First week as an attending

[beyond all hope]

I've just finished my first week as an academic attending.

I was post-call June 29th, and I moved to a new state July 1rst, and started working July 3rd. I didn't know anyone, hadn't had any orientation to the ED, I just had to jump in on a Monday in the middle of a holiday weekend (prescription for disaster)

The first day everyone thought I was a new intern because I didn't have the 'attending' hunter green scrubs. Despite that the residents, ancillary staff were great. I asked for things to be done and they were done....within a few hours. I had to rely on the residents to take care of details. I didn't even know where the bathrooms were.

Being an attending you have less control and more responsibility. I don't have the time to recheck patients, follow up on all the lab results, read CTs like I used to. I have to assume that things are being done as I'm reported most of the time ('the labs are normal, patient feels better, can I send him home?'). I only have time to check on critical details, otherwise I get behind in patient presentations and teaching.

It's great in that I get to practice the kind of medicine I've always wanted to. I've made some pretty risky decisions based on what I thought was best (sending home an 87 year old after a nasty fall because he didn't want to stay, for example), and I've made some poor decisions, some bogus admissions, and probably made a horde of mistakes that I won't know about until later. I've also made some pretty good decisions which made me feel like a real doctor.

(more later, have to go teach ATLS)

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[Dimoak]

I've just finished my first week as an academic attending.

I was post-call June 29th, and I moved to a new state July 1rst, and started working July 3rd. I didn't know anyone, hadn't had any orientation to the ED, I just had to jump in on a Monday in the middle of a holiday weekend (prescription for disaster)

The first day everyone thought I was a new intern because I didn't have the 'attending' hunter green scrubs. Despite that the residents, ancillary staff were great. I asked for things to be done and they were done....within a few hours. I had to rely on the residents to take care of details. I didn't even know where the bathrooms were.

Being an attending you have less control and more responsibility. I don't have the time to recheck patients, follow up on all the lab results, read CTs like I used to. I have to assume that things are being done as I'm reported most of the time ('the labs are normal, patient feels better, can I send him home?'). I only have time to check on critical details, otherwise I get behind in patient presentations and teaching.

It's great in that I get to practice the kind of medicine I've always wanted to. I've made some pretty risky decisions based on what I thought was best (sending home an 87 year old after a nasty fall because he didn't want to stay, for example), and I've made some poor decisions, some bogus admissions, and probably made a horde of mistakes that I won't know about until later. I've also made some pretty good decisions which made me feel like a real doctor.

(more later, have to go teach ATLS)

Wow, sounds like an interesting experience. I've never really heard an attending's perspective before, so this would be interesting. Thanks for the brief glimpse into the world of attending!

 

[mikecwru]

I've just finished my first week as an academic attending.

I was post-call June 29th, and I moved to a new state July 1rst, and started working July 3rd. I didn't know anyone, hadn't had any orientation to the ED, I just had to jump in on a Monday in the middle of a holiday weekend (prescription for disaster)

The first day everyone thought I was a new intern because I didn't have the 'attending' hunter green scrubs. Despite that the residents, ancillary staff were great. I asked for things to be done and they were done....within a few hours. I had to rely on the residents to take care of details. I didn't even know where the bathrooms were.

Being an attending you have less control and more responsibility. I don't have the time to recheck patients, follow up on all the lab results, read CTs like I used to. I have to assume that things are being done as I'm reported most of the time ('the labs are normal, patient feels better, can I send him home?'). I only have time to check on critical details, otherwise I get behind in patient presentations and teaching.

It's great in that I get to practice the kind of medicine I've always wanted to. I've made some pretty risky decisions based on what I thought was best (sending home an 87 year old after a nasty fall because he didn't want to stay, for example), and I've made some poor decisions, some bogus admissions, and probably made a horde of mistakes that I won't know about until later. I've also made some pretty good decisions which made me feel like a real doctor.

(more later, have to go teach ATLS)

This was my first week as well, and yes, the hardest thing is letting go and trusting that some things get done. I don't think it's too odd of a feeling though because (a) we're brand new and more importantly (b) the residents are brand new and things ARE more likely to fall through the cracks as I've caught multiple times this week.

My first shift was the second day shift, my next shift was day trauma, my third shift was evening trauma on the 4th (get out the KY), and then I did three urgent care shifts.

I've gotten to manage multiple trauma resuscitations with the residents along with several sick medical patients and everything went fine. Overall, easier transition that people were suggesting.

miek

 

[DrQuinn]

I have two orientation days this week... tomorrow is the occ med and benefits day, Friday is the orientation to the ED, and my first shift is a 7a-3p next Wed... so I have 9 more days of freedom!

I'll be at an academic position, although the program is brand new so we only have PGY1s... who I first met this weekend and seem really great. I warned them that they'll probably be teaching me more as I first start out, we're a pretty busy ED, 80k no peds. Not sure how many attending hours are covered, but I'll update next week after my first shift!

Q

 

[Scrubbs]

Interesting to hear everyone else's experiences. My graduating class has been going back and forth in emails about their first days, etc. I've got 2 attending shifts under my belt, no orientation, and my first one was with another new attending. Baptism by fire, that's all I have to say. Its been good though. I feel well trained, but the jump to supervising residents, med students and off-service brand new interns has been interesting. Keeping track of your own patients is waaaaaay easier than keeping track of everyone else's. It'll get easier though. After all, we'll never have to have our first attending shift again!

 

[roja]

I have about 8 shifts under now. Fast tracks, main ED's, late nights. First weekend overnights are this weekend.

