family practice issues and general life events

Posts tagged ‘medical’

To all those graduating residency this month (or close to anyway)

OR What I wished someone told me when I was about to graduate.

Congratulations, welcome to the world of medicine.  Does it seem a little belated?  After all you have been licensed anywhere for 2 to 5 years depending on your specialty, you graduated from medical school and have been officially a doctor for 3 to 6 years, not to mention the 4 years of medical school before that.  So while I grant you it seems a little belated, it is not.  You are now officially on your own.  There is no back up.

For the last 6 months or so you have been counting down the days, the nights on call, weekends on call, or some variation until you were done.  You have taken board exams, presented research and have either had a graduation or are about to have a graduation that is not quite like the ones from medical school and college, but they are still nice, and they are still a big deal.  (I seemed to have forgotten that, and didn’t think to invite my parents to mine.  Whoops)  But you have been counting down the days until your time in now your time and you don’t have to answer to anyone else.

And a funny thing happens, the moment you graduate, you instantly become one of us.  In a way you weren’t before.  Those that are staying close to the program that they graduated from will find it a little more amazing the change from resident to the next morning ATTENDING.  And for the easy stuff it is amazing.  Ear infections, I got that.  Hypertension, well I will use my favorite ACE or beta blocker.  You have bronchitis, and you will be super doctor until “What the heck is that?”  Well that is what you will be thinking, and you will have to stop yourself from saying “I am going to grab my attending to come in here and look at that.”  Because you no longer have an attending you are the attending.  So you will pull out your books or go online to your favorite site and you will figure out to your best opinion what it is.  And if you are right, you will be a hero, and if you are wrong well they will either return and you will try something else, or they will go somewhere else.  You are now the EXPERT.

But don’t think that you are alone.  I made that mistake.  The profession is quite willing to help its fellow physicians, you only have to ask.  Which EMR is best, ask.  Most are more than willing to let you look at their systems and try them out.  You need help with a case in the hospital, you can either officially or unofficially consult one of your colleagues, we love being asked for advice from fellow physicians.  Just don’t ask investment advice, some are really good at it, and some are really bad, best to find a financial advisor on your own.

Make sure you have a good accountant, a good lawyer and a good relationship with a bank.  Seems silly, but those will save you time and again especially if you are starting out on your own.  Rare now a days.  I did it 7 years ago, and it is probably due to the accountant and bank that I am still standing.  You didn’t go to business school, you went to medical school, but school and residency failed to teach you about the business of medicine.  And it is a business.  You want to get an MBA, great idea in a few years.  The first couple you need to work on getting your feet wet in the medical field.  So surround yourself with a great support staff.

Your spouse/significant other who went through all of this with you, was not trained in billing and coding for the most part.  So if they are going to run your business, they need to get trained.  While the motivation is their (It’s their money too) the knowledge may be lacking and you are probably not qualified enough to teach them.  They need to either get some training or hire someone who is trained.

Take time off.  No not the first month, but you cannot go constantly.  It does not serve you and it does not improve the care you provide to your patient.  And all of  your patients are going to get sick and they are all going to be mad that you left them when they were the sickest ever, but that first day back your lobby will be filled because that guy down the street that was covering you, just doesn’t know what they are doing.

And if you are at the program you trained at DO NOT ever in that first year use the line. “When I was a resident…”  Most of the program was just a resident with you, and it loses its meaning when they can come back and say, “You were a resident just last month.”  My fourth year in medical school, I witnessed that from one of the new attending, who went around saying that.  You can say it after everyone who was ever in residency with you has graduated, but until then, they knew you in residency.

And if you use that line don’t follow it with something ridiculous like “I would have liked to get up at 2 am and do an H&P if my attending would have asked me to.”

No you wouldn’t have, and you didn’t like it.  You complained to your fellow resident the next day.  There are crappy things that residents have to do because they are learning and are residents don’t insult them by pretending they aren’t.  And remember you were once a resident, don’t just abuse them because you can.  It doesn’t make you a better doctor among your colleagues.  It just makes you an ass.

This list is far from exhaustive, and I am sure if I had time I could keep going, but I don’t and this blog is getting a little long.  So congratulations on your achievements and hard work.  And welcome to the club.  You membership fees are now due.  (This is only half a joke, you have no idea how expensive it becomes to keep all these groups fees paid)


When did my career become a secret?

A couple of days ago I noticed something. When people ask me where I work, I don’t usually introduce myself as a doctor.  It was one thing, when buying a car, that I would off-handedly say, “I work at the hospital.”  You are always told adding Dr to your name adds zeros to every purchase, buying a car, building a clinic, buying a house.  Anyway, in purchasing, you just don’t do it.

