You have recently graduated residency or fellowship and it is now time to start your first job as an attending. You are filled with mixed emotions, which may include excitement (to finally get to this stage), relief (to no longer be at the whims of medical training), and nervousness (to be “on your own”). All very valid and all very real feelings. Here is some insight to help you with the transition from training to attending-hood:
First of all – congrats!
In medicine we often do not take the time to pat ourselves on the back and it is important as you go into this new stage that you take pride in what you have accomplished. You have completed years (no.. decades!) of training. You have gotten through more transition periods than we can list and just know this is just another adjustment period. Congratulations on everything you have accomplished to get here!
Trust your training, but know no one knows it all
Imposter syndrome can rear its head at any time. It is easy to question ourselves and our readiness to be taking care of patients on our own, but at the end of the day, trust your training and your ability to work-up patients. Your program allowed you to graduate for a reason; the American Board of Dermatology certified you for a reason. You know so much dermatology and can truly help patients.
However, part of trusting your training is also knowing when you don’t know something and being okay with that and knowing what to do next. You have to make peace that even the experts in the field have not seen everything and so it is only right that you will cross paths with patients that stump you. When this happens reach out to your support team (see below) and spend your time outside of work trying to put the puzzle together. Patients (for the most part) are very understanding of saying “you know, I think I need to spend a bit more time with your case. Let me go do some more investigating and let’s touch base again next week.” Take the biopsy, order the labs, read the Bolognia chapter. There is this pressure to feel like we have to give patients an answer within their appointment slot, but that is not the case – it is okay to take your time as long as there is no imminent threat. Patients just want to know you care and are willing to try and help them.
Find your dermatology support system:
While being an attending means you are seeing patients independently, it does not mean you are alone. I cannot overemphasize enough how important it is to have colleagues you can reach out to in times of need. Think of all of the times even your attendings in residency pulled in another attending to take a look at a case. The support system can come in a variety of different ways:
- The other attendings you work with at your practice. Before you even get started, you can approach them and ask them what their thoughts are about being pulled in to see a difficult case when one comes across your schedule. You can also see how they feel about sharing the patient’s chart through the EMR for them to take a peek. Most of the time, they will be understanding and wanting to help a new graduate and a new co-worker. However, sometimes the clinic may not be conducive to this (solo practice, busy clinic, days off, etc.).
- Also shadowing one of them before officially starting can be helpful if you are not familiar with the specific flow of the clinic you will be joining!
- The attendings from your residency program. I have found that although you may now be in another state, the attendings from your residency program are some of the best mentors and now colleagues to reach out to. They have dedicated so much of their time during your residency to training you and want to see you succeed on the other side. I can almost promise you you are not the first graduate to ask them for their insight.
- Your co-residents! This may be your residency class or even the residents who graduated before or will graduate after you. Those from your class are probably experiencing the same feelings as you and would love to bounce cases off you as well. Form group chats, have zoom dates, have after-hours phone calls. Being able to lean on each other is so invaluable.
- ClubDerm! You are a part of ClubDerm and already have such a wonderful network through this organization. We are all apart of ClubDerm because we want to help each other grow and succeed. You have a built-in support right here.
- Societies and conferences – such a great place to make connections and ask questions. The learning never stops!
- Facebook groups – there are many groups that will accept you once you become board certified. Dermatologists really enjoy helping one another and this is a great way to stay connected, even when you feel separated. Just remember – you are never alone.
Find your dermatology support system:
While being an attending means you are seeing patients independently, it does not mean you are alone. I cannot overemphasize enough how important it is to have colleagues you can reach out to in times of need. Think of all of the times even your attendings in residency pulled in another attending to take a look at a case. The support system can come in a variety of different ways:
- The other attendings you work with at your practice. Before you even get started, you can approach them and ask them what their thoughts are about being pulled in to see a difficult case when one comes across your schedule. You can also see how they feel about sharing the patient’s chart through the EMR for them to take a peek. Most of the time, they will be understanding and wanting to help a new graduate and a new co-worker. However, sometimes the clinic may not be conducive to this (solo practice, busy clinic, days off, etc.).
- Also shadowing one of them before officially starting can be helpful if you are not familiar with the specific flow of the clinic you will be joining!
- The attendings from your residency program. I have found that although you may now be in another state, the attendings from your residency program are some of the best mentors and now colleagues to reach out to. They have dedicated so much of their time during your residency to training you and want to see you succeed on the other side. I can almost promise you you are not the first graduate to ask them for their insight.
- Your co-residents! This may be your residency class or even the residents who graduated before or will graduate after you. Those from your class are probably experiencing the same feelings as you and would love to bounce cases off you as well. Form group chats, have zoom dates, have after-hours phone calls. Being able to lean on each other is so invaluable.
- ClubDerm! You are a part of ClubDerm and already have such a wonderful network through this organization. We are all apart of ClubDerm because we want to help each other grow and succeed. You have a built-in support right here.
- Societies and conferences – such a great place to make connections and ask questions. The learning never stops!
- Facebook groups – there are many groups that will accept you once you become board certified. Dermatologists really enjoy helping one another and this is a great way to stay connected, even when you feel separated. Just remember – you are never alone.
Meet with your medical assistants early and often:
Whether or not it is what you signed up for, managing people is now a part of your job description and is important for a happy and productive clinic. Your medical assistants may be new and will be looking to you for guidance on the role and what dermatology actually is, or they may be seasoned and will be the ones teaching you and helping you in immeasurable ways. Every attending does things a bit differently and has a different expectation and if this is not discussed or open to discussion it may lead to clashing. It is important to meet with your team before starting and discuss your expectations and flow and ask what your team might need from you as well. You really are a team with a common goal of providing patients with the best care possible. Be open to giving and receiving feedback. Also, do not be afraid to voice what you might need for success to your office manager or the clinic partners.
Having read this means you care and want to do the best for your patients, your team, and yourself. Take a deep breath, trust your training, and lean on your support system. You’ve got this!
