What are some residency survival tips?
Here are some tips assembled by several members of the Pennsylvania Medical Society:
- Know everything about your patients—read up on one topic per day.
- Place a nametag on your stethoscope.
- Save time by photocopying your admission notes.
- Update your personal procedure log after each new procedure; this is often important for certification and credentialing and can be hard to recall down the road.
- Try to see new admissions in the ER.
- Take care of yourself. Eat and sleep when you can; make time to exercise daily.
- Dictate discharge summaries at the time of discharge.
- Research clinical information quickly by accessing “JAMA” and “Archives” specialty journals—free online to AMA members.
- Smile and introduce yourself.
- Prepare an on-call bag; include an extra pair of scrubs, deodorant, and a snack.
- Remember that “uncommon manifestations of common diseases are more common than common manifestations of uncommon diseases.”
- If it's not documented, it wasn't done.
What are the rules for resident work hours? Are there limits on how much I can work?
In 2007, resident work hours—or duty hours—were restricted to 80 hours per week, averaged over a four-week period, according to the Accreditation Council for Graduate Medical Education (ACGME),. This includes all in-house call activities. The ACGME says, “Duty hours are defined as all clinical and academic activities related to the program; i.e., patient care (both inpatient and outpatient), administrative duties relative to patient care, the provision for transfer of patient care, time spent in-house during call activities, and scheduled activities, such as conferences. Duty hours do not include reading and preparation time spent away from the duty site.”
You must be provided with one day in seven free from all educational and clinical responsibilities, averaged over a four-week period, including call. The ACGME rules also require adequate rest time as well as time for personal activities.
For more details on work-hour restrictions, visit the ACGME website.
Will I be making independent decisions?
Yes, but don't be a hero, taking on more responsibility than you are ready for. All of your supervisors are there for a reason, and really don't mind being called to answer your questions. They do mind, however, if they are not called and you make a mistake that hurts someone.
How do I handle problems with my residency? What if I feel like I’m being treated unfairly?
It isn’t uncommon for residents to feel like they’re being treated like second-class citizens. You’re required to work long hours and to do a lot of thankless grunt work. But don’t take it personally. Every physician is required to do the same kind of training.
If, however, you feel that you have a legitimate complaint, the best first step is always to communicate your feelings to your chief resident or residency program director. Give them the opportunity to address your situation and to work toward a solution with you.
Should all normal communications channels fail, the ACGME has a complaint process in place. This complaint process should be initiated only if you can’t resolve your problems in other ways.
How do I find and apply for a fellowship?
By the end of Post Graduate Year 1 (PGY1) or PGY2, depending on the length of your residency, you should be making a decision about a fellowship.
Many fellowships follow training in internal medicine, and the American College of Physicians website has an excellent article about applying for a fellowship. This article is beneficial even if you are not an internal medicine resident. If you are in any kind of residency, you can search for training programs on the ACGME website or on the website of your specialty’s professional association.
On a less formal basis, ask your residency program coordinator or attending physicians for recommendations. Is there an attending whom you believe to be a model physician? Then ask that physician where he or she did a fellowship.
How do I cope with lack of sleep? How do I maintain a reasonable quality of life?
It may seem overly simplified but it’s true: The only way to deal with a lack of sleep is to sleep more. Residency duty hour restrictions put in place in 2007 were enacted for this reason. The intended benefits are increased safety for patients and improved well-being of residents.
Those extra hours in your week—hours your predecessors did not have—should be used to recharge, relax, and rest. This includes spending time with your family and friends in activities that provide you with more energy, not less, for your time at work.
How can I find a mentor?
Mentoring relationships can start spontaneously or on purpose. Perhaps you hit it off with an attending or a chief resident, and a mentoring relationship starts quite naturally. Peter Lund, MD, an Erie urologist and past president of the Pennsylvania Medical Society, remembers, “I had a department chair who had an informal sit down with his senior residents. He went through some basic principles of practice and he would also hit on some financial issues. This also left the door open for curbstone consults when we out on our own.”
In many cases, however, residents must seek out a mentor who fits their needs. Here are a few tips:
- Know yourself: Think of where you need guidance and find a mentor who is strong in those areas. Also, what types of personalities click with you? Don’t choose a mentor you don’t like being around.
- Take the initiative: You need to initiate a mentoring relationship. Many mentors will be honored to help you but you have to seek it. This doesn’t mean you have to officially ask, “Will you be my mentor?” Many such relationships are just simply nurtured over a casual cup of coffee without an official invitation.
- Keep an open mind: Your mentor does not have to be the head of your department or an esteemed physician in your specialty. It could be anyone who can help you grow in areas you recognized as weak spots. A layperson staff member at your hospital may be just the person to help you improve your interpersonal communications.
- Ask your colleagues: Some of your fellow residents—usually those a year or two ahead of you—may already have a mentor they would recommend.
What is organized medicine and why should I care?
To some, “organized medicine” may seem like an oxymoron. After all, the medical profession sometimes seems anything but organized. But organized medicine is the profession’s attempt to unite all physicians to make decisions for the betterment of the profession and, more importantly, for the improvement of patient care. This is done through large and small organizations, from the American Medical Association and large national specialty societies to small county societies and specialty groups.
These organizations, like the Pennsylvania Medical Society, represent you and speak for the profession. They are supported in large part by the dues paid by members and, to a lesser degree, through revenue from services they sell. Physician support of and involvement in the Pennsylvania Medical Society and other medical associations keep them alive and ensure that they are supporting causes and advocating on issues that matter to you.
What options exist outside of the day-to-day practice of medicine for people who have graduated from medical school (i.e. what are some non-clinical career options)?
One of the best options is to obtain your MD/PhD degree at one of about 100 such dual degree programs. This opens up a number of science and research opportunities. Read about these careers.
But the options for your career expand even more once you have a few years of patient care experience under your belt. Some physicians choose to leave the active practice of medicine and go to work in government health departments or as medical directors for health insurance companies. Others are more entrepreneurial and start businesses like physician placement services or quality assurance companies. Many physicians opt to continue spending some time in clinical practice while also teaching, researching, writing, or developing business opportunities.
The fact of the matter is that the wealth of knowledge you obtain in medical school, post graduate training and medical practice opens up many career horizons. It all depends on your creativity and industriousness.
What are some knowledge areas that I may want to explore on my own?
You may be surprised what your residency teaches you in addition to clinical skills in your specialty. In fact, it is now required that you receive training in a number of core competencies. Some physicians say that they wish they knew more about billing and coding. Some physicians also comment that training in documentation—whether for billing compliance or more accurate medical records—would have been valuable.
Medicare coding is an area where many young physicians are lacking when they leave residency. You can learn more about coding with Practice Principles Coding Basics from the Pennsylvania Medical Society. It’s free for members.
Contributors: Scott Shapiro, Ken Certa, Peter Lund