I have ot say, being an attending is AWESOME.

and my first paycheck is this week.. Show me the money, honey*

*only coming out of residency would an academic fellows paycheck seem like a big deal.

 

[JackBauERfan]

I have about 8 shifts under now. Fast tracks, main ED's, late nights. First weekend overnights are this weekend.

I have ot say, being an attending is AWESOME.

and my first paycheck is this week.. Show me the money, honey*

*only coming out of residency would an academic fellows paycheck seem like a big deal.

i like the 'show me the money honey' line. Althought i prob won't be using it for awhile ahah.

also, yeah it is nice to see all your experiences, sounds like most of you are enjoying it, even though it is a different role than what you are doing in residency. It seems like community ED would be a similar experience as residency, since you would have no residents to follow up on labs and report on imaging. With academic though you get to teach a good bit, which is not there in community at all, unless you go to a hospital with some minor affiliations.

 

[roja]

i like the 'show me the money honey' line. Althought i prob won't be using it for awhile ahah.

also, yeah it is nice to see all your experiences, sounds like most of you are enjoying it, even though it is a different role than what you are doing in residency. It seems like community ED would be a similar experience as residency, since you would have no residents to follow up on labs and report on imaging. With academic though you get to teach a good bit, which is not there in community at all, unless you go to a hospital with some minor affiliations.

I thought theypaid big bucks up there in the bronx. And you aren't paying that manhattan rent.

I love the academic stuff. (although my first faculty meeting was well, less than glorious.. although we did get better coffee than residency conference...) The teaching is great and writing 'agree with resident note and plan' is much better than writing a whole note. (granted I have to make sure they are writing an approriate note...)

 

[beyond all hope]

BTW good to hear other perspectives. Keep the blogs coming...

In my hospital I supervise everyone: EM and offservice residents, medstudents, and even PAs. PAs range in quality, like anyone else. They're of resident responsibilities but have a different attitude. Some of them act like attendings, some have bad nurse attitude. One of my PAs says things like "I don't do NG lavages," or "I'm not going to rectalize that patient."

It's unfortunate that I still don't have control over the weaker aspects of the team, such as the clerks, nursing assistants, etc. You'd be suprised how much a bad clerk can screw up your ED.

On the academic side, I've already been asked to be on a committee, and probably will be on more in the future. I'm trying to get a RCT started. That's a boatload of work. IRC approval and statitstics and getting funds and yadda yadda yadda...

More random thoughts...

Sick people are easy. Shotgun labs, prophylactic abx, admit to ICU. I've already had to do a difficult intubation for one of the residents (thank god I got the tube) and direct some resuscitations. As a new attending, your critical care and procedural skills are as strong as they ever will be.

Healthy people are usually easy. It's the ones in the middle that can burn you.

Don't let the residents or nurses rush you into a decision. Just admitting a patient won't save you. You can't assume the admitting team will catch your mistakes. Most dangerous diagnoses are picked up in the ED, and if you miss them, patients are almost as likely to die on the floor as they are at home.

And for chrissake, there is no such thing as basic labs! Any lab test you don't need is just going to slow you down. Rarely do CBCs or BMPs catch any crucial information. A white count doesn't mean spit in the acute setting. Even acidosis (much more crucial information) is rarely a surprise. If you think someone's going to be acidotic, you should know it before you do a BMP.

(interrupted again)

 

[JackBauERfan]

I thought theypaid big bucks up there in the bronx. And you aren't paying that manhattan rent.

I love the academic stuff. (although my first faculty meeting was well, less than glorious.. although we did get better coffee than residency conference...) The teaching is great and writing 'agree with resident note and plan' is much better than writing a whole note. (granted I have to make sure they are writing an approriate note...)

I'm saving up some decent money down here in alabama! the residency pays 41K and free food ALL the time. My rent is a measely (sp?) 550. um no kids.. so can't wait to come up to ny and pay triple that hahaha. I still have one year, but I definitely will be asking the reliable EM forum about tips/tricks of ED in NY, specifically bronx haha. Good thing there are a few folks here from around there! I actually had one friend go to surgery at st. lukes and one friend going into psychiatry there! So if you see some UAB interns don't mess with them tooooo much haha.

 

[DrQuinn]

Still haven't had my first shift as an attending, but did go to my first faculty meeting today. Met most of my colleagues, I am definately the youngest one there (in age... but there is also one other new grad there with me), but it was cool to see that EP's really don't change regionally. We're all slightly ADD, slightly eccentric, and all like to make funny/cynical comments (and talk about giving out Motrin instead of Percocets). Tomorrow I have my orientation, and first shift is next Wednesday............... ack!

Q

 

[DrQuinn]

So, I had my semi-first shift. My med director said it would be a good idea to come in before I really started working (i.e. tomorrow) and see a few patients just to learn the system. Initially, I said "WTF" in regards to coming in without really being on the schedule, but I ended up doing it today... boy am I glad I did.

First off, we have our own charting system/computer system that our ED designed (Azyxxi)... took me atleast a coupel hours to really feel comfortable with it... but had I been the attending on, I woulda been screwed... First patient was.......... 56 year old HIV +, CD 4 count less than 80, COPDer on home O2, hx of PEs, hx of a trach 5 months ago, coming in dyspneic. Oh well, nothing better than just getting thrown in and seeing what happens.

Anyways, tomorrow is my first real shift, double coverage (thank God), 7a-3p. I will let everyone know how it goes.

Deep down, it wasn't as bad as I thought it would be. Jus tlearning the system and who to call when is what is the hardeest part.
Q