My First Year As An Attending – What I have learned

After many years of training, it finally happened, I was going to be an attending. The goal we all strive for – to take the training wheels off, practice what we learned, and provide the best care possible for our patients. I spent months leading up to my first week on service incredibly nervous and found myself reviewing guidelines, trials, and any other resource to help me succeed – safe to say, I was psyching myself into a frenzy.

Like many of us, the fear of failure is an incredibly motivating factor but perhaps not the healthiest mindset. I’d like to share my journey as a first-year attending and what I learned in hopes of helping others who are finally taking off the training wheels.

Day 1 as attending, celebrating great news our patient was undergoing heart transplant.

1. Your department wants you to be successful. It may feel like you are alone as an attending, but your department invested a lot of time and resources for you to join. They want you to succeed and encourage open lines of communication. The senior members in both my departments (cardiology and critical care) expected me to call them when I was struggling with a challenging case, needed clarity on how to navigate the new system I was working in, and to touch base on how I was doing. I have called my colleagues on the weekends and at odd hours to ensure I was providing the best care for my patients – and the best part, they did not once make me feel inferior or as if I was doing a bad job.

2. Push your socializing boundaries. When I started working for UPMC, I only knew the handful of people who interviewed me. Many of my colleagues knew who I was through the continued updates from our division leadership regarding new hires but to me, everyone was a stranger. The best way I can describe it is as a year of continued blind-dating. I would meet faculty members, make small talk, and then move on.

I, therefore, made it a mission to get to know as many people as possible. I would introduce myself to all of the nursing staff in the mornings when I would see patients. This gave me a chance to get to know my CICU/CTICU team and get updates on the patients. When I would meet other attendings (in cardiology and critical care), I would introduce myself and get their phone number. I took the same approach for attendings who were consulting on my patients so I could continue to develop relationships across the health care system.

I’m fortunately a very social person, so this was not a terribly big challenge but if you are a bit shyer, this may very well feel uncomfortable and awkward. Keep in mind, that your colleagues want to get to know you (as you are the newest hire) but you have to get to know an entire division’s worth of faculty. Plus, if you throw in the trainees it becomes an even bigger task.

Supporting Go Red For Women with the entire CTICU Team

3. Don’t be afraid to ask for help. In order to be successful, don’t be afraid to ask for help, whether that is related to patient or personal care. Being a new attending has numerous challenges but asking for help isn’t one of them. I remember a difficult case being evaluated amongst our cardiogenic shock team to discuss the possibility of placing a patient on ECMO. I wasn’t sure the best course of action as I was the attending in the CTICU that week and my input would be heavily weighed. I immediately reached out to our CTICU Medical Director to hop on the call. He was able to give his insight on the case, which helped us determine a better clinical course. I was able to debrief with him afterward and learned for the next time I would encounter a similar situation.

4. Don’t forget your past mentors. Many of us will start working as hospitals we have never stepped foot in. Our past relationships are of incredible value. I still text and call my mentors for advice. They are a great objective 3rd party to speak to.

5. Enjoy the process. Being an attending is hard but remember the years of training you have completed getting to this point. We became physicians to accomplish a variety of goals (research, clinical care, etc) and we are well trained for it.

Although the training wheels may have come off and I am no longer considered a trainee, I make sure I am diligent in growing and learning at every opportunity. I’ve learned so much in my first year as an attending and can’t wait to see what else is in store.


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