Five years ago, as a relatively new staff physician, I had written a letter to my younger-selfas to subscribe some wisdom to the to what I wish I had known heading into residency. Five years later, I’ve realized that early staff transition phase had a lot of growth and learning, and I think there are some things I’ve learned about the practice of medicine that I wish I knew a long time ago. 


Hey you. It’s you. Here is another letter to yourself, because you’re older and wiser (although you may not feel it). Hate to break it to you; but the Flames haven’t gotten any better, but you survived a pandemic in the last few years, so take the wins where you get them. But listen.. 

 

Mentorship still matters

There will be a lot of people in your ‘panel of mentors’ that will influence your career, even after residency. They have valuable insights, and they provide you with good opportunities – be grateful for that, those people are really important to you. They often see things that you don’t through wisdom and clarity, so continue to reach out for advice as you start to advance your career.

You’ll start to recognize that your practice pattern is an amalgamation of many individuals – remember, the biggest predictor of how you will practice medicine is how you were taught, so this should come as no surprise. Be cognizant of this during difficult times or cases, the ‘what would so and so do’ is a really value tool! 

Pay it back – because there can be a lot of intrinsic job satisfaction gained through mentorship, its why so many people enjoy doing it (as opposed to be forced into it). Make sure your mentees know that you’re approachable, and that you are there to help them. Have them formally and informally, but use your insights to lend help where you think it may be needed, because it is very rewarding. Further to this; you’re a lucky beneficiary of a lot of sponsorship from mentors so pay it back! When you find opportunities or roles that others would shine in, open those doors for them. 

Learn to say no

We are so used to constantly jumping through hoops – to get into undergrad, med school, residency and then even to get a staff job. Once you’re a staff, the hoops don’t magically stop, and so its easy to get caught up in the grind of academia, especially as you work towards promotion. It is important here to recognize where your interests lie, so you can say no to things that you are not interested in, or things that you do not have the time for.

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I took on a research project in my first two years as staff, and soon came to realize I hated it. I had the opportunity to re-explore that area, but realized my passion on the topic was gone – research just simply isn’t for me. So I learned to find other avenues to pursue academic interests, and it turns out that is totally fine, carve out your own path.

We’re inherently trained to say ‘yes’ to opportunities, but make sure that there is a value add in your area of interest, and that it is something you have passion about, especially if it is going to be unpaid. As you cement yourself and your position/role it is important to recognize that you need to avoid unpaid work, because ultimately this is still just a job, and you have greater priorities outside of work.

It IS just a job

I say it often, but it took me a few years as staff to realize this; if something unfortunate were to happen to me (like I was hit by a bus); I would be quite replaceable at work but I am not replaceable at home. This helps set my priorities, in recognizing that I refuse to let a job make me miserable.

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I often see (especially nowadays) people ask ‘how is work’; and usually the commentary is quite negative. I’m very cognizant of this, because I do not want to feel or be made to feel like my job is making me unhappy or miserable. So I’m very deliberate in my approach to work and how I consider it, I take as much good as I can, because it it can become too easy for this job to grind people down. The House of God is a nice reminder of this dark side to medicine and that one can decide to live in that space, or not.

 

Learn something new every year

Physicians who survive a long career in medicine often ensure that they are maintaining some form of active and passive CME. I like to have a specific focus each year for something that I work on in my practice. One year it was reading my own CT scans, another was working on my cardiac PoCUS skills, and one year I picked wellness as my goal. These are important trend setters, and good to bring up in reappointment meetings to help hold you accountable to yourself. It helps to ensure you’re hitting your peak as a physician and optimizing the toolbox that you have.

It is also important to use this new staff time to engage the things that you used to enjoy, or have wanted to explore outside of medicine. Throughout your training, medicine has occupied so much of your brain as a ‘learning mandate’. It is wonderful to experience and learn new things without the pressure of an exam or evaluation looming over your heard – learning or doing something, just for you.

In the same light, its really important to re-engage old hobbies that you may have dropped (or new ones that you have wanted to pick up); engagement in hobbies results in a 30% decrease in depressive symptoms, a greater tangible benefit than any medications we have.

Take regular vacations

Vacations are important to help reset and ground you amongst the chaos that is prevalent in medicine. These are resetting, grounding and incredibly valuable. Its important to set aside this time to get away from the grind of work and life, to re-connect with family and friends, and recharge your batteries. Even if you have no actual vacation getaway planned, use vacation time well to optimize your schedule. One of the best things about being a staff physician is increasing control over your schedule (and perhaps one of the hardest things in residency is the complete lack of control here). Use it wisely. Make sure to book off important dates! Mothers day, birthdays etc. you often think, ‘meh, I’ll figure it out later’ – don’t do it, you always regret working these days.