However, this time it was different.  I was eating dinner with my children at the Olive Garden, when the waiter asked what I did for a living.

I was wearing scrubs, so the question was initially, “So did you work all day.”


“So what do you do?”

It was not the waiters fault, he was perfectly hospitable, taking care that our table had drinks and attention that anyone would appreciate.  We talked about the iPad 2, since I happened to have both children’s and mine with me.  And if I thought it would be a good deal to buy one, and if we liked ours.  All perfectly pleasant.  It was only when he came over during a discussion with my oldest, as to why I could not donate blood at his school’s blood drive the next day.  (Previous years, I have, but this year it was on a Wednesday, and most Wednesdays I barely have time for lunch much less time to drive 30 minutes to his school, donate blood, and return to work)  So I pulled up my schedule on the iPad, and showed him how full it was.  Still not overly impressed, he said, what about after work?  At that point, I promised him, if by some miracle of miracles, I were to finish by 4 pm, I would donate blood.  However, since I have yet to get out of the office by 530pm on a Wednesday in about 8 months, well it probably was not going to happen.  And this is when the above conversation happened.

I don’t know why I stuttered.  I am not really ashamed of what I do.  Obviously I would not be blogging about it online if I were.  But stutter I did, as I admitted that I was a physician.  Admitted, is this what the once noble profession I dreamed of being as a child came too?  Or maybe it was that I was caught off guard, since it was an early dinner due to having to leave work early in the afternoon to take my youngest to speech, and then kill time between therapy and a skate party.  And maybe that I was worried I would have to explain.

I spend a lot of my day explaining things.  Why I don’t take call, why I don’t go to the hospital regularly, why I have no desire to work in the ER, why I leave early on Tuesday and don’t see patients on Thursday.  And maybe that was the reason.  However, he did not ask for explanations, he actually was reassuring that my career was not equivalent to that of a drug dealer, even though some days, I think that is what I have become, at least in the eyes of some patients.

Maybe I spend too much time online, reading the terrible things people say about doctors, how they make too much money, they rush in and out of rooms too fast, they take too much time to get to their room, that they just don’t care.

I heard a joke once in training that the person who yells out first “Is there a doctor here?” is probably a physician themselves.  And sometimes, I wonder if that is true.  The days, weeks, months, years of fighting public perception as a money hungry individual willing to throw their patient under the bus for a dollar on one side, and the fighting for the dollars rightfully earned trying to provide the patient care that they deserve may have worn us down.  The time spent fighting against liability claims and fear of lawsuits despite no wrong doing, maybe those have worn us down as a profession.  The stories of physicians who have stopped to help someone on the side of the road and despite no wrong doing receiving a lawsuit for a bad outcome.  Maybe that is why we no longer stand up and say I am a doctor.  Or maybe, I just I don’t want to be chased through the grocery store to look at a mole.

And in my case, where my husband and I made the choice where he would take my call, so that one of us could be at home at night with our children, maybe I just didn’t want to explain one more time, why I don’t go to the hospital.  It is not that I can’t, it was that I put my kids before my career.  It is the years spent justifying why I don’t do shifts in the ER like my husband.  It is the time spent alone, at night, wondering if I made the right choice.  Did I do what was best for my patient?  Did I make a difference for the better?  Or what am I missing on that patient?

For the most part, I love my job.  I like that I am in most of my patients’ lives.  In many instances, after they get a recommendation from a specialist, they come back and ask me what I think they should do.  Or if they could have a second opinion, not necessarily that they disagree with the first, but that it is a major decision and they would like to have another perspective.  I don’t make as much in my clinic, as my husband makes doing his shifts in the ER.  I see the reports as to doctors not choosing primary care residencies, and I understand.  The money is not as good, and most of us graduate with a large amount of debt.  And you have to spend a large amount of time fighting, fighting insurance companies, fighting for payments, and watching the general population equate your training with that of a midlevel.  Even though you have twice as much training, 4 times as much debt, and way more liability.  And then at the end of the day, you notice the pile of paperwork- not visit notes, but other paperwork.  Prior authorizations, home health messages, home health certifications/re-certifications, various forms for patients regarding why they cannot work, disability questionnaires, and random notes that the patient wanted you to write for them yesterday.  Add to that orders that the specialist decides that they want done, but don’t want to obtain the prior authorization themselves, despite having the pertinent data needed to get the test approved, and yet they don’t send it to you.  So I understand why students are not choosing a career in primary care.

And maybe it is just a combination of all of those reasons that I don’t introduce myself as doctor out in public.  At maybe, just maybe that is why I stutter when asked what I do for a living.

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