Junior attending position at same place as residency

[dpmd]

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Any thoughts on this? It could be bad because the other faculty and residents may not be able to see you as an attending. On the other hand, you know the system and get along well with the people (presumably you wouldn't want to stay there if you didn't). Plus, no need to move. I'm sure there are aspects I haven't considered and would love some input on considering this right out of residency (not coming back after a fellowship).

 

[SLUser11]

Any thoughts on this? It could be bad because the other faculty and residents may not be able to see you as an attending. On the other hand, you know the system and get along well with the people (presumably you wouldn't want to stay there if you didn't). Plus, no need to move. I'm sure there are aspects I haven't considered and would love some input on considering this right out of residency (not coming back after a fellowship).

I've thought about this before as well. It somewhat depends on your current reputation, and on the general attitude of your co-residents.

On the upside, you will feel comfortable right away, and you may have some built-in referrals due to you being well-known at the institution. You won't have to develop relationships with your residents because you already know them.

However, there are many downsides. You may not garner the appropriate amount of respect from your residents, and they may rank your requests/cases/consults last on their to-do list behind the more established attendings. The ones with attitude problems may be defiant to taking orders from you. Nurses/scrubs/janitors may have the same problem.

But it's not just your co-residents that may have a problems seeing you as an attending....it may be your new partners as well. It's not uncommon to treat a new attending as a "super fellow," etc, and you may end up getting treated like you're below them, even though you're now sitting at the same table.

I think it's generally easier to assert your authority in a new environment. However, if you have a sweet deal at your home program, you should definitely consider it. Eventually, you'll no longer be the junior-most staff, and respect will come as long as you earn it.

 

[surg]

It's going to be a transition wherever you end up. If you love the area and can see the current faculty as your partners, then go ahead and do it if there aren't any better offers on the table. It'll take about a half-cycle (3-4 years) before all the residents start thinking you are faculty in the way they think of the other faculty, a relatively short blip, but a noticeable one if you are the kind of person who would get hung up on status issues. Probably take about the same amount of time for you to feel not totally like a fraud calling your chair by his/her first name in a casual situation, or telling another faculty they are wrong at M&M.

I think the major thing that hasn't been mentioned yet is whether you would find it difficult to do things differently than your current attendings. It can feel like they are looking over your shoulder and if you decide you want to practice not according to their dogma (e.g. they do some sort of non-evidenced based thing that they all believe in), you may find that you feel guilty about it, or stressed out about it. Also, depending on what kind of person you are, you may feel more at ease going to your partners for help though, since you are already in that mode, but that is balanced against the possibility that you might not choose to follow their advice and will you be ok standing up for your point of view as their former resident?

Good luck with your decision.

 

[Smurfette]

I've thought about this before as well. It somewhat depends on your current reputation, and on the general attitude of your co-residents.

On the upside, you will feel comfortable right away, and you may have some built-in referrals due to you being well-known at the institution. You won't have to develop relationships with your residents because you already know them.

However, there are many downsides. You may not garner the appropriate amount of respect from your residents, and they may rank your requests/cases/consults last on their to-do list behind the more established attendings. The ones with attitude problems may be defiant to taking orders from you. Nurses/scrubs/janitors may have the same problem.

But it's not just your co-residents that may have a problems seeing you as an attending....it may be your new partners as well. It's not uncommon to treat a new attending as a "super fellow," etc, and you may end up getting treated like you're below them, even though you're now sitting at the same table.

I think it's generally easier to assert your authority in a new environment. However, if you have a sweet deal at your home program, you should definitely consider it. Eventually, you'll no longer be the junior-most staff, and respect will come as long as you earn it.

Good post. I agree that in some environments, it would be hard to be seen as an equal to the established attendings at first.

I also think the offer to stay on is likely to be tempting and the group knows this...and therefore, you may not get as high of a salary offer, or some other perks that someone from the 'outside' may be offered to sweeten the deal. Having other offers gives you flexibility and negotiating power.

 

[cpants]

One thing that hasn't been mentioned is that you are still in a learning role as a junior attending. Sure you are fully independent, but I have frequently seen junior attendings call someone more in the senior into the room for help and advice or sideline someone about a consult. One drawback is that you may lose the opportunity to learn from others' expertise. You only learn the X Program way of doing things.

 

[doc05]

I agree with all of the above.

Most notably, I've worked with many attendings just out of residency or fellowship. It's a tricky situation wherever you go; make sure not to make the same mistakes typical of new attendings. This may be more or less of an issue depending upon the environment of your current institution.

I think it is probably a lot easier to come back after fellowship than directly after residency...

 

[SLUser11]

One thing that hasn't been mentioned is that you are still in a learning role as a junior attending. Sure you are fully independent, but I have frequently seen junior attendings call someone more in the senior into the room for help and advice or sideline someone about a consult. One drawback is that you may lose the opportunity to learn from others' expertise. You only learn the X Program way of doing things.

It's definitely good to have a mentor that you can call on for help during a tough case....but you shouldn't have to call senior attendings into the OR on a frequent basis if you're well trained.

I think discussing patients outside the OR, or "sidelining" your co-workers, will continue even when you're a senior attending. It's just a good idea.

Surgery is a lifetime of learning, but I personally don't want my co-workers next year to view me as a "junior attending still in a learning role." To me, that's synonymous with "super fellow."

 

[blue2000]

i did it for a year. I really enjoyed it for the most part. I was pleased that the other attendings went out of their way to treat me ilke "one of them" rather than a resident. It was a little tough with some of the residents; I butted heads with some chiefs when we wanted to do things differently. At times, I felt awkward, but ultimately the patient was my patient and if I wanted it done a certain way, it was me on the line. I also liked having a pre-existing relationship with other attendings, and because I'd had a very positive experience in residency that was really beneficial to me as a junior attending. I think I called a more senior person into the OR 4 times during the year; one time when I wanted back up on a liver case (that wasn't supposed to be a liver case) when I had lysed adhesions from midnight til 6 AM on a lady with a j-pouch and I was starting to distrust the anatomy I was seeing, and one time when I was I had been called into an ortho OR and I thought the attending was being negligent -- he wanted me to essentially cover him in doing something that I thought would be disastrous. I called someone more senior to help negotiate a difficult political situation. Oh, one time I just wanted someone to look at a bad case of radiation enteritis because I hadn't really seen it up close before. Now that I'm in private practice in a small town, I don't have that backstop, which was nice at times.

Overall, it was a very good experience for me, but I think all the caveats and pitfalls that people have brought up are very appropriate to consider when you are thinking about taking that kind of offer. Oh yeah, I got paid terribly, but was looking at a 50% raise if I'd stayed on.

 

[C5toC9]

At my institution, many of the attendings are homegrown from the residency program but then did fellowship elsewhere and some even a little bit of private practice after that before coming back as junior attendings.