I received an email with the following request: “I’m a resident, and I’m interested to hear what words of wisdom you can share that you learned over the course of your career.”

I’ve been mulling it over, and here are the results of my mullings. I place them roughly in chronological order, starting with the time of residency and proceeding from there.

Learn the Most You Can During Training

Take on hard cases. I’m not saying to just not avoid taking on hard cases. Instead, I’m saying to affirmatively put yourself out there to take them on. This forces you to learn treatments that are not first-line or even second-line. The complexity of the presentation forces you to juggle several treatments that are likely necessary and need to be prioritized and coordinated. Take full advantage of asking questions and learning from your faculty.

You’re unlikely to have another such opportunity in your career. All too often, physicians get stuck in the approaches and procedures they learn during training and afterward only partially and belatedly expand their treatment armamentarium. They remain forever more limited in their knowledge and skill than they otherwise would have been.

Appreciate Your Peers

As a resident or fellow, you are part of a peer group. Ever since most of us were toddlers, we’ve been surrounded by peers, from preschool on through residency and fellowship. Guess what? After training, this long run of ‘peerdom’ is over. Yes, you will work with clinicians, both in your specialty and in others, but after training, they will be perceived as work colleagues or even work friends. The sense of being ensconced in a peer group will be over. This change is subtle and sometimes goes unnoticed. But even when not explicitly noticed, a sense of something missing can still arise. And when noticed, it can seem profoundly sad.

Thus, a substantial number of people transitioning from a peer-ensconced environment to a more straight-up work environment feel somewhat lost and sad… anxious even. And often, sooner or later, a nostalgia sets in, focused on those ‘tough but glorious’ years spent among peers.

My advice is to recognize that such a transition away from a peer-centered environment is coming and to take advantage of still being part of one while you still can. What this means for me is to cherish my peers, build closer friendships, and take the first step to make things happen. When the last year of the program approaches, take the risk and tell everyone (who matters to you) how much you appreciate your time together and how you’ll miss them. Be explicit that you want to stay in touch and voice the desire to plan reunions, perhaps at your specialty association’s annual convention. Many of your peers may be thinking of doing the same, but ultimately, they don’t take action. YOU can be the instigator. There’s no reason to be shy about letting people know they mean a lot to you and that you’re not willing to let the good times fade away.

Explore and Be Bold in Job Selection After Training

Do the most interesting things and take the jobs that are far different from what you’ve experienced during training. Do this while you’re still (relatively) young. Especially if you’re still single and without kids, it’s easier to explore possibilities, including ones in other countries.

A common self-imposed constraint is to seek and take a position that feels familiar to you based on what you’ve been exposed to during training. This is not necessarily a problem; it may be exactly what you’ve always wanted to do, and it meets your way of being in the world.

However, a possible downside of choosing the familiar is that it can lead to ‘premature closure’ in the long term. You’re deciding what you want for your career from a constrained space of possibilities, one limited to the range of experiences you’ve already been exposed to during training.

Know How to Read Employment Contracts

So many horror stories I’ve heard over the years. Please make sure you never sign an employment contract before you review it word by word. And after you’ve done so, hire an attorney specializing in medical practice employment contracts. Yes, it may cost a grand or two, but it could save you years of heartache and tens of thousands (or more) dollars. And, as I’ve pointed out above, I advise you both to read the contract carefully and hire an attorney. Yes, you can understand contracts if you give yourself the time to – and you should give yourself that time. (I’ll cover details of that important issue in a separate post.)

Consider Your Career Trajectory from the Start

Because our education and training are so long and we hardly make any money until we complete them, our ‘adult life’ starts much later than it does for most other people, including other professionals. When you are finally an attending making a good salary, you could be in your early to mid-thirties. After all this time – so, so many years – you rightly focus on your work. It’s new, scary, exciting, and the money can be exhilarating. But, the years of your life left to, for example, meet the person of your dreams to marry and to have children, are now short.

In my experience, it is uncommon that anyone in your program or, later, your place of employment, will ask you when and how you’re planning to make time to start a family. Why would they? It’s both too personal and not in their interest. They want you working!

So, you must rely on yourself to keep all this in mind. I know too many physicians – and others – who let those prime years slip by and are left single – when they’d rather be married – and childless – when they’d rather have children. Take heed. Plan and be resolute.

Take Risks in Mid and Late Career Too

Take risks. This only applies if you’re the type of person who likes and values taking risks. Even if you aren’t, there may come a day you feel the call to pursue something that’s more off the beaten path. Or, perhaps, one day you’ll be forced to.

As physicians and other healthcare providers, we have the balance of power on our side rather than the employer’s. In almost every specialty of medicine, there exist clinician shortages. Given this state of affairs, we are a scarce commodity and, thus, have the power to set the terms of employment on our side.

We are the ones courted to take a job, usually from the many that we are offered. This ability to choose your job because you always have opportunities available affords you the ability to either switch jobs with relative ease or to walk away from clinical medicine to try another profession.

Let me share my personal experiences to illustrate. When I started my first board review course in 2002, I was extremely anxious because I didn’t know yet how to succeed. Despite that stress, I knew I at least had my day job as a junior faculty member at the University of Illinois. So, I wasn’t risking my livelihood. But as my courses grew in popularity and the amount of work they required, I had to confront the choice of which career I would pursue: that of a clinician in an academic position or that of an entrepreneur building a family of CME courses. I could no longer do both. I ultimately chose to resign my faculty position and to dedicate myself fully to my growing company.

What helped me make that leap was the realization that even if I quit my job, I could, if needed, find another one in a matter of days. I thought about all the people who set out on a new venture, with no guarantee of success or of returning to their previous profession. I, on the other hand, did have a fallback plan. I could go back to clinical work as a physician, either through an institution, a group practice, or on my own. So, I realized I had no real obstacles to pursuing my dream, other than the stress of wondering whether I would succeed in my venture.

Thanks, and let me know what you think and which topic you would want me to cover.

Dr. Jack

Quotes of the Week

“Life is either a daring adventure or nothing at all.” ― Helen Keller

“If it scares you, it might be a good thing to try.” — Seth Godin

“Don’t be too scared to calculate risks” ― Sunday Adelaja

“The truth is, everyone is going to hurt you. You just got to find the ones worth suffering for.” ― Bob Marley

“True friends don’t come with conditions.” ― Aaron Lauritsen