New Attendings

[Mighty Mouse]

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Just want to hear from the new attendings in the group. What do you like about it? What are you finding difficult?

My experience after 2 days: everyone is incredibly nice to this outsider in a traditionally inbred academic program.

There are so many things that are dramatically different from the way I did things where I trained....some medical things for sure, but more the logistics and beaurocratic stuff...that my head is spinning.

This is truly my dream job, but the learning curve on "the system" is steep. Just wanted to commiserate with anyone else out there who may be experiencing similar things.

 

[Greenbbs]

I'll let you know in a few days. I have 2 days of hospital orientation followed by the beginning of ED orientation before they turn me loose (although they said they were going to see if I wanted to be independent on Friday instead).

 

[DrMom]

I've survived 4 shifts at 2 of the 3 hospitals I will rotate through. Everyone has been great so far. Trying to figure out all of the different order sheets, admission protocols, physician groups, etc for each place.

 

[EM2BE]

Question for you all: is it as terrifying as it is to start 3rd year / intern year? I was scared to write an order the other day without clearing it first. I'm sure that part wears off, but are there other things that take over that part of being terrified?

 

[docB]

Question for you all: is it as terrifying as it is to start 3rd year / intern year? I was scared to write an order the other day without clearing it first. I'm sure that part wears off, but are there other things that take over that part of being terrified?

I kept looking over my shoulder at codes for the first year waiting for my attending to nod at my orders. I'm not sure what replaced the terror. Emptiness maybe... annoyance... But that's just me😛.

 

[It'sElectric]

Question for you all: is it as terrifying as it is to start 3rd year / intern year? I was scared to write an order the other day without clearing it first. I'm sure that part wears off, but are there other things that take over that part of being terrified?

Not to hijack, but intern here as well. Worse than being scared to write an order, I've never felt so dumb or incompetent in my life. Can't help but think that after every shift, they're thinking, "we matched this guy???!!"

 

[xaelia]

Off to my first moonlighting shift, 8a-8p single-coverage in a 13,000 annual visit 7-bed rural ED.

All I've had for the last three nights are stress dreams about medicine.

 

[Stitch]

Question for you all: is it as terrifying as it is to start 3rd year / intern year? I was scared to write an order the other day without clearing it first. I'm sure that part wears off, but are there other things that take over that part of being terrified?

The first patient you discharge home you'll worry about. Even if it's simple. It's sort of like writing that first order as an intern.

 

[Greenbbs]

The first attending shift for me was today. Went well.

Saw 2 criticals (a septic shock and an altered that needed tubed), plus a bunch of other intermediate stuff.

I generally felt pretty good about who i admitted and discharged.

Piece of cake!

 

[badgerprarie]

I have done 4 shifts so far and love it! Yes I have had my butt kicked adapting to a new system, but am loving it. The program at the UW definitely gave me the necessary training to deal with a fast paced community ED.

Great pathology. Now I am the guy calling the tertiary care center after the dx and procedures have been done for definitive care.

I find that when I am not at the hospital virtually every day (shifts, conference, meetings, journal club, charting, etc.) with 3 different attendings wanting to know why what they want done hasn't happened yet it is much easier to focus. Much easier to listen because my mind is rested.

We also used EPIC for charting in residency and it seemed that at least half of the time I was off was spent charting. Now we use a t sheet like system and I am done within an hour of my shift with charts, usually 30 minutes or less.

For you guys still in, it does get better!

 

[EMS5]

Out of sheer curiosity, what is the setup at the hospital where everyone is now working?

I.e. trauma center vs not, ICU/NICU/PICU availability, ob/gyn, volume, acuity, those little things....just curious what kind of environments everyone is practicing in out of residency

 

[DrMom]

I'm mostly in a small community hospital that is a rural critical access hospital. The ED is 8 beds, but can use some other spaces to expand to 10. I don't know how many beds are in the hospital, but not many. No OB, no ICU, no peds, no specialists in house. Have to transfer anyone who is not just minorly sick/injured. I can talk with specialists on call at the big hospital in the system, but have to transfer if pts need specialist care now.

I'll also occasionally be at two other community hospitals in the same system that are in more affluent areas and have OB, peds, GS, and some other specialists. Still no ICU.

 

[xaelia]

Respiratory arrest and expired on third single-coverage moonlighting shift.

CVA dementia 20-25% EF and 100% obstruction of LAD, RCA, and Circ last cath after MI earlier this month, but, still lame when you walk into foaming at the mouth -> bradycardia -> PEA.

 

[abscess]

Who all works at a >15k volume place single coverage and is EM boarded?

whoops, I mean <15 K.

 

[WerdSalid]

I do. 17K annual volume. single coverage. mid-level provider "sometimes".

 

[lucky_deadman]

In my first week of shifts I've had several intubations, CVLs, STEMIs, Cardiac Arrests, and a bunch of critical care time billed. 😀

 

[lucky_deadman]

We also used EPIC for charting in residency and it seemed that at least half of the time I was off was spent charting. Now we use a t sheet like system and I am done within an hour of my shift with charts, usually 30 minutes or less.

Pretty much the same here. Went from electronic template system to T sheets means I'm essentially done with my chart when I walk out of the room.

For you guys still in, it does get better!

I definitely second this.

 

[Greenbbs]

In my first week of shifts I've had several intubations, CVLs, STEMIs, Cardiac Arrests, and a bunch of critical care time billed. 😀

I feel you. In my first 3 weeks, I've had no fewer than 3 patients/shift (i average about 20 a shift) that need critical care time. And they're horribly ill.

 

[Hawkeye Kid]

I have to admit that I'm a little jealous. I've been an academic attending for just over a year, and while I've definitely seen my share of critically ill folks, I've personally put in one CVL, one chest tube, and intubated zero people since residency. Hopefully muscle memory won't fail me when the time comes...