Originally published in the July/Aug 2020 PPMA Newsletter

By PPMA Board Member Christine Nolan, DPM

It is that time of year. Residents are graduating and becoming attendings, joining the ranks of full immersion into practice-hood. It is a transition, and for myself and I am sure others, it’s a jump. You go from having a safety net to jumping off the trapeze without one. Often times as a resident, life seems so certain. You have all the answers to questions, you are prepared, but the reality remains that final decisions lie in the hands of another. 

As I sit here and start to write this article, it’s almost 8:00 p.m., and I am waiting for two add-on cases to go. I have already had a full day of clinic patients, and our Neurosurgical team just bumped me. Things do not always improve once you are an attending, just so you, as new residency graduates, know. 

As an Attending:

• You will be stretched beyond whatever limits you thought you had;
• Former instincts begin to flex;
• Things you once thought to be absolute are not;
• You will seemingly learn to doubt yourself and trust yourself simultaneously; and
• Grow at what seems like a staggering pace.

I want to share some of my insights I have gained since becoming an attending not that many years ago—

Breathe (something I wish people had told me). The transition from resident to attending is greater than from student to resident. Not only are you managing patients, performing surgeries, dictating charts, and teaching residents, but also you are getting to know the ins and outs of both your practice and your hospital system. 

You will struggle. You may have failures and disappointments; these will resolve. You will become more accomplished, faster, smarter, and more flexible. It is important to understand and not be too hard on yourself. Take a breath. 

Use the resources of your past and your present. Reach out to residency attendings and co-residents. You have not isolated yourself from where you have been, you have merely acquired more resources. With modern technology, information can be shared at rapid paces. Take a few moments to step away, open a book, look online, text a friend. Though you are the point for the final decision, it does not need to come in isolation. Use your new resources as well; talk to your partners, setup a day or a month with them or local doctors to discuss complex patients and complications. Get to know your colleagues around you. 

Don’t give up. There are going to be those days. Every patient has a problem or complication and nothing seems to go right, but don’t give up. Hold on to your successes and learn from your failures. Complications tend to fatigue you both physically and emotionally. You question yourself as a provider. Know this: Everyone has complications. If you are a surgeon, you will have failures. Accept them, learn from them, but be determined to make your-self better because of them. Don’t hide them from yourself or your patients. If you do, they will grow. You will lose trust in yourself, and people will lose trust in you. 

Be confident. Your staff and those around you will see that. Your patients will see that. Prepare yourself and know what you are doing, even when you’re not sure of it yourself. Don’t shy away from cases because you’re new and don’t yet feel capable—get comfortable. You are never going to get competent until you do them. If you want to gain some confidence, ask a partner to scrub, do a cadaver lab, read and  watch videos. Do what  you need to in order to gain confidence. If you don’t, how will you ever get there. Always continue to seek and learn and to do the best for those you serve.

Don’t watch the clock. How long was the tourniquet time? How far am I behind on my schedule? What time is that next case? In the beginning, you are going to be slow. Your tourniquet time is going to be longer than you want. You are going to get behind in your schedule. Trust me when I say, you will get faster. 

As you start out, your focus should just be about doing what is best for the patient, not time. Don’t let anyone taunt you for how long it took or how far you are behind. Did you do what was right for the patient? Are you giving each patient the attention his or her condition needs? Then nothing else matters. Focus on your patients, your skills and the rest will come with time. 

Don’t expect yourself to be “first-rate” after one day or even one year. Success won’t happen overnight. We all have to start somewhere. I hope that you will read these tips and know, we’ve all been there, and we as your colleagues welcome you all.