I will be graduating in a few months and I have to admit, I am scared to death. I feel very comfortable with the general bread and butter surgery and feel like I can handle 99% of what comes my way. What i'm worried about is that one percent. I know what i'm feeling is not abnormal, but i just had to get it off my chest. If any of you guys who are relatively new attendings can give me any advice I would appreciate it.
new surgeon
- Thread starter pogo
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Take advantage of your partners for both intellectual and technical help. You don't have to handle everything by yourself.
And realize that even an experienced, competent gen surgeon will only handle 99.5% of everything well. You're most of the way there 🙂
And realize that even an experienced, competent gen surgeon will only handle 99.5% of everything well. You're most of the way there 🙂
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I'm a new attending myself in solo private practice. If you have good training you will be able to handle just about everything you would see in private practice. If something is beyond what you can handle, just recommend transfer to another center.
N
njbmd
I actually did more than a few cases with my partners. It helped them to see my style and it helped me to know their style. Now, we are one big happy family with a high level of comfort with each other. I don't take regular General Surgery call which helps tremendously (I am in Vascular).
My biggest hurdle was my teaching duties. It took loads of time to keep up with journal reading, prepare lectures and keep medical students in order (I took over a clerkship). After about three months, I was settled into what I had to do.
If I have a big case, I still ask my most experienced partner to scrub with me which he loves (and so do I). In short, all of those little "pearls" and "hints" that you have accumulated through your training will come back to you. I hear my program director whispering in my ear all of the time. Still, I don't have the comfort level that my partners have and I won't have that comfort level until I get more experience. The important thing to realize is that you have enough experience to get the job done and learn at the same time. Good luck and enjoy your independence.
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Sounds simple, but where I live, the tertiary centers will not take uninsured patients.
Heck, they won't take very many Medicaid patients, either.
Sometimes, you just have to suck it up and do the best you can.
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Then how can they be the tertiary centers? My understanding was that being the big fish meant you had to eat some of the cost from time to time.
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Depends on the center.
Mayo for example accepts insurance, but not many plans and not uninsured. I've had them refuse to see patients not on their plans, same happens with some other tertiary centers.
I'm 2 months in and i'll be honest - calll still is terrifying. All those "interesting cases" as a resident are now less interesting and more terrifying! Everyone warned me that your first year in practice will bring the craziest cases you've ever seen and it hasn't disappointed. I'm doing a locum in a tertiary referral centre so everythiing challenging gets dumped here and there is no place else to send them. However, the other surgeons have been very good about helping me out when i need it.
As for advice - know your limitations and don't be afraid to ask for help. Know who are your "go to people". When you're in the middle of a disaster, don't be afraid to bail and go into damage control mode. For example, I was doign a gallbladder from hell (super-obese woman with ++ comorbidities). I didn't think i could get the gallbladder out without killing the woman, so i just put a drain into it. The senior resident on with me called me a pansy, however, the patient was discharged home 3 days later and is still alive.
Also, act confident even if you're not. If the residents, nurses, ER docs, etc. sense any fear they will totally exploit it. Have some trusted collegues you can call when you need to (in private) without getting a reputation that you're weak or don't know what you're doing. Everyone will try and take advantage of you, but don't let them!
Good luck.
As for advice - know your limitations and don't be afraid to ask for help. Know who are your "go to people". When you're in the middle of a disaster, don't be afraid to bail and go into damage control mode. For example, I was doign a gallbladder from hell (super-obese woman with ++ comorbidities). I didn't think i could get the gallbladder out without killing the woman, so i just put a drain into it. The senior resident on with me called me a pansy, however, the patient was discharged home 3 days later and is still alive.
Also, act confident even if you're not. If the residents, nurses, ER docs, etc. sense any fear they will totally exploit it. Have some trusted collegues you can call when you need to (in private) without getting a reputation that you're weak or don't know what you're doing. Everyone will try and take advantage of you, but don't let them!
Good luck.
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Things I've learned (or tried to) in my short new career:
1) Ask for help when you need it.
2) But if you need help, do not appear to struggle because your reputation in the beginning is *very* important.
3) Do cases with your senior partners. Not only is it a great way to learn something but it eases you into practice.
4) Let them know when you have a tricky case; do not be afraid to discuss concerns with them. Its much better to admit up front that you are unsure about something than admit you made a mistake and now are trying to fi it.
6) Remember you are (often) practicing in a place where they don't know you and your personality. Jokes that would fly at your old residency/fellowship program may not in a new environment.
7) Never speak bad about a colleague, patient, etc. it will immediately be broadcast on the nurse's network about how evil you are. I learned this when I was worried that my plastic surgeon wasn't going to show up (which he had been known to do before) late on a Friday afternoon of a holiday weekend. It quickly got back to him that I said, '"I don't know where the hell he is" when questioned by OR staff about his whereabouts and of course, my comments were totally blown out of proportion to my actual anger.
8) Learn how to bill and make sure to check your receipts. Medical billers will often "write off" cases that they think are too hard to collect. No biggie if its a $55 office visit; a pretty big deal when its a $12,000 brachytherapy catheter insertion. Trust no one unless your mother does your billing (and even then she might make mistakes).
