Medical people know that July is a pivotal month. Things change, big time.
In the academic world, July 1st is the day when graduated medical students wake up as doctors. Well, at least officially an intern is a doctor. I seem to remember internship feeling like a demotion.
In my world of private practice, July is when you start seeing new faces in the hospital. Young faces, which, sadly, look younger all the time.
My colleague, Dr Wes, recently posted about the other side of July, in which new doctors, especially specialists, enter a much different medical arena. He contrasted the good-old days, when specialists happily delayed gratification, knowing that a lucrative and respected private practice job awaited, with the current medical climate. Some might call Dr Wes’ position on the current climate a tad pessimistic.
He rightly describes the likelihood that specialists will be hired by a large hospital rather than a small group of established doctors. He also points out that hospitals face an increasing degree of uncertainty. Will their referral sources continue? Will procedure volumes justify new specialists’ salaries? He adds a cold wind to an already rainy parade, by reminding young specialists that their large loans that will soon come due.
His advice to new specialists: Rent, don’t buy.
Now, you all know how I feel about pessimism. Such gloomy thinking only accelerates inflammation—which causes sticky platelets and irritable arteries.
Let me add to my esteemed colleague’s advice with an additional five, slightly more optimistic nooggets of wisdom for new doctors entering the private world.
1. Ignore your pay-stub. It is true, unless you were a heck of moonlighter, you just got a pay raise. Congratulations. But, I implore you to keep living as if you were still in training. Drive an inexpensive car. No, check that, embrace that clunker like it was a pink phone case— something that sets you apart. Don’t add to your debt by buying a huge house. Say no to the country club. Live close to the hospital. Use the extra monthly income to pay off loans. Think of the word: cushion.
2. Keep an open-mind: Yes, we know that you are up on the latest techniques, having seen, and perhaps even used the latest laser, balloon or robot, tools that our hospital cannot afford. You are also well-versed in spread-sheets and abstract writing, and you probably know many well-published people—maybe your former teachers were “thought-leaders.” That’s great. Nifty even.
But the thing is, now you are on your own. That humble technician scrubbed-in with you has seen many young docs flail. She has seen the mistakes you are about to make. Listen to her, respect her, pretend she is a professor. She wants to help you; she will help you, if you let her.
Likewise, the older docs around the hospital will help you too. Though many of us trained when procainamide was still available, and taking night call meant carrying a bag-phone around, we have probably done your primary procedure 7,399 more times than you have. We have limped out of the hospital in dismay after causing the complication you have yet to cause. We look at your newness with envy. We want to learn from you. You have capital, don’t blow it by acting too much like a cardiologist.
3. Be nice to people. Not just the obvious people, like the woman who sets out lunch in the doctors’ lounge or the procedure schedulers, but everyone else too. This hospital will be your new home. You will see these folks at the grocery, on the ball fields with your kids and soon enough you will need medical care—sooner if you are a bike racer. You are the new kid in class, people want to make friends with you. Let them.
4. Call your referring docs. To folks of my era, this came naturally. The phone call to the referring doctor after a consult or procedure served two purposes: one was to keep the primary care doc in the loop, and the second was to introduce yourself, and perhaps your new specialty. (For me, electrophysiology barely existed in 1996.) But now, the alliances between hospitals and doctors act to create barriers between medical colleagues. I would urge you to call a primary doctor even if they are owned by another institution. Not only because it is right-minded, but also because the changing marketplace may soon make partners of you two.
5. Have fun. Don’t let the checklists, forms, protocols, cubicle-doctors and metastasis of quality measures get you down. At the end of the day, your special skills which came from years of hard work will ultimately help you better mankind. This is a large treasure indeed. And it is immensely fun.