The patient had arrived for a urology procedure with a blood glucose in
the 400’s. He suffered from a recent stomach bug and had gotten off schedule
with administration of his meds. While his GI symptoms had subsided, he was
feeling crappy overall. I decided to cancel his case and went about initiating
treatment to get his blood sugar under control. When I informed the urologist
of my findings and decision, he said, “Who’s your attending physician
today?”
“I am the attending.”
(Translation: I’M THE BOSS, today and every day!)
::: crickets ::: crickets :::
I work at the academic institution where I trained, and because of my sick leave I finished my training at a different time of year than most
residents, the news of my status change has been slow. Gradually, the surgeons
and nurses and techs are starting to learn, but I still get this kind of thing
occasionally.
There is a slight shift in the way that surgeons and other team members
treat you when you complete your training and become one of “the
bosses”. The difference could be one day from pre- to post-graduation, but
you will suddenly feel much more part of the decision-making team and less
of… well, a worker-bee. Don’t get me wrong, I have never been mistreated by
an anesthesia or surgery attending, but residents are not the ultimate decision
makers on the team.
The transition from resident to attending physician is full of challenges,
not the least of which is fully accepting the mantle of your new status. It
doesn’t matter your specialty (or even your profession, as many career paths
involve long periods of apprenticeship), this role shift can involve a great
deal of stress. How have I dealt with my transition? A few key ways:
1. Check the ego. Even though you have earned your
newfound status, you still suffer from a lack of experience. Like asking for beta from a climber who has mastered a route before
me, I (unapologetically) ask the opinions of my more senior anesthesia
colleagues in equivocal situations. It is a difficult balance to be direct in
your intentions without being perceived as making a power play. But if
extemporaneous speech is not your forte, read on…
2. Be confident. I’ll admit this is sometimes a
challenge for me, one that I got dinged for during residency and still struggle
with occasionally. When asked off-the-cuff patient management questions by my
attending supervisors, I would know what I wanted to say but sometimes stumble
on the answer. With a case cancellation or any other anesthesia-related
decision-making, you must be confident in your reasoning and able to
communicate that effectively to the other team members. This skill is the
cornerstone of our Anesthesia Oral Board exam (coming up for me next spring)!
How to work on confidence? Practice your explanations in your head, on paper,
to your spouse/dog/mirror, etc. If you ever catch me daydreaming during an
uneventful case or a grand rounds presentation, it’s likely that I’m doing this
in my head!
3. Focus on the basics. Although residency might be
(thankfully) over, we as physicians are never finished with training and
learning. There are still days when I am humbled by a challenging case, and I
don’t expect this to change. It inspires me to reference a text or review the
latest practice guidelines. Focusing on “doing anesthesia” and making
the right choices for my patients will lead to the best outcomes for everyone.
4. Foster relationships. A nice consequence of my change in
status has been getting to know the medical team members (especially the
surgeons) on a more personal level. Whenever possible, I greet them in the
morning and try to spend a few minutes going over some details of patient
management for the day, which makes for a smoother, more efficient flow
overall.
5. Remember professionalism. My Professionalism
APGAR applies not only to interactions with patients but also to any
member of the healthcare team. And of course, when in a stressful situation,
this is the first thing that suffers. While as an attending you may be
interacting with the medical team more directly, you still must maintain some
air of separation.
What about you? How does your current role cause you stress, and how do you
overcome it? If you’ve recently transitioned from trainee to “a
boss”, what changes (good or bad) have you noticed, and how have you dealt
with them? Share them here!
Maximize Happiness by Recognizing your Childhood Limitations
When I finished my otolaryngology training in the late 1980's, I stayed on as faculty at the institution where I'd done my training. It took a full cycle of residents- ie, the ones who were PGY1s when I was a fellow, graduating- before I felt like a real faculty member.
Karen, Thanks for your input! Another woman in my group has had the same experience. I don't know what component of this is a "young female doc" thing… I should ask some of my recently-finished male colleagues and find out how much it happens to them!