9) Do your notes and coding, etc. ASAP after you encounter the patient. Nothing is worse than trying to recall something about a patient 2 weeks later. Dictate if you can, have someone else transcribe if you can, but do it as the patient leaves you.
10) Enjoy the small victories. I made a diagnosis yesterday on a patient that 3 other physicians had missed (SVC syndrome). It felt great after a rough day to know that I am actually competent.
So admire your skin closure, or how you handled that chronic pancreatitis patient or whatever makes you feel better. Brag a little here on SDN (like I just did).
11) And finally remember, you aren't alone. If you joined the right group or have a good mentor and back-up, there should be someone available to talk things through with you, scrub in, etc. when you need them.
1) Ask for help when you need it.
2) But if you need help, do not appear to struggle because your reputation in the beginning is *very* important.
3) Do cases with your senior partners. Not only is it a great way to learn something but it eases you into practice.
4) Let them know when you have a tricky case; do not be afraid to discuss concerns with them. Its much better to admit up front that you are unsure about something than admit you made a mistake and now are trying to fi it.
6) Remember you are (often) practicing in a place where they don't know you and your personality. Jokes that would fly at your old residency/fellowship program may not in a new environment.
7) Never speak bad about a colleague, patient, etc. it will immediately be broadcast on the nurse's network about how evil you are. I learned this when I was worried that my plastic surgeon wasn't going to show up (which he had been known to do before) late on a Friday afternoon of a holiday weekend. It quickly got back to him that I said, '"I don't know where the hell he is" when questioned by OR staff about his whereabouts and of course, my comments were totally blown out of proportion to my actual anger.
8) Learn how to bill and make sure to check your receipts. Medical billers will often "write off" cases that they think are too hard to collect. No biggie if its a $55 office visit; a pretty big deal when its a $12,000 brachytherapy catheter insertion. Trust no one unless your mother does your billing (and even then she might make mistakes).
9) Do your notes and coding, etc. ASAP after you encounter the patient. Nothing is worse than trying to recall something about a patient 2 weeks later. Dictate if you can, have someone else transcribe if you can, but do it as the patient leaves you.
10) Enjoy the small victories. I made a diagnosis yesterday on a patient that 3 other physicians had missed (SVC syndrome). It felt great after a rough day to know that I am actually competent.
So admire your skin closure, or how you handled that chronic pancreatitis patient or whatever makes you feel better. Brag a little here on SDN (like I just did).11) And finally remember, you aren't alone. If you joined the right group or have a good mentor and back-up, there should be someone available to talk things through with you, scrub in, etc. when you need them.
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To the first poster,
I too am a new attending. I have found that at first I was more nervous than a intern given a scalpel for the first time! Quickly though you realize that "I know how to do this" and your old lessons take over. The other thing to keep in mind is that faculty will realize that as a new attending your senior partners will expect to mentor you--just tell them "if I get into trouble I'll call you." To a person everyone offered unwavering support, e.g. they told me to call and they'd be there. That gives you the confidence to know someone has your back.
Another thing that makes it easier is to realize that some cases are hard and would be a hard for anybody--you just do your best and that's all anyone could do. It does seem that the most difficult thing is judgement rather than technical ability.
I agree with the above poster who said that you must enjoy your successes: I did an early exlap for a blunt trauma small bowel injury--a correct judgment call and that was sweet--it builds confidence.
Another thing, left unsaid, is that the money is nice, very nice after all the sacrifice.
As a new attending you do not have the experience of your senior partner but you do have things that you can control. You can care more, and work harder than someone who is used to it all. Also, what makes a surgeon great is to not accept anything less than perfect and to always try to improve.
This is what its all about, your time is now.
All in all, it feels good and right to be an attending, a well deserved reward for the hard life we have chosen.
It is better to be lucky than good...
I too am a new attending. I have found that at first I was more nervous than a intern given a scalpel for the first time! Quickly though you realize that "I know how to do this" and your old lessons take over. The other thing to keep in mind is that faculty will realize that as a new attending your senior partners will expect to mentor you--just tell them "if I get into trouble I'll call you." To a person everyone offered unwavering support, e.g. they told me to call and they'd be there. That gives you the confidence to know someone has your back.
Another thing that makes it easier is to realize that some cases are hard and would be a hard for anybody--you just do your best and that's all anyone could do. It does seem that the most difficult thing is judgement rather than technical ability.
I agree with the above poster who said that you must enjoy your successes: I did an early exlap for a blunt trauma small bowel injury--a correct judgment call and that was sweet--it builds confidence.
Another thing, left unsaid, is that the money is nice, very nice after all the sacrifice.
As a new attending you do not have the experience of your senior partner but you do have things that you can control. You can care more, and work harder than someone who is used to it all. Also, what makes a surgeon great is to not accept anything less than perfect and to always try to improve.
This is what its all about, your time is now.
All in all, it feels good and right to be an attending, a well deserved reward for the hard life we have chosen.
It is better to be lucky than good...
