If it’s just to “get them on board” that’s bulls*it and obviously you don’t do it.

If it’s for a legitimate question like “are we capable of handling this sub specialty problem in this hospital” or “I’m considering discharge for this time sensitive or other high risk diagnosis” then you should absolutely call, just know exactly what your question/concern is and be ready to present it in a single line, with context if needed.

Frankly, if you’re new and don’t know if you should call or not you should definitely call. Especially because the attitude towards consults in academics vs private life is night and day.

The only way I’ve gotten in “trouble“ as an attending was by not calling because I wouldn’t have in residency. No bad outcomes but a few raised eyebrows from consultants who I now get along with well.

Yes of course, the situation matters. If it's something that will change acute decision making than absolutely call. But many times it really doesn't. Common example: you're overnight at a place where hospitalists admit CP but always aks you notify cards (which is an obnoxius problem unto itself) -- don't call cards until your wrapping up your shift.

 

[dadaddadaBATMAN]

Yes of course, the situation matters. If it's something that will change acute decision making than absolutely call. But many times it really doesn't. Common example: you're overnight at a place where hospitalists admit CP but always aks you notify cards (which is an obnoxius problem unto itself) -- don't call cards until your wrapping up your shift.

Definitely. For things like this I’ll ask them in the moment if it’s going to change what they do right then, and tell them either they should call in am or I can if not.

 

[GeneralVeers]

Yes of course, the situation matters. If it's something that will change acute decision making than absolutely call. But many times it really doesn't. Common example: you're overnight at a place where hospitalists admit CP but always aks you notify cards (which is an obnoxius problem unto itself) -- don't call cards until your wrapping up your shift.

I don't waste my time with this. If it's not urgent and night shift I let the hospitalist call. It's too hard to call at the end of shift, as sometimes cardiology won't call back for 30-60 minutes.

 

[namethatsmell]

I don't waste my time with this. If it's not urgent and night shift I let the hospitalist call. It's too hard to call at the end of shift, as sometimes cardiology won't call back for 30-60 minutes.

“Let the hospitalist call” is not congruent with reality at many places where these kinds of shenanigans are ingrained in the culture, though of course it should be their job. I’ve not stayed at those places long enough to warrant taking the time to fight that battle. Just have the clerk call the consultant’s cell 30 mins before you’re due to leave.

 

[emergentmd]

Do these 2 things and you will be be a happy EM doc. Everything else will fall into place. Let me reiterate that 1>2>>>>> Everything else.

1. Leave on time. I leave right on time about 2/3 of the time, leave within 30 min 1/3 of the time. I may leave an hr late once every 6 month.
2. Eat and use the restroom.

I remember on one of my 1st shifts as an attending and I was 3 hrs late leaving doing an LP on a pt. Big Mistake and never did it again.

Leave on time - easier said than done. I have worked at even the crappiest most inefficient place and I still leave on time. I get paid mostly by the hours and there is no reason for me to stick around any longer than what I am paid for. Tips:
#1 - Order everything on the 1st try. I order EVERYTHING on 99% of my patients on the first shot. Rarely does adding another lab happen that will change their course. I will order Labs, CT at the same time. My techs knows to check the Cr/preg tests before doing the CT and I put a note on the order stating this.
#2 - DO NOT pick up a complicated pt 90 min before shift ends. And if I do, I am bugging the nurses to do the Labs stat. They know my only stat labs are my I am going home labs. I have a good relationship with them and alittle polite begging works.
#3 - If I pick up a sick pt an hr before my shift and have to see then, I PAN lab them and give it to the next doc. I am not waiting 1 hr after my shift. Who cares about alittle loss of RVUs.
#4 - DO NOT wait around for a consult to call you back. Repeat, my time is just as valuable and if they do not call back in 15 minutes I am out the door. I give the clerk my cell number and have them call me while I walking out the door. I see docs waiting for consults to call back and repeatedly repagging.
#5 - Foster a good relationship with your staff. Buy them dinner. Be polite to them. Be there when they need help. This is GOLD. They will take care of you.
#6 - Build a good relationship with your specialists. When I need a CT scan read STAT (need to go home), they will read it next. I have 90% of the consults on my phone and they get text msgs.
#7 - Figure out your EMR and maximize efficiency. I have not had an EMR where I can not finish a chart from start to finish in 5 Minutes. Yes I have timed myself and easy charts <2 min. I have done 20 charts in 1 hr. I see way too many docs finish their shift, go to the back to chart, and reappear 2 hrs later finishing up. Did they somehow figured out a way to get paid for charting?

Eat and use the restroom - In a 10 hr shift, I leave the ER 4-5 times to get a snack/food. After 2 hrs in the pit, I need to get out and leave the place. I clear out all sick pts and leave. I don't care if there are 10 sore throats waiting, they can wait another 15 minutes. No doc has every complained that I leave the ER to eat. Why? Because see above paragraph. I am efficient. and my name is typically on 2/3 of the board. hard to complain when I leave the ER with 2/3 of the pts. I see the most pts/hr in my group. See above - Be efficient/order labs once/get the pts out. Some docs work twice as hard as I do and see half the pts b/c they nickle and dime a pt working them up for 5 hrs. I can get 3 pts discharged/admitted in the same room in 5 hrs.