Friday, October 23, 2015

10 lessons learned in 10 years of Private Practice

This summer marked two major milestones in my life: My 40th birthday and 10 years in practice. Both have prompted some serious reflection on my part. As I thought about the most significant lessons I've learned over the years, I realized some were grasped the hard way and others came from great advice (some of which I got from this blog). For those of you in residency or just getting your ears wet in practice, here's a bit of what I've learned, hopefully it might help a little.

1. Make friends

When I first started practice I would often ask senior physicians what advice they would have for a new kid starting out and I was surprised to hear from several colleagues (male and female ): make time for your friends outside medicine. Several remarked that the felt lonely and isolated as they got older having devoted most of their effort to their career with what little time they had left over to their families.

Quality friendships require the one thing I hold the most precious: time. However, thanks to this early advice, over the years I have been very purposeful about making an effort to make time for relationships. Now I have a community of close friends who truly enrich my life and offer me a reprieve from the drama of the medical community. This year I unexpectedly lost my father and I'm not sure how I would of have survived without the support of my girlfriends.

2. The sky is not falling

Since the day I started medical school in 2001 I have heard how the sky is falling. Managed care, EMR, meaningful use, ICD 10 these were all going to send us to the poor house and ruin medicine. Yes, they have caused me some headaches and I may not make as much money as doctors did in the glory days, but I still can pay my bills, take care of my patients and enjoy my job. (see #10)

3. Lean in (but don't fall in the damn lake and drown)

I hate self help books, but if you haven't yet read Lean In then stop reading this post and go to Amazon right now and buy it. In medicine many committees may feel like pointless wastes of time. I would encouraged you to attempt to find one you can be passionate about and get involved. (If not "passionate" than at least one that doesn't make you want to bang your head against the wall out of desperate boredom) By being willing to say "yes" and giving a little bit of your time to get involved in the processes of your organization, you can learn a lot about hospital administration and make valuable networking connections.

I can always find time for a least one committee, but sometimes I can get a little carried away with my ambitious projects. Recently, I found myself on 4 major committees (all volunteer) at my hospital. That was a little too much. I'm still learning to find the balance between leaning in and falling in.

4. I can't please everyone

In medicine, there is a lot of emphasis on patient satisfaction. It's not enough to provide good care, you must be nice as well so the you and the hospital get good grades on our score cards. That's not to mention internet ranking sites, blogs and facebook. If someone hasn't written something nasty about you that wasn't true, then you haven't been doing this long enough.

Of course, we all want to be liked, but in medicine, sometimes you have to be the bad guy. At the end of the day you must be kind and compassionate to all your patients. They will not always like you and that's OK.

5. Know my stuff

Some of the best advice I got as a resident was that you can't know everything, but the key is to know your bread and butter conditions, learn what's normal, know your emergencies and you can look up everything else. I remind myself of this advice when I begin to feel overwhelmed with keeping up to date in my field. I focus on knowing the basics inside and out and keeping references handy.

6. Find my own version of work life balance

To me my work life balance is a combination of having a fantastic SAHD husband, living 8 minutes from my office/hospital and the flexibility of being my own boss in private practice. When I first started practice I would frequently fret during slow office weeks that I would never make my overheard and equally fret during busy office weeks that my children would grow up never seeing their mother. I slowly learned to enjoy the slow season and embrace the fact that the busy season would help me pay my kids tuition.

{In my opinion no one has ever explained work-life balance better than FreshMD right here on this blog.}

7. Be kind

Be kind. Treat the janitor with the same respect you treat the CEO. Treat the cokehead patient with the same care you would your best friend.

Especially in surgical specialties practitioners tend to yell and pitch fits to get their way. I've seen nurses chewed out for pulling the wrong size gloves for a doctor. To be a confident, respected female physician you do not have to be a bitch. The only excuse for yelling is emergent situations where patient safety is being compromised. I'm not saying to be a pushover, but you can be assertive without being mean. When you are characterized by levelheaded kindness, your true complaints will be taken much more seriously by your supervisors.

8. My kids will not be scarred for life because I missed a few bedtimes

I've missed a lot of bedtimes over the years. I still hate the fact that I have to miss out on important events in the lives of my littles because of my job. But at age 11 and 6, they are doing fine and I can already see that the missed bedtimes are harder on me than them. And I promise all you resident mamas out there: LIFE DOES GET BETTER!

9. Have a financial plan

Again, I hate reading non fiction, but one of the best financial book I have read is The Millionaire Next Door. The title is rather misleading, seeming to be yet another "get rich quick" book, but the actual point of the book is to learn to live well below your means and focus on avoiding the traps of debt. I wish I had read it as a resident.

10. I love my calling

There will be rough days. Patients will die, you will get sued, many nights you won't sleep but through all the crap, try your hardest to focus on the times you made a difference. Don't let yourself become a bitter and filled with self pity. This isn't a job we have, but a calling. Concentrate on the moments you saved a life, provided comfort to the grieving, eased someone's pain and changed their lives. If you find the grey cloud of negativity hovering for too long, then make a way to cut back your schedule and refuel your soul.


I'm not vain enough to believe that what's worked for me, will be the answer to all. I tried to leave out all the obvious things like eating your broccoli, exercising and maintaining your marriage. Hopefully even if my advice doesn't apply that much to you, it may make you pause and think.


Anybody else have some lessons to share?




6 comments:

  1. Wonderful post, thanks so much! I'm internal medicine in a group practice, attending level for... seven years now! I would add: Cope Well. This is a tough career with some brutal training. Prioritizing self-care is key. Unhealthy or inadequate stress release leads to burnout. Eat healthy, exercise as you can (I used to do call-room calisthenics!) and sleep as much as possible. Limit the Liver Rounds and ditch the drugs. The work hard/ play hard routine can bite you in the ass. An essential part of being a doctor (and a mother) is taking care of yourself... I speak from experience.

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  2. Lovely post! I couldn't agree more with all the points you made. Thank you for the reminders.

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  3. Great post with practical advice. I would add that you should give back and mentor, especially young mothers in medicine. Some of the most rewarding moments I've had in medicine since my kids were born is interacting with my mentors and in turn mentoring residents behind me in training.

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  4. Great post! Thanks for your candid reflections!

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  5. "The sky is not falling." So true, even during residency.

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