From Med School to Residency & Beyond: Reflections on Being ‘Almost There’

  • /Reviewed by: Amy Rontal, MD
  • The new year is upon us. And the changing of the calendar page is a perfect allegory for turning the pages of our lives. This will undoubtedly be a big year for you – because you are one year closer to being there. Throughout college, medical school,  and residency, there’s an arduous journey, all with the purpose of getting “there.” We tell ourselves things like “Oh, when I’m an attending…” We can fill in the blank with whatever truths or fallacies we like.

    I started with Med School Tutors many moons ago as an eager, if not idealistic, medical student. The joys and pains of residency are now behind me, and with only six months of fellowship to go before I truly am out on my own, I can’t help but think of the next step. It will be the culmination of a near decade-long journey through medical school and training that has all led me here to this. I’ve collected a number of thoughts and conclusions along the way that I thought might give readers some insights into what can be expected. Enjoy some unsolicited wisdom!

    This is it? vs. This is IT!

    As the time came along for me to go on job interviews, I got to see how surgery and anesthesia were conducted at a private hospital, removed from the comforts and familiarity of my home training institution. No longer was I standing in the ivory tower of academic medicine, but rather seeing how the “outside” world does what we do. And for most intents and purposes, it was ostensibly the same. For better or for worse, it simply seemed like just another day. My 13 years of higher education was all leading here to do THIS. There was a comfort in seeing that it was something I was ready for and had been well trained to do. But at the same time, there was a realization that in the end, it will be a job. Sure, an incredibly rewarding, intellectually stimulating, important member of society sort of job….but a job all the same. Much like the transition into adulthood, there’s a gradual organic change and accrual of responsibility over time.

    Working a lot – The new normal

    Somewhere along the way, if haven’t already, you will realize that throughout medical school and residency, you have to work a lot. No two ways about it. Is completing training going to change that? In the sense that you will still have to work a lot, no. Even when all of the scut work is said and done, you will still be working a lot. Even if your clinical demands are curtailed from the 80 hour weeks you became accustomed to, there will be administrative duties to handle as well. And as you transition through phases of life, there will be other demands placed on you outside of work, like balancing ever-changing finances and growing a family, should you choose to. Luckily, you’ve no doubt built some gumption that you will carry with you throughout life. It is a GOOD THING to have forged a tireless work ethic and stamina for being brilliant in your 20th hour on your feet. Being tougher and more resilient is no sin.

    Mo’ Money, Same Problems

    They say that having a lot of money only solves your money problems. And some have even questioned whether that’s true, as so many financial problems are related to behavior and decision making rather than the lines on the bottom of the balance sheet. Regardless, it’s hard to argue that for the same amount of work, it is better to make three to eight times more money than you are making in residency. And certainly better to take home six-figures rather than paying five-figures annually to attend medical school!

    Start building good financial habits early on. While it can be difficult to make ends meet when cash flow is non-existent, building a healthy attitude towards money, spending, and finance while in the red will save you boatloads when the ship comes in.

    Also remember that money doesn’t cure misery. Go into a field where you love the day-to-day, rather than merely chasing dollar signs. Yes, it is certainly important to make sure your chosen career is financially sustainable, but make sure you enjoy it and are in it for more than the money.

    The light at the end of the tunnel?

    So often, our attitude is geared to “getting through” something, surviving a hard time with the promise of future salvation. I just gotta get through this call, or this year of residency, or training altogether, then and only then will life be grand. I’m here to say, don’t put a blanket statement on five to 10 years of your life, discounting them with your breath held and your head down, as something to “get through.” You should appreciate the successes and tribulations of every step of the way. You have to find some way to pull some enjoyment from the day-to-day, even when it feels like drudgery. If you set up a mentality that the next three, five, or 10 years are going to be terrible, but then things will get better, you are creating a self-fulfilling prophecy that the path will indeed stink. Make sure that the path of training has some joy in it, with positive relationships, personal growth, and outside interests. Rather than having a light only at the end of the tunnel, make sure the tunnel itself is lit.

    While the hand holding ends, it is very rare to be “on one’s own”

    It came time to look for a job, and for the first time, there wasn’t a huge governing body to upload documents into that would tell me where I would be working. There were so many considerations! Shady practices to dodge, malpractice definitions to interpret, partnerships, buy-ins, benefits…There were no deadlines listed or help desks to call.

    This autonomy and necessity for self-sustaining ambition is a perfect analogy for becoming an attending…it would be my name at the bottom of the chart. Rather than calling on my attendings for guidance, people would soon be calling on me. It remains a daunting thought, and I’m told that the first phase of being an attending is fraught with concern and uncertainties. But it will be a rare occasion when you are truly on your own.

    You have mentors and colleagues – people that have been in very similar situations and have navigated them successfully. Call upon them to help guide you through this personally uncharted territory.

    At a recent echocardiography lecture, I asked our attendings “What do I do when I see a finding that I have no idea what it is, despite my training and certifications?” They replied “You call us,” and explained how they get phone calls and FaceTimes from previous fellows soliciting their help. You should be building a network of mentors and colleagues who you can trust and respect. Sure, you might be the most qualified person to do your job in a 50-mile radius…but you will not be “alone.”

    I hope these reflections paint a realistic expectation of the path ahead, and give you at least a touch of actionable advice to make the experience slightly more awesome. You are getting to learn the practice of most real and necessary subject in the world. Take the responsibility seriously, and allow it to foster your growth as a human being. You are receiving a gift like none other.