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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.

 

“The views, opinions, and positions expressed within this blog are those of the author(s) alone and do not represent those of the American Heart Association. The accuracy, completeness, and validity of any statements made within this article are not guaranteed. We accept no liability for any errors, omissions, or representations. The copyright of this content belongs to the author and any liability with regards to infringement of intellectual property rights remains with them. The Early Career Voice blog is not intended to provide medical advice or treatment. Only your healthcare provider can provide that. The American Heart Association recommends that you consult your healthcare provider regarding your health matters. If you think you are having a heart attack, stroke, or another emergency, please call 911 immediately.”

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Finding your first job after training – what I learned from the process.

We all look forward to the day we can finish training and finally become attendings. For me, that day crept up faster than I was ready for. In the midst of a pandemic, not only was I juggling clinical responsibilities, I also had to figure out how to find “my perfect” first job. I tried a number of different strategies but here is what I learned from the process.

  1. Attending job searches is NOT the same as residency or fellowship positions. For many of us, we filled out an application and started clicking away on any and all programs that we thought would help us become physicians. We then interviewed all of the US in hopes a computer algorithm will match us to our first-choice program. This isn’t the approach I took for attending jobs. I only spoke to places I had an interest in working and felt would be a great fit for my first job. It’s important for us to shift away from thinking of a residency/fellowship position as the process is not the same and requires a different approach.
  2. What is my dream job? And more importantly, write it down! One of the most important things I learned is I need to have a clear vision of what type of job I am looking for. Specifically, I first had to decide if I want to work in an academic environment vs community setting vs private practice vs locum, etc etc. This was the key step to focus my target search. More importantly, employers will ask asked me “what are you looking to do?” By having a concrete answer, the process was much more smooth and fruitful.

Other things to consider are how much inpatient time I’d like to do, how to develop an outpatient clinic, and opportunities to be involved in trainee education. For those

who are wanting to do research, is having protected time important and if so, how much time would you

want. By having this road map of your “dream job” before talking to employers will show you are prepared and have done adequate research for your first attending job. It will be up to the employers to then help your roadmap become a reality.

Career development is important for all of us and working for a practice that will support our career goals is important. Having an idea of your 5-year (or 10-year) plan to discuss with an employer will help you gage if the employer can help you grow and develop to achieve those goals.

  1. Utilize your network. There was a point when I was getting nowhere with my job search. Emails were going unanswered, no new jobs had been posted at places I was interested, and everything felt very grim. I then spoke to my program director who was able to help me get in touch with former fellows (and now attendings) at different programs to see if they have something that would suit my dream job.

    I also spoke to several of my co-fellows which turned into all of us sharing where we have interviewed or places we think the other may find as a good fit. Don’t be afraid to reach out if you’re in this position – you have nothing to lose but a lot to gain! Reaching out to mentors is also important as they may have leads on jobs you may not have considered before.

Although this conversation can be extensive and this is not an exhaustive list, I’ll end with this: we put a lot of pressure on ourselves to find the perfect job right out of training. However, the first job doesn’t need to be the last job. You can always look for a better fit – but DO NOT burn any bridges with your current employer!

 

 

“The views, opinions and positions expressed within this blog are those of the author(s) alone and do not represent those of the American Heart Association. The accuracy, completeness and validity of any statements made within this article are not guaranteed. We accept no liability for any errors, omissions or representations. The copyright of this content belongs to the author and any liability with regards to infringement of intellectual property rights remains with them. The Early Career Voice blog is not intended to provide medical advice or treatment. Only your healthcare provider can provide that. The American Heart Association recommends that you consult your healthcare provider regarding your personal health matters. If you think you are having a heart attack, stroke or another emergency, please call 911 immediately.”

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Advice on Looking for Academic Cardiology Positions: The First Ever AHA Early Career Voice Vlog

I am happy to present the first-ever AHA Early Career Voice Vlog! I am pleased to be able to have Drs. Rajat Kalra, Forum Kamdar, and Kurt Prins, all early faculty in academic cardiology, discuss their experience looking for and obtaining academic cardiology positions. Drs. Kalra, Kamdar, and Prins have been my mentors and role models throughout my residency and fellowship training and I am so glad they were willing to share their experiences and advice with us! They discussed various topics from how they looked for academic cardiology positions to how they negotiated their contracts.

Speakers:

Dr. Rajat Kalra is a clinician-scientist in the Imaging Section of the University of Minnesota’s Cardiovascular Division. His academic interests pertain to the use of clinical, laboratory, and imaging biomarkers to define the mechanisms underlying heart failure and cardiac arrest and refine prognostication in these conditions, Dr. Kalra’s clinical interests encompass the breadth of general cardiology and cardiac imaging.

Dr. Forum Kamdar is an advanced heart failure and transplant cardiologist and a Doris Duke-funded physician-scientist. She has a strong clinical and research interest in advanced heart failure associated with neuromuscular disorders. Her lab developed patient cell-based models of Duchenne muscular dystrophy to further elucidate mechanisms and she co-founded the Neuromuscular Cardiomyopathy Clinic.

Dr. Kurt Prins is an NIH-funded physician-scientist who performs translational research to understand mechanisms of right ventricular dysfunction in pulmonary hypertension. He also sees pulmonary hypertension patients.

“The views, opinions and positions expressed within this blog are those of the author(s) alone and do not represent those of the American Heart Association. The accuracy, completeness and validity of any statements made within this article are not guaranteed. We accept no liability for any errors, omissions or representations. The copyright of this content belongs to the author and any liability with regards to infringement of intellectual property rights remains with them. The Early Career Voice blog is not intended to provide medical advice or treatment. Only your healthcare provider can provide that. The American Heart Association recommends that you consult your healthcare provider regarding your personal health matters. If you think you are having a heart attack, stroke or another emergency, please call 911 immediately.”