Transitioning from Doctor in Training to Attending Physician

NOVEMBER 14, 2016
InvestingDoc
Making the jump from a doctor in training to attending physician was one of the most stressful transitions that I have made yet. Now that I am almost six months into a new job, I thought it would be a good time to look back and reflect on the financial, emotional, and workload of what it means to be a new physician. 

Learning curve

Change can be hard to conform to. This is definitely true when the change is going from a resident or fellow to attending. New hospitals mean a new way to admit patients, new EMR, and a new system of how to call consults. The practice of medicine and the grunt work of treating a CHF exacerbation is, of course, the same. However, it's the little details, like who is the case manager and social worker, who can help me find a nursing home for this patient that take up extra time. The learning curve to navigate the hospital system to ensure the quickest and best treatment for my patient was larger than I thought. Maybe I was a little too confident when going to a new job since I trained at four different hospitals and thought I was prepared for anything.

Another aspect of the large learning curve is being comfortable covering 30+ patients on a day where, for whatever reason, many other people with the group may be off. Being primary for 30 patients while still taking admits and doing discharges was a huge learning curve. Time management became crucial during these periods of times. Five extra minutes on something behind the scenes per patient, such as figuring out where stress tests are at in the system, can add up to huge amounts of time when carrying 30+ patients.

Time spent at work
There is a lot of debate online about duty hours and its effect on new physicians. Since I have only gone through residency after the duty hours have taken effect, its hard to compare it to the "old" method. My only glimpse of this was when I was able to moonlight and would work the occasional 48-hour shift over an entire weekend as a resident. Gone are the 28 hour calls every third or fourth day for up to four or five months out of the year. In its place are several 16 hour shifts that, at times, can be quite taxing but no where near as intense as the 28-hour shifts.

Overall, I find that the shifts as an attending are much easier compared to residency. I have been finding myself spending much less time in the hospital while still spending more personal time with patients. Not having two hours of lectures a day and two to four hours rounding with the attending in residency on wards really frees up my day to spend that extra time with patients each day that I truly enjoy.

Stress
As an attending on general medicine wards, I will admit that the stress level now is much higher than when I was a resident. There have been many nights where, even though I go home early, I have been waking up in the middle of the night checking repeat labs to monitor that patients hyponatremia to ensure that the sodium does not overcorrect. Despite me being home more than when I was a resident, I find myself sleeping much less and experiencing anxiety before a new shift. The only time in residency I had this type of feeling was when I was on nights alone in the ICU or taking neuro stroke call (our program required this). My stress levels have gone up dramatically post residency, but they have also drastically improved. At the time of me writing this article, I will admit to some level of anxiety before a new week of work, but nothing compared to what I had when I first started.

Waiting for a paycheck
The light at the end of the tunnel is, for some, the attending paycheck. After all the hard work and over $100,000 in student loans, I would be lying if I said I was not excited about the prospect of a much larger check. My contract clearly stated the terms of how I was to get paid. The contract is based heavily off of RVU after submission of bills by the provider.

While in residency, the attending does all of the billing. We were able to practice what codes we think we could bill for, but in the end, they would be the ones interacting with the companies. Somehow I missed the fact that it usually takes four to six weeks for payment to come in. This oversight on my part left me without a paycheck for the first two months of my job.

To get by in the meantime without a paycheck, I opened up an interest-free credit card that I have since paid off now that I had several paychecks come in. Despite me saving three months worth of expenses, I still ran out of cash about a month too early. I dramatically underestimated how much it costs to move to a city that has a higher cost of living.

Bureaucracy
The paperwork, meetings, and training sessions did not slow down as an attending. Many of the older attendings grumble at a lot of this work, but this has never changed for me. From undergraduate education to now I have been taking numerous surveys, attending meetings with no clear goal, and online training sessions. It's the only world I know and have just accepted it at this point. Even my friends who are in other fields say that they have to put up with the same stuff, so I'll just accept that this is just a fact of life at this point.


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