Five Things Docs Wish They Had Known During Residency

The residency years might be some of the most challenging and most daunting you’ve ever experienced. They are also guaranteed to be some of the most fulfilling. But how do you not only make the most of it, but also get the most from it, especially because this experience sets the stage for your medical career?

We’ve asked several veteran physicians to reflect on what they wish they had known during their residencies. The following pearls of wisdom are likely to give you a jump on the landing (and medical career) that lies ahead.

1: You’ve Been Gifted the Keys to the Attending’s Practice

It’s easy to forget that the attending has done a lot to build the trust of patients and colleagues, and to grow their practice and expertise. Many times, residents get lost in the patient flow without stepping back to consider patients’ motivation for coming to a practice or hospital, and to a specific physician. Or, that the attending is placing their trust into the residents’ hands.

“It’s really powerful to think for a second that you’re taking care of that patient because of that attending’s trust,” said Sahil Mehta, MD, founder of MedSchoolCoach, an educational consulting firm, and an interventional radiologist at Beth Israel Deaconess Medical Center in Boston. “Showing genuine gratitude, coming prepared, being engaged, and asking thoughtful questions are some of the things you’ll do more of if you realize that you’ve been invited into their practice.”

Helen Kang Morgan, MD, said that she still runs into people whose children she delivered and on whom she made a lasting impression.

“Not only is it a privilege to be making all of these decisions for all of these patients, but for the patients themselves, this may be their only experience and one that they may never forget,” said Morgan, clinical professor of obstetrics and gynecology, and associate chair of faculty development and faculty life at the University of Michigan School of Medicine in Ann Arbor, Michigan.

“Be more aware while you are going through the experience and try not to get so caught up with the busy,” she said. “Lean into your value set and notice the things to be grateful for in the midst of how hard you’re working.”

2. Healthcare Is a Team Sport

“Healthcare is a team sport. Your effectiveness and the outcomes of your patients are positively influenced by seeking input from multiple people and by relying on your colleagues,” said John Andrews, MD, a pediatrician and vice president of graduate medical education innovations at the American Medical Association.

Andrews recalled that when he first left medical school, he quickly realized that he needed to immediately hone a key skill: Interacting with his colleagues.

“It counters the traditional narrative of the physician as captain of the ship. I learned how to rely on my fellow residents, the nursing staff, therapists in the hospital — who all had their relevant areas of expertise. Residents should negotiate those relationships with respect and active listening,” he said.

3. It’s a Time to Build Your Community

Residency is a time (and the opportunity) to start forming a circle of experienced physicians, peers, and mentors who will accompany you throughout your medical career.

“It’s really the time to put yourself in the mindset that things are going to be very different after residency, that you’ll be managing yourself without attending oversight, and asking yourself how you would manage this without supervision,” said Ted O’Connell, MD, director of Medical Education at Kaiser Permanente of Northern California. “Those first 12-18 months after residency are probably the hardest and the learning curve can seem almost as steep as one’s intern year in terms of just the jolt to the system,” he said.

Having close friends or colleagues you can call in times of personal or professional challenge is very important, said Jay W. Lee, MD, MPH, medical director at Integrated Health Partners of Southern California, and a member of the board of directors of the American Academy of Family Physicians.

“When you leave residency, you’re leaving a comfortable cocoon and it can be very isolating,” he said.

O’Connell also suggested that residents seek mentors and build friendships and relationships from within and outside the medical community, which helps build a pool of different perspectives and experiences to assist with patient care and relationships, as well as research, job, and professional society opportunities.

4. Learn How the Machinery Operates

Although the practice of medicine extends well beyond the clinical arena, the business of medicine is not taught in medical school or in residency, Mehta said. “Residents often completely miss insurance pre-authorization, deductibles, and billing — all of the things that go into a practice,” he said. “It’s important to figure this out or what it takes early on because the system you end up in might be different than the system you’re doing your training in.”

Though shifts are long, and schedules are packed, Mehta said that residents should find some time to sit down with a practice manager and understand billing practices before they leave residency and are left on their own to work through the intricacies.

A related issue is understanding how federal, state, and local policies and practices can impact the practice of medicine.

“There are things that are going around upstream from the distal end of the delivery system that very much impact our ability to take the best care of patients,” Lee said, adding that residents should look into their institution’s journal clubs and guest lecture series, as well as attend spring conferences of major medical institutions to learn the ins and outs of the “medical industrial complex.”

5. Nobody’s Perfect

“During residency, you’re going to make mistakes, you’re going to struggle, and you’re going to have people unhappy with you,” said Morgan. “One of the most important things is to develop what we call ‘master adaptive skills’ or a ‘growth mindset,’ so when you make a mistake, you can figure out what you can learn from that experience instead of taking it personally.”

Andrews agreed.

“I see a lot of people struggle in residency now because they think that it exists to teach them something and fail to recognize that what they’re doing is really a job,” he said.

Mehta is co-founder of MedSchoolCoach. Lee is medical director at Integrated Health Partners of Southern California. O’Connell isdirector of Medical Education at Kaiser Permanente of Northern California. Morgan and Lee reported no relevant financial relationships.

Liz Scherer is a health and science journalist.