Happy First Year in Practice to me!

It wouldn't have occurred to me if it weren't for all the updates on Facebook...

I've actually been in practice for a full year and two days now.

A few things I know now that I wish I'd known then (and to all you new attendings, congratulations!):

1. It's normal to feel scared, nervous or unsure. Everyone I know goes through the same feelings. It doesn't mean that you're incompetent, or that you're not really ready to be on your own. Maybe there are a few people out there who leave residency feeling 100% confident.... I kind of feel though that being a bit cautious will help you stay out of trouble in the long run. And, it gets better.

2. Nobody expects you to know everything all of a sudden. Remember that whole "challenge of lifelong learning" that's always bandied about and that you probably gushed about in the med school interviews when they asked you why you wanted to be a doctor? It's true. You will learn a lot during your first year of practice... see points 3, 4 and 5 for some good ways to keep learning.

3. You may not know the answer to a question, but you probably developed the skills to find the answer during med school and residency. Check textbooks, review literature, and get a subscription to Up-to-Date if you don't have one already.

4. Get a mentor. No, seriously. You need someone more experienced than you who is in the same specialty and who you feel comfortable asking for advice. Also important... you have to realize that negative outcomes are going to happen. As a doctor, you're not God. You can do everything right and do everything possible and still have an unhappy ending. It's so important to be able to debrief with someone like a trusted mentor.

5. Don't be afraid to phone a specialist or get a consult if you're unsure about something. Multiple specialists have told me and other new attendings that they expect that we will consult them lots for the first few months. In fact, they're more likely to get upset if you allow yourself to get in over your head and then ask them to deal with the fallout.

6. Take some time off.

7. But, I would recommend against taking too much time off. Use your judgment but I would say that at this stage, you need experience, and the more the better.

8. Start saving for taxes right away. Maybe you've been surviving residency by dreaming of the day that you can buy that Corvette. Go ahead, but make sure that you won't be in the hole when tax time rolls around.