Parth Shah, DO
CO ACEP Fellow
Young Physicians Section
CO ACEP Board of Directors
July is nationally known as the month newly graduated medical students begin their residencies. However, it is also the month (August, if you take some time off) when new attendings start their careers, after they have completed their training. Just like the start of residency, starting your career as a new attending comes with its own set of challenges and a period of adjustment. Here are some tips (some may be familiar from starting residency) to help you transition into your career as a new attending.
- Introduce yourself to your ED team (nurses, techs, unit clerks, EVERYONE). These are the people that are going to be your support staff moving forward. Introducing yourself is any easy step to help start building rapport.
- Trust your training and your judgement. Coming across your first sick patients can be daunting since you no longer having an attending watching your back. BUT you spent years training in the specialty of emergency medicine, building up your clinical acumen and procedural skills.
- Trust your team. If someone from your team expresses a concern to you, take it seriously. That person is coming to you because they’re worried about something. Working in the ED, we pick up on patterns and can sense when something is off. Even if it turns out to be something minor, it’s better to address a concern rather than write it off and miss something important.
- Rely on your higher ups. If you’re stuck trying to make a clinical decision or must deal with an odd social situation reach out to your medical directors! Along with their administrative duties, they’re a great resource to use to get advice on a tough case or figuring out an obscure consult.
- Find your practice style. Do you want to be more cavalier or conservative? Use the first couple months to figure out what practice style you’re comfortable with, maybe it’s something more middle of the road. Overall, Emergency Medicine is practiced differently by everyone. This is an important time for you to find out how you want to practice for the rest of your career (granted your practice will likely evolve as the years go on).
- As a new attending, the buck stops with you. Ultimately you are liable for the patients in your department. However, this should not result in you over testing all your patients to avoid missing something. The unfortunate reality is that you will have misses in your career. A large part of our job is risk stratifying and trying to mitigate risk. Point 2 plays into this a bit. Trust your clinical gestalt and try to do the best for your patients. Extensive workups on all patients leads to increased utilization of ED resources, slowing ED workflow and unnecessarily increasing costs for patients.
Anecdotally, my first 6 months as an attending were definitely a huge adjustment, especially going from a large academic hospital staffed with many attendings and residents to being the single physician covering the emergency department at a community hospital. However, I think I grew exponentially as a physician. It was challenging but also one of the most rewarding times of my career. Although being on your own can be scary, take pride in that independence and over the true ownership you have in the care of your patients and management of your emergency department.