Tips for New Attendings

It is that time of year… it’s hotter, more humid and more hazy. However, while most of the academic world slows down in the summer for sabbatical, hospitals everywhere are frantically orienting new interns before unleashing them to take care of patients… supervised, of course.

While much attention is paid to the “July effect” and the start of new interns, it’s worth noting that many times residents, attendings, nurses, pharmacists and others are VERY in tune with new interns starting and stand at the ready to not only teach, but also ensure that patients receive safe care. In some ways, it’s an example of the Reason’s Swiss Cheese Model in hyperdrive. That is why attending in July is harder. Everyone knows it.

I’m often asked by graduating medical students for advice before they start internship. Here’s a brief version of what I recommend focusing on internal #medicine interns. I limited to 6 suggestions but realize there are far more!#TipsForNewDocs#MedEd@ACPinternists@FutureDocs

— Sanjay Saint (@sanjaysaint) June 21, 2019

Surprisingly, little attention is paid to new attendings, though, who often also start in July. This year, we are onboarding 20 new hospitalists at UChicago Medicine. In discussions with other colleagues elsewhere, we are not alone. While Twitter is rife with #tipsfornewdocs, I do not often see #tipsfornewattendings who often may be in greater need than the interns who have the supportive culture and environment that being in training often offers. So here are my top tips for new attendings.

• It’s ok to say I don’t know. Many attendings have angst about being asked a question by a patient, nurse or a member of their team that they will not know the answer to. It’s absolutely ok to say, “Great question – I don’t have the answer at the moment, but let me look it up and get back to you.” I often email answers to questions that have come up on my team later that evening or the next day so we can discuss in a more robust fashion.
• You are a supervisor, not a friend. Many new resident graduates fall into this trap of wanting to be the uber cool attending who not only trusts their residents but is also their friend. Beware of this trap. Your residents do not want a friend; they want someone they RESPECT. And respect means sometimes you will disagree or push back on decisions.
• Don’t ask what; ask why. It’s often easy to fall into this trap of asking questions to understand what your team is thinking, and many questions focus on “what should we do”. It is often easy to guess what needs to happen – start fluids for hypotension for example. The key to really getting at whether learners truly appreciate the nuances of medical care is to ask “why”. Why do you think that is what we should do? Often the why allows you to detect areas that need more clarification or make a teaching point.
• Don’t forget about the patient. Keep in mind that with all the check boxes that you or your residents may be focused on, it is easy to lose sight of what the patient cares about most. I never assume patients understand why they are in the hospital or what their top goal is. Often, I ask, “Can you tell me in your own words why you are here in the hospital?” This is often very revealing and offers an opportunity to really ensure that patients understand their care and also can reflect on why they need to be in the hospital.
• Get a coach. No matter what your clinical context will be, it is likely you will benefit from some targeted coaching on how to be more efficient, wrestle with the electronic health record, stay on top of your CME requirements, or how to advance your career in your new role.
• Find your friends. Medicine is hard, and being an attending is often very hard. A good friend goes a long way to ensuring that your good days are better and that your bad days are not spiraling out of control. They can also ease your imposter syndrome and put things in perspective.

No matter where and when you are starting your career, a little bit of advice always goes a long way. Let us know what your tips are.