Ep. 25 - Lessons I Wish I Learned Sooner After Graduation

Residency graduation doesn't mean you've finished learning - it just means you are learning in a new way. This is exciting, and, possibly, terrifying. In this solo episode, Mary reflects on the advice she often shares with new grads, including how to keep growing as a physician, build systems that make work and life more sustainable, and approach the early years of practice with confidence, intention, and kindness toward yourself and others.

Transcript

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Hello everyone, welcome back to The Long Call, the podcast where we delve into the complexities, lessons, and triumphs of residency. Through candid conversations, we want to explore how meaning and connection can emerge from the challenges, chaos, and unexpected moments along the way. It's about discovering the purpose and sometimes even magic woven into the everyday work of being a physician. As always, the views, thoughts, and opinions expressed in this podcast are solely our own and do not reflect the policies or positions of any institution, organization, or employer. This podcast is for informational and reflective purposes only and is not affiliated with, endorsed by, or representative of any official entity. And while Kyla and I are both doctors, we are not your doctors, and we are not providing any medical advice on this podcast. This is Mary, and we're trying another solo episode today. This is the time of year when we see another incredible group of residents graduate and go out into the world, either to their attending jobs or to fellowship. I've had the privilege of meeting with some of our program's now recent grads over the past month or so, and I've been sharing some advice with them as they asked for it, which inspired today's episode. I still remember my first years in attending more vividly than any particular year of residency. It was exciting but also terrifying. I think I expected the medicine to be the hardest part. I remember I was the most scared of not knowing the answer or what to do in scenarios that I potentially hadn't encountered in residency. But that wasn't what turned out to be the most challenging. The hardest part was actually figuring out how to build a sustainable career while figuring out the day-to-day of how to be an attendee. So today I want to share some advice that I wish someone had given me before I started. Some is about clinic, some about the OR, some are ideas for efficiency, some ideas for life outside of the hospital. But it all comes back to the idea of setting yourself up not just for survival in your early years after graduation, but instead intentionally building practices that let you enjoy the career you've worked so hard for. So my first lesson is to keep learning like a resident. There's a famous physician who recommends to keep living like a resident when you start as an attending. This is a bit of financial advice, but my twist on this is to keep learning like a resident. One of the scariest places for me as an early attending was the OR. While I felt well prepared by my training, it still felt like incredible responsibility in a high-stakes environment. One thing that helped enormously was treating myself like I was still training. For each case, I would do something to intentionally prepare. Watch a video or reread the relevant chapter in the surgical textbook. Not because I didn't know how to do the operation, but because thinking through the steps prior to the case sharpened my interoperative thinking. It's remarkable how much confidence comes from spending 20 minutes reviewing a case before walking into the OR. I still intentionally block time to watch operative videos, and these days I also spend time on the robotic trainer every month. Which leads me to my next suggestion for deliberate practice and goal setting. Don't walk into a surgery just thinking I'm going to do a hysterectomy. Try to walk in with a specific goal in mind, like today I'm going to improve my bladder flap dissection, or I'm going to work on my left-handed instrument handling, or I'm going to teach my intern how to enter laparoscopically with an easy-to-understand framework. The best surgeons don't just accumulate cases and get better accidentally with experience. They accumulate intentional improvements. And by choosing one small goal every operation over hundreds of cases, those tiny improvements become expertise. My next lesson is to be kind to your future self. And this lesson really doesn't have much to do with medicine. It's really about documentation and it could actually be applied across a variety of contexts. This is probably my least exciting and maybe most valuable piece of advice. To finish your EMR tasks before you go home, your charting and your inbox. Almost every time I don't, I end up regretting it. Because tomorrow's work becomes today's work plus yesterday's leftovers, and that can compound pretty quickly. And honestly, when you hold yourself to a timeline, it gets done more efficiently in the long run. My other advice here is to embrace B-charting. Many experts have suggested this, and I embraced this early in my career. And so far no one has expressed disappointment in my charting. Notes do need to be accurate and complete, but your notes don't have to be beautiful. Nobody is grading your punctuation or giving away awards for elegant prose. Good enough documentation that communicates clearly will be perfect documentation that keeps you at work for another hour, or even worse, bringing your charting home. My other advice for charting is to build templates early and update them often. And then to pre-chart whenever you find unexpected downtime. If a patient no-shows or in between OR cases, for me during slower moments on LD, I'd pull up the following week's patients and just make quick notes for each one. That investment then pays you back all of the next week as you can see your patients and close your charts more efficiently, and it does just feel a lot better emotionally to be working ahead toward the following week rather than trying to catch up from the days and weeks prior. Basically, you're just trying to reduce friction for your future self. Whenever you are at work, if the next task isn't immediately obvious, you can ask yourself, what can I do now to make life easier for my future self? My next advice is to be intentional with your career. In my experience, early in your career, you'll be asked to do everything, and you'll probably be eager to say yes at first. Join a committee? Yes. Do a lecture? Of course. Join a research project? Sounds like a great opportunity. At first, saying yes feels like being a team player, and of course, we all do need to pitch in for our teams to function, and we're happy to cover for one another when needed. After all, we will all need our colleagues' help at some point in our careers. But when your automatic response to everything is a yes, eventually it can become a recipe for burnout. One framework I love is asking myself whether an opportunity does one of the two peas. Does it pay me andor does it promote me? Ideally, it can do both. But if the answer is neither, then it's okay to say no. That doesn't mean never volunteering, but it does