..But also learn how to keep your tank full

Too often, we come back from a vacation feeling refreshed and recharged, only to work a few shifts and be back to a depleted baseline, with no vacation planned for a few more months. It is important to develop a system of personal agency in order to ensure that you are not completely draining your tank every time you work, because that is not sustainable for a long and healthy career in medicine. 

When you graduate, you’re still going to be skeptical about concepts of wellness. Citing that residency is hard; but everyone has to jump through hoops.. just be resilient. 

That is just you being naive; the reality is these concepts will become increasing more important to you, as you realize it is within your power to decide if medicine is going to hurt you are not. Engage in mindfulness and personal agency, because in the midst of a crumbling and damaged system – it is this that will ensure your self preservation. Sure, physicians shouldn’t have to focus on being so resilient, but the reality is that the system doesn’t care if you’re burnt out – only you do. So, make sure you take control over the variables that you can control to achieve personal agency

Don’t be afraid to phone a friend

There is often a sense of having ‘something to prove’ for new staff when they graduate. Remember, you don’t have to try and save the world, and there are lot of friends around to help. Whether it is a consultant to help clarify some nuance, or a colleague to look at a rash with you – there is always something around who is happy to help you navigate nuance. Medicine is vast and humbling – you will not have seen everything, and that is where experience can be such a valuable tool. 

Work smart

Don’t pick up work for the sake of picking up work (there’s a slippery slope where it becomes easy to justify purchases in terms of number of shifts ti would take to pay for it). Pick up high value work that either adds value (cognitively or financially) because chances are, you’re going to graduate and already be over-worked. So if you’re going to add.. make sure it has value. 

In the same vein, one of the best pieces of advice I ever received came from Dr. Lisa Calder (now CEO for the CMPA) – who told me to find how much I like to work, and build a lifestyle around it, rather than trying to work to match up with a particular lifestyle.

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Don’t be afraid to re-evaluate your practice

Early in your career, you will receive a few patient complaints that you may brush off because they happened during busy night shifts. But, there is a unifying theme – and it may take you a while to see that your communication style needs a change. Nothing drastic, but honing this will really help your approach with patients, and how you feel at work.

At some point in your training you heard that physicians reach their peak performance about five years after their exam because they have the maintained book knowledge, but they have acquired a lot of the nuance that lives in medicine through experience and seeing patients – let this principle guide your arc to learn and grow. You will hit a point a few years in where you feel comfortable in your style and practice pattern, and this confidence is useful. A good ER doc is humble, but has a bit of swagger, your experience will help you accomplish this but make sure you have an open mind to learning opportunities. 

Maintain a procedural skillset

There is a greater opportunity for procedures in residency, as a staff it is easier to pass it off to a resident or a consulting service. Try to find opportunities to do procedures when you can, because this will help you maintain your skillset, and remember that you’re often doing the harder procedures, where others were unable to do them. It is easy over a long career to let certain skills atrophy; so keep this in mind – because sometimes departmental pressures actually need to be pushed to the side to allow you to maintain competence with a rare procedure, or something that you haven’t done in a while. 

 

Compartmentalize with Reflection

Throughout med school and residency, a lot of focus is placed on your educational journey, and so there is almost a sense of privilege around what you are going through. Once you’re staff – its just life, its just a job. So it becomes important to compartmentalize what you do at work, as to not bring the toxic aspects of healthcare home with you. People can accomplish this in different ways, but what works for you is reflection. A post work debrief in the shower becomes a very valuable tool to analyze your shift, your performance, the cases you saw, and leave that shift in the past with a positive reflection. If the department is experiencing system pressures constantly, it isn’t helpful for your family to bring that home – so this skillset becomes critical for managing the stress of work and learning to leave it there. You’l see lots of colleagues that struggle with this; use that as a lesson for where you want your homeostasis to sit.

 

Make sure you enjoy it

Find the good, it does exist in medicine. Interesting cases, satisfying teaching experiences, strong patient rapport. This is the good stuff, and the reason why you went into medicine. Find a little bit of this every day, to ensure that you are enjoying your job.. because that is where career longevity comes from. Remember; its just a job, but its one that you actually really enjoy.

 

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