Transition from residency: what's it like after graduation?

[IlianaSedai]

---

Members don't see this ad.

Hello everyone,

I was wondering if someone on here could talk about their experiences going from EM resident to practicing emergency physician. What is your typical day like? What differences did you find striking? Are the population and/or case variety different in your new job from what you saw as a resident? What does your typical work week look like, and how have your responsibilities changed?

 

[coachB]

It is a whole new world. I did nothing (and I mean NOTHING) for like the last 6 months of medical school. Then, I jumped into residency where I was working more than I ever have in my life. There is no comparison between medical school and residency - none - unless you really were there 80+ hours a week, thought about and signed every order, took every consultation, and endured endless hours of nagging by nurses, punishment by upper level residents, and stayed up all night long on call, on your feet running, and collecting all of the information you could ever find on 20+ patients to present a book report on each one on rounds in the morning - and take the nagging and punishment all over again.

But, on the bright side, I think I've learned to anticipate the nagging and punishment, streamline my work, become more efficient, formulate quicker plans, and actually become effective at PRACTICING medicine. I think there is less stress in residency because you aren't studying to ace that next exam or practical. Every day is a practical and each patient is a new board question. You learn to manage as effectively (and efficiently) as you can to make the day go by. I find that I am actually wanting to learn more for the sake of need, then feeling like i have to learn for the sake of a test, which is quite rewarding for me. The learning curve is very steep and can be overwhelming at times, but is the best education I have ever recieved.

EM residency is tough because each month there is a new field of medicine to practice, new systems to learn, new nurses to meet and endure, new residents with new expectations, and different challenges that you never learned in medical school but are expected to have mastered because of that MD behind your name. Think about starting a new residency each month for a year - that's sort of what it is like. It's like third year of medical school on steroids with the responsibility that comes with being the MD.

Don't expect to know anything from medical school when you start, and don't make any comparison to school. Residency is an animal that will take you time to tame - but it will be your best pet for you to love and snuggle with.

I'm done with the after school special analogies - get ready for a ride...

perhaps you should reread the original question

 

[NinerNiner999]

DOH 😱 😱 - and can you believe I just inserted a central line? I'll answer the real question in a couple years...

 

[spyderdoc]

It's basically like residency, except you don't have to report to an attending and you get a ****load more money. Of course by the time you pay your new fat mortgage, new fat car (gotta get the M3), and your med school loan payments, you are actually making about what you were as house staff. So I guess the real difference is the fact that you actually have to be responsible for your own ass....
I suggest you do some moonlighting if you can to help with the transition. It really helps build confidence and clinical skills....

 

[docB]

The toughest part is getting used to not having anyone looking over your shoulder. When it hits the fan you can't turn around and ask "What should I do?" I started worrying about liability a LOT more. There's also no one to pick up the slack when you get overwhelmed. I found procedures to be a BIG problem. In residency if you have a cool procedure it's fun. In private practice it's a pain because the rest of the ER and the new pts don't stop. I found that when it was bad I'd literally have to hold most of my procedures until the end of my shift or 'til my backup came in. Then I'd turn into procedure doc for a couple of hours.

 

[Sessamoid]

The previous posters pretty much covered my thoughts on the question. I would second the advice to do some moonlighting before you graduate. I also worry about liability a lot more than I did in residency.
I'd also advise you to take a job where you'll be at least double-covered for part of the time when you first get out. Working in a single coverage situation is exactly as docB described. I often had to postpone procedures for hours until the flow of sick patients slowed down, often until just before (and sometimes after) shift change. I can't say I particularly enjoyed working single coverage.
You'll also become a lot more aware (and probably annoyed) about the business side of emergency medicine. Once you get out of residency, there are a boatload more distractions from your primary responsibilities of taking care of patients.

Please excuse any typos as I'm posting this from my Treo650.

 

[docB]

Sessamoid brought up the business of EM part. I can't believe I forgot about that. As a resident you don't worry about it but as an attending you have to think about billing, how your documentation affects billing, how many pts per hour you're seeing and so forth. It's complex but you have to get to know it. Actually you're motivated to learn since it affects your bottom line. We all wish it wasn't like that but it is.

 

[Sessamoid]

BTW, to the OP, is your nickname a WoT reference?

 

[aphistis]

BTW, to the OP, is your nickname a WoT reference?

That'd be a hell of a coincidence if it isn't.

 

[Sessamoid]

That'd be a hell of a coincidence if it isn't.

Yeah, I guess, but I haven't read any of Jordan's books in ages, and I wasn't sure if I had the right source.

 

[EMDrMoe]

Thanks, niner, even though you didn't read the initial question 🙂 I'd been wondering about residency and how it feels. Your post really helped spell things out. So, it definitely served a purpose, albeit not the originally intended one!!!