mean volunteering strategically. Try to keep that in mind and remember that every yes you give is also a no to something else. And usually that something is time with your family, your patients, or perhaps even your own sanity, and you need to protect all of those things. Take on those things that are particularly meaningful to you in your career, or short of that, that you are at least being paid to do. Some of my best strategies for saying no include imposing a mandatory waiting period on yourself. For example, always waiting 24 hours before making a decision, having a buddy you always review an opportunity with before saying yes or no. This could be your partner, a work friend, or a prior residency classmate. And then if you decide to say no, considering if there is someone else you can suggest for the opportunity where it might be more aligned with their goals. This is a hard skill for a lot of us and it does take practice, but like most things, it can get easier and more natural with time. One more note on this is that I think we are often inclined to say yes at work and no to people at home. But I would challenge you to consider if that is what you want to be doing. Consider where you are replaceable versus irreplaceable and who your yeses and no's mean more to. Alright, lesson four that I have is to build systems outside of work in service of the life that you want. One of the biggest mistakes I made early on was thinking that once I wasn't attending, I could do everything. Be a great doctor, a great spouse, a great parent, and a great house manager. Cook, clean, shop, do the laundry, meal plan, everything. And as individual activities, I think I am actually pretty good at all of those things. However, eventually I realized just because I can do something doesn't mean I should. And being good at a bunch of things probably limits my ability to be great at the few things that matter most to me. So I started being more selective and strategically trading money for time. One example is I do enjoy grocery shopping with my partner. It was actually one of our favorite activities to do together when we were engaged. At that point I was in medical school and he was a teacher. But early in my attending life, when we had two small children, it wasn't exactly the relaxing activity that it used to be. So we started placing orders online for pickup, and these days we actually have groceries delivered. Neither of us love cleaning the house, so we hired someone to do that once we had my attending salary. Similarly, if meal planning stresses you out, you can simplify it or use a meal delivery service. The goal here isn't to outsource your life, it's to outsource the things that don't matter so you have more energy for those things that do. If you love cooking and that brings you joy, obviously don't outsource that. Be strategic. Another important point here is to talk with your family, particularly if you have a partner. Your life changed in many ways overnight after graduation, and so did theirs. While in many ways life does get easier after residency, it is still a new world to navigate, and you need to be in communication about what is working and what is not. Don't assume since it's easier, you can just figure it out as you go. Be intentional, but also be ready to pivot. It's normal to not get things right the first time when you are figuring out something new, so expect to iterate. Be willing to change it up when reality looks different than your expectations. One thing I figured out early in my attending life was that my postcall days are best used for recovery and reconnection. I used to get home from a 24 and think that I could get a bunch of work done around our home. It seemed like a great opportunity since everyone was at school or daycare. But in my postcall stupor, things took three times as long as they should have, leaving me with much less time to take a short nap than I had planned before my family got home. And that version of me in the evening was not delightful to spend time with. Luckily, I recognized the pattern and was able to change my strategy for post-call days. So now I focus on rest first, then spending time with my family after I've recovered. And yes, our house is messier than it used to be, but we are all happier. Alright, another lesson is to try to find something bigger than routine patient care. Clinic is great, and building relationships with patients over time is truly rewarding. And operating is wonderful, and as you grow as a surgeon and take on more complex cases, it becomes even more fulfilling. But eventually some of that can start to feel somewhat monotonous. I think every physician needs something beyond seeing patients, a niche, if you will. It could be teaching, research, quality improvement, leadership, advocacy, whatever it is, work on finding your mission. Something that keeps you excited to continue working, even when you come up against the usual frustrations of clinical work. You don't need to know what this is immediately. Just try to be intentional about looking for it. Having a larger purpose transforms work from simply completing today's schedule into building a sustainable career. And my final lesson is to lift other people as you climb. This last lesson might be the most important. Medicine doesn't need more competition, it needs more generosity. So celebrate other people's wins, recommend colleagues for opportunities, introduce people, answer your emails, share your templates, share your talks, mentor residents and medical students. Build your network intentionally. Not because networking is transactional, but because careers are built on relationships. Especially for those underrepresented in medicine, many biases remain real. You may have to prove your competence multiple times. You may have to be more intentional about advocating for yourself. Perhaps most importantly, don't spend your energy judging how someone else balances work and family life. There isn't one right way. Different families work differently and different careers work differently. So try to support one another because medicine is hard enough already. I'll leave you with one final thought. When I graduated residency, I thought becoming an attending meant I finally had to have all the answers. Now I know it means becoming comfortable learning in public. You're going to make mistakes, you're going to have cases that humble you, you're going to continue to wonder whether you're good enough. And it's important to know that that's normal. Nothing has gone wrong when you feel like this. You're simply experiencing the growing pains of becoming the physician you've spent years preparing to be. Be kind to yourself, protect your relationships, keep learning, build systems that make your life easier, find work that energizes you. And remember, you aren't going to become the perfect physician overnight. All that is asked is that you try to become a little bit better than you were yesterday. Thanks for listening to the Long Call. If you're one of this year's graduates, congratulations. We're excited to welcome you as colleagues. If you have comments, questions, or ideas for a future episode, please reach out to us via email at longcallpodcast at gmail.com. And we'll catch you on call next time.