Life as an Attending: First impressions!

Life as an Attending: First impressions!

By: LifeofaMedStudent

Residency ended late June and I’ve officially been on the job for about 10 working days now. The transition has been interesting! There have definitely been things that surprised me, a few that didn’t, and a few things I’ve missed leaving residency. Here are the first impressions of my new job out of anesthesia residency:

It’s a very busy time of life:

I can’t believe how busy the start has been – and not a lot of it to do with actual medicine. We moved in late June to a new house 1.5 hours away from our residency location. We are mostly “unpacked” but I wouldn’t say completely settled – as we are now in the phase of organizing and hanging things. One garage space is still taken up by things that haven’t found a place in our new home yet. Oh and our old house back in Indianapolis has not sold yet – so I’m driving over and keeping that yard mowed once a week. While the housing market is up a bit, I still lean against buying a home during residency (maybe for the hassle alone, let alone financial risk).

Then the other big issue I’m facing is my coming anesthesia board exam – July 28th. This is a “big one” (actually, aren’t they all?) and composes the “written” exam of the process for board certification. While the pass rate is fairly high (I think 85-90%), I certainly don’t want the headache, embarrassment (imagine telling my new partners I failed), or cost (it’d be another $1000) of failing. As such, I’ve been trying to study about 30-60min each morning and 30-60min each night which is pretty hard given everything else.

Lastly, of course, is a new job – which I’ve had to learn a lot of things on the fly. Billing/coding is completely new, but luckily the EMR is one I’d used in residency. The OR suites are different, the surgeons are different, all the nursing staff is different, the pharmacy system is different. It’s just been a lot new faces and trying to remember where everything is. I think the most challenging aspect has been trying to still be fast/efficient, while not making mistakes – both medically and paperwork-wise. Because of this, I’m getting there a little earlier and staying a little later than I probably will need to in a couple of months.

Massive Academic Center to Smaller Community Private Practice:

Holy cow the difference! Almost all of it has been very positive. I went from being one of about 70-80 anesthesia residents alone (literally thousand+ residents in the system), to one of maybe THREE new docs the entire hospital hired the last month. As such, I’ve gotten quite a warm welcome which has been incredibly nice.

My orientation day was basically just a special “physician liaison” walking me around the hospital and introducing me to people – including the hospital CEO – who incredibly dropped what he was doing and spent about 10 minutes talking to me. Then the physician liaison took me out to an upscale sushi restaurant and basically asked me a ton of questions to see if there were any areas that I (or maybe more importantly my wife) would be unhappy about in this smaller hospital/city. Luckily since I started my training here, and my wife is from here, I don’t expect any lifestyle issues.

Between the physician liaison, the real food (breakfast AND lunch) in the physician lounge, and getting some face-time with the hospital CEO on my first day, I was really impressed. The entire day was focused on making me happy there permanently.  I really felt welcomed and “at home” in a many ways!

Of course, I can’t say everything is as good as the giant academic center I left. The equipment is about 2-3 years behind, but still pretty good. Some of the techniques are a bit behind as well. The surgeons are very good but certainly less specialized.  In residency, we always seemed to have the latest and greatest equipment, techniques, protocols. Now, I’ll probably have to get used to having the “iPhone 6” of ultrasounds after the “iPhone 7” has launched. This is something minor though I can certainly come to accept. 

Practicing:

I’m probably lucky, in that I feel I’m very well trained coming out of residency. Coming from a major “clinical” program that gave you plenty of autonomy, I am finding most days are running well. I also am joining a small but very experienced group that is happy to lend advice when needed.  In an instance or two, I already haven’t hesitated to ask. 

One partner of the group gave me some particularly memorable advice. “If I kill a patient, everyone will blame the patient and then forget about it. But I’ve been here years. You’re new. And if you kill a patient, they’ll blame you and remember it. BE CONSERVATIVE!” So while I know I’m probably at the peak of the Dunning-Kruger effect, I’m trying to be confident yet simple and conservative in my patient care. So far that mindset is serving me well.  

It amazes me how much slower/clumsier I am with simple routine tasks but with new/different equipment. This has probably been the most frustrating part to me personally when technical skill has usually been one of my stronger points. I expect this will pass in a few weeks, luckily. 

One thing that has not changed much is the number of hours I work. Our residency was pretty good to upper levels even at a massive program. Because of this towards the end, I was usually only logging 50-60 hours a week, at max. Now as an attending, I’m probably going to come in around 50 hours/week most of the time – which isn’t exactly a huge drop-off.  The big difference will be that I get to go from 4 weeks of vacation a year to 8! My first week off is already coming up to study for boards preceding the exam. 

What I miss:

The biggest part of residency I miss is the people. Residents, attendings, and definitely the nursing staff. Those relationships take years to build and while I have no doubt I’ll make similar connections and build similar professional relationships – starting over is certainly daunting. I had a lot of fun in the last few months of residency because I knew the attendings and nurses I worked with so well. Patient care is also an aspect to this, as you learn nurses you can trust and be an extension of your care without worry or second thought.

Financial:

I just thought I’d put a quick update on some of my financial plans now that I’m an attending. The first thing I’ve done is set up my paychecks to max out my 401k in the next 5 months. This is to insure I get the full amount held ($18,000 in 2017) and also the max of our group “match” by year-end. I’ve likewise set up to max out our family HSA in 3 months to be available in case of need.  I’ve already increased my disability insurance coverage to around $18,000/month through policies from Principle and MetLife.

We purchased a new home, which is definitely an upgrade. I did this through a Physician Home loan via Regions Bank which I am very happy with. We wanted a home that we could stay in for a decade and grow into. We did go a little bigger/better than we need now. However, we stayed to a strict <1x yearly salary which we more than easily achieved thanks to moving to a low cost of living area.

By the end of 2017 I have the following plans:

• Increase my term life insurance coverage (currently at 1.3 million total, want to go to 3.3 million total staggered for 10-30 years).
• Add 2 million in umbrella insurance. 
• Private refinance my student loans and plan to pay off within 5 years (currently at $225,000 and counting).
• Pay off the credit card debt we have from losing my moonlighting job and moving/new house expenses (~$15,000 at 0% interest x 18 months)
• Max out backdoor Roth IRAs for wife and I ($11000 combined)

I hope to keep driving the old Honda for as long as possible and do not plan on making the mistake of a new BMW like I almost did at the end of medical school. While I know our spending will increase slowly, the goal is that our day-to-day living changes as little as possible from residency, for as long as possible, to put us on the best financial footing possible. Likewise, I’ve already found out about the potential for extra home call coverage at a small rural access hospital. Early on, I’m going to pick up as much as possible to add some additional income to meet early financial goals. 

Lastly, I’ll say this – for all the talk of physician unhappiness – I still find it very rewarding, both as a profession and especially financially. My first paycheck was for only three days of work, and was already more than AN ENTIRE MONTH of residency. There will be more and greater expenses – taxes, student loans, catch-up retirement savings, and insurance products especially – but being an anesthesiologist in a smaller community is certainly a financial blessing when paired with a little restraint and the right mindset.

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