What I wish I had known coming out of residency

Nicholas Kusnezov, MD, reflects on his experiences since residency and what he wished he had known as a new attending surgeon and as a physician new to locums.

In residency, you grow increasingly fearless. As you ascend in your training, you tackle more difficult cases and take on more complex patients. Ultimately, you get comfortable in a well-established system, operating under the purview of your staff. Unfortunately, comfort begets complacency, and when your training ends, you are for all intents and purposes on your own.

You learn the most about yourself the first year out. Your comfort level, your competency, and your tolerances. That being said, there are a few items of major importance that I wish I anticipated coming out of residency that would have made the transition easier.

Don’t expect help

The first thing I would say is do not expect any help. Beyond that, expect that not only will you not have help, but forces will seem to conspire against you. As a staff of mine once said, “saboteurs are everywhere”. While that might seem cynical, it prepares you for the worst. And if you expect the worst, you will not be unprepared.

As a locum, you will often find yourself in situations where you are understaffed and the staff you have are underqualified. Academic institutions, such as the one you trained at, generally have almost every fixing and level of support conceivable. Out in the real world, you will find that you have far fewer back-ups and contingencies beyond those you anticipate prior to getting in the situation where you need them.

The longer that you are out in practice — ultimately on your own — the more you start to consider the “what ifs”: those situations where you require certain bailouts that you may not have anticipated beforehand. To be successful and to avoid disaster, you should remain versatile and expect the unexpected.

young physician and a patient

Know what you’re worth

The second thing that I would stress is that it is paramount to learn and know what your time is worth. Coming out of residency, any amount of compensation seems incredible, given the paltry amount that you were paid for the colossal amount of work you did during your training. However, you should realize that your time as a trained and skilled professional is worth a certain amount of money, the threshold below which you should not waste your time.

If you choose to work locum tenens, you’ll find a number of assignments will all present around the same time and offer different compensation structures. You should choose the assignment you feel most appropriately reflects your training and desired pay. That said, I would recommend stair-stepping toward this goal, and consistently working assignments with no less than equal compensation to what you received from the previous assignment. Additionally, if you have been regularly working an assignment for a period of time and are reliably the “go-to” physician for that assignment, then I would strongly recommend negotiating some sort of increase in pay if not a bonus structure.

Find purpose and value in what you do

Lastly, and perhaps most importantly, once you are out of training, you will lose the structure and framework that has guided you ultimately throughout your entire life up to that point. You have essentially been in school for most — if not all — of your life, and you are now on your own. As a result, and with this newfound freedom, it is imperative to find purpose and value in what you do.

When working locums, you should look for assignments that reflect not necessarily what you feel you should be doing but that you enjoy doing. This may be based on the case mix, location, or compensation structure — or more often a combination of these factors. For instance, if you feel you are (and always have been) more of a shift-worker, potentially selecting for solely on-call assignments could benefit you the most. This would give you time to decompress after the shifts. In any case, find a structure that is fulfilling on a personal level.

And make time for yourself and your family. Enjoy what you do.

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