An All-Inclusive Guide to Making Your First Year in Practice Not Suck As Much As Wayfaring’s
Hi there, just curious if you’d share what things you were looking for in your first job vs what things you value now, now that you’ve been working out there on your own. Anything that must be in the contract that wasn’t there before (or vice versa)? Tips for future graduating residents?
Yaaaaasssss so many advices. So many things. This ask has been in my inbox for months because I have too many things to say about it and I can’t seem to organize it properly.
Let’s break it down into 3 sections: 1) What I thought I wanted 2) What I needed and didn’t know to ask/look for 3) What I want now. Here goes.
What I thought I wanted:
big dolla$$$
super sweet signing bonus
moving allowance
loan repayment assistance
regular 40 hour work schedule
nice patients
independence / autonomy in decisionmaking
ability to practice the way I was trained - with up to date guidelines and procedures and equipment
What I wanted and didn’t know to ask for:
Supportive colleagues - In your first year of practice out of residency you lose every ounce of confidence that you gained as a senior resident. You question minor decisions and are constantly afraid of killing people or being sued. It is extra hard to practice in a new town when your partners in practice are not supportive. Sometimes you need someone to lay a fresh set of eyes on a wonky EKG or a weird rash, you know? I didn’t have that option. It made me study harder and somewhat be more cautious and definitely more creative in my practice. But having a colleague to commiserate with at the end of the day or to consult on difficult cases would have been really nice. You don’t have to be BFFs with your colleagues, but they have to be people you can agree/get along with and trust to take care of your patients in your absence.
Friends - This sounds obvious, but I moved to a new town that literally has no people anywhere close to my age. Even having one person I knew and could confide in would have been wonderful. One person to go to a movie with or watch a football game with would have been a sanity saver for me. Find a place where you can find other people like you.
A reasonable amount of time off - I got less time off in my first job than I did as a resident. That was unacceptable to me. This would be fine if my practice didn’t act like they were going to go bankrupt if I took an unpaid day or even a half day to go to the doctor, but they did. You need a place where you can take one week off every 3-4 months if possible, even if all that time isn’t paid. Medicine is such a stressful job. Make sure they’re giving you rest time.
A non-toxic work environment - I knew going into my job that I was replacing a workaholic and that I was joining a workaholic. What I didn’t realize was that I was also expected to be a workaholic and anything less than killing myself was seen as laziness. Pay attention to the culture at your new job. Ask the docs what they do for fun or to relax and more importantly when the last time was they did that thing. If they don’t have any answers, they’re too busy.
Diversity. This may just be me, but I went into family medicine because I get bored easily. I need variety of patient types and disease types and socioeconomic groups and everything else. I realized quickly in my practice that most of my patients were privately insured elderly white people. As in, the most boring demographic for Wayfaring.
A Balanced schedule. I figured that when I joined a practice that had been established for 30 years that the workflow kinks would have been worked out and it would run like a well oiled machine. In reality I would have 8 physicals a day and 5 of my most complicated patients in hospital follow ups back to back, all scheduled for just 15 minutes. There has to be balance in the schedule. You have to be able to take a little extra time here and make it up elsewhere.
What I want now:
fair dolla$$$. In actuality, what’s fair is actually considerably more than what I was making in my first job. I was grossly underpaid, particularly considering this being a rural area where nobody wants to work (typically those jobs are paid much higher). It’s not about the bottom dollar value for me. It’s about compensating me in a way that is comparable to my peers.
Colleagues who can be both friends and mentors. See above.
Good benefits. Two years of no dental or vision sucks when your most expensive problems are dental and vision related. Life insurance and retirement plans aren’t something most 30 year olds think of, but they’re really important, and I didn’t have those to start with.
A flexible schedule. The whole world doesn’t need to fall apart if I need to switch my regular day off or if I need a half day to go to the doctor.
Administrative time. Preferably a full week day, but a half day is great too. I’m happy working 4 10 or 12 hour days a week to have one week day off to catch up on work I’m behind on or get my hair cut and get my taxes done and see my psychiatrist, you know?
Knowledgeable and helpful staff. I need staff who don’t perpetuate old wives’ tales and notions like “you need a zpack for that cold”. I need to work with people who will ask if they don’t understand something rather than just make something up and who can help me educate my patients. I need folks who are prompt and who can anticipate some needs.
To not be responsible for other peoples’ paychecks. In private practice, if I take time off or scale back, the practice loses money and thus our staff lose hours or money too. The staff in my first job were horribly underpaid and I don’t like the idea of the entire burden of the practice’s finances hanging on my shoulders. Sign me up for that hospital-owned practice, please.
To not have to turn patients away based on payer source. This is a national problem and is definitely not limited to my first job. But my first job wouldn’t let me take Medicaid patients at all. It made it completely impossible for me to build any sort of pediatric or OB practice in our town. I don’t like the idea of turning away a patient because their type of insurance doesn’t pay as well. I want to just treat patients and not have to worry about their payments. Hello, single payer healthcare system. Get on it! Obviously I will still have to worry about whether my patient can afford their meds or whether their insurance will cover their meds, but I won’t have to pick and choose what patients I accept based on their payer source.
To deliver quality, up to date care. To work with people who will back up my evidence-based decisions and not practice based on feelings and patient satisfaction. To work with people who will encourage me to learn more and do new things.
There you have it folks. A lil summary of what I want, what you might want, and what I’ve learned in these first (almost) 2 years of practice. Here’s to better future jobs for us all!
Reblogging for future review…thanks!
Probably one of the most important #medblr posts you can read while still in med school/residency. Thank you, @wayfaringmd for allowing your suffering to result in potentially-greater job satisfaction for the rest of us.
However: NO thank you, @wayfaringmd, for getting this ear worm of a song stuck in my head.
