Transitioning From Residency To Clinical Practice

By Dr. Thuc Huynh

In 74 days, thousands of residents will be graduating residency; I being one of them.

For me, it’s been 13 years since beginning college and finishing as a family practice physician. For others in surgical residencies or other fellowships, their road has been much longer. As our days of leaning on our attendings come to an end, it’s now time for us to transition to our new role and acquire a greater deal of responsibility. Now, it’s time for us to be the attendings that others rely on. Are you ready?

Take a break

Before you dive into this newfound responsibility. Take a break. We’ve been at it for years; this grind of education. If you think about it, there are very few times in our life that we will be able to take a long break. It’s a trend that with every major task completed, there has always been a nice break for me. I took 2 months off after high school before college, 2 months off before medical school, and 2 months before residency. So it’s only natural that I take 2 months off before starting my next adventure. With every break, I’ve used the time to recuperate from the toils of the recently completed task and re-energize for the future. It works. Take a break after residency. Do what you’ve always wanted to do but couldn’t because of all those 30 hour calls. You’ll enter your next job with a brighter outlook and well rested.

Get into the groove

Let’s face it. We’re going to be slow with productivity at the start. It’s okay. Our bosses know that we have no clue about their system, paperwork, and sometimes not even their geographical area. As we get used to our new surroundings, we’ll get faster. In addition, most jobs will start you off with fewer patients because they anticipate we’ll be slower. Eventually, they’ll add more patients to your schedule. Become familiar with the available resources at your disposal. Look online, ask your nurses, ask your colleagues.

Don’t be afraid to ask

We’re not expected to know everything. Just because we’ve graduated residency, it doesn’t mean we’re now know-it-alls. Don’t be afraid to ask your partners for their opinions on cases. They have years of experience and are a valuable resource. I’ve already let my current attendings know that I’ll be calling them from time to time over my career.

Don’t stop learning

This one goes with the topic right above. If you don’t know something, improve yourself. A career in medicine essentially means you’ll be learning for life. New guidelines and breakthroughs in medicine require us to stay updated in order to practice the best standards of care for our patients. Get involved with CME classes, conferences, or credits online.

Finally, don’t burn yourself out We’ll be in this business for years, whether it’s practicing medicine or moving into nonclinical roles. To avoid burnout, remember to take a break. Not a 2 month break like we talked about before; but a mini-break. Use up those vacation days. Engage yourself in hobbies like joining a book club or work on your garden. For me, I enjoy working on my websites and actively engaging in social media. Do anything that will take your mind off of medicine for a while so you can rest and re-energize.

Keep in mind these simple principles as you transition from residency to clinical practice. I wish all of us a rewarding and successful career. Congratulations Class of 2011!

About: Dr. Thuc Huynh is a family practice physician and physician technologist. Her main interest lies around how medicine can play a role with web 2.0 and social media. Dr. Huynh is currently Chief Resident at her Family Medicine Residency in Rapid City, SD and CEO of ScrubdIN, a startup company that aims to help health professionals and e-patients choose their next medical app. She blogs at http://thuchuynh.com

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59 Top Physician Blogs Worth Reading

While the majority of physicians haven't exactly embraced the rise of social media, here are some of the physician thought leaders who have.

The following blogs are not listed in any order but randomly placed in a general category. We've intentionally not linked to any blogs that have no recent posts and aren't currently active. If there's a blog that should be included in this list, please list it in the comments of this post.

Note: If you're looking for the blogs of our contributing authors, you can find links to them all next to their contributing authors bios.

Medicine & Specialties

These doctors write about outside interests, but their individual specialties tend to be their blogs focus.

1. ExpedMed: On Wilderness Medicine if you're in to adventuresome CME.
2. Uncommon Student MD: Student doctors in medical school and residency.
3. Doctor Anonymous: Passionate about medicine and social media.
4. Dr Helen: A forensic psychologist commenting on popular culture, politics and psychological issues.
5. A Life In The Day Of A Basics Doc: This roadside doctor handles trauma and writes about his experiences. Sobering and riveting.
6. Dr. Grumpy: This docs sick of patient shenanigans, the stupidity of insurance companies, and the daily insanity.
7. Movin' Meat: This Pacific Northwest physician posts stories of ER drama and healthcare reform issues will make you think.
8. Doc Gurley: A board-certified Internist physician and the only Harvard Medical School graduate to have been awarded a Shoney’s Ten-Step Pin for documented excellence in waitressing.
9. A Life In The Day Of A Basics Doc: A a blow-by-blow account of accident scenes, including shattered glass and drunk drivers.
10. MDOD: A collective of physicians from diverse specialties, all writing under pseudonyms, this blog shares case studies and humorous stories from work.
11. 33 Charts: Bryan Vartabedian, M.D. blog focused on pediatric health and social media
12. High Tech Surgeon: If you’re curious about the latest technology or the possibility of surgery performed by a robot, this blog is for you. Written by a general surgeon grounded in the practical applications of these innovations.
13. Clinical Correlations: NYU Department of Medicine educational site inspiring both new and seasoned physicians alike that internal medicine is much more than a job.
14. Cacoethes Cognitum: Group site who make a pastime of turning medical cases and discussions into medically irrelevant history lessons, philosophical rants, and displays of one-upsmanship.
15. At Your Cervix: (Best Name) RN blog about your cervix and stuff.
16. Respectful Insolence: A pseudonymous surgeon/scientist concerning medicine and quackery, science and pseudoscience, history and pseudohistory.
17. Mothers In Medicine: A group blog by physician-mothers, writing about the unique challenges and joys of tending to two distinct patient populations, both of whom can be quite demanding.
18. Bioethics Discussion Blog: Once a week or so, Dr. Bernstein offers a blog entry of varying interests, always in the world of bioethics.
19. Docnotes: Health, technology, family medicine and other observations.
20. The Dermatology Blog: All about skin care written by a dermatologist.
21. Buckeye Surgeon: Ruminations by a non-academic general surgeon from the heart of the rust belt.
22. Clinical Cases and Images: CasesBlog: This blog offers health news, updated daily, by a former Cleveland Clinic assistant professor of medicine.
23. Doctor David’s Blog: Follow the musings of a pediatric oncologist.
24. Dr. Deb: This lady is all business. She’s a psychologist specializing in trauma and depression and uses her blog for educating the public.
25. Dr. Len’s Cancer Blog: Dr. Lichtenfeld is Deputy Chief Medical Officer for the national office of the American Cancer Society.
26. Gruntdoc: A highly popular blog written by a doctor who once served in the U.S. Navy.
27. RangelMD: Learn more about sickness with a dash of cynicism from this highly popular doctor’s blog.
28. Aggravated Doc Surg: Takes on massive chunks of history to explain how the medical system ended up in such a mess. Posts are detailed and well-researched, but it’s the punchy writing that keeps you engaged.
29. Retired Doc’s Thoughts: Although some entries focus on health care debates, the focus here is on internal medicine, endurance training, exercise and gerontology.
30. Suture for a Living: Although this plastic surgeon is into ‘stitches’ in quilts as well as on bodies, the focus is more on medicine and health than on sewing.
31. California Medicine Man: Medical issues in the news. California Medicine Man is a physician and assistant professor at UCLA.
32. The Underwear Drawer: This is a personal online journals os an anesthesiology resident in Atlanta and “what happens next.”
33. A Chance To Cut Is A Chance To Cure: Analysis on issues relevant to surgeons, from insurance to policy.

Healthcare & Medical Issues

These blogs are focused on healthcare, managment and how it all works (or doesn't).

1. Life As A Healtcare CIO: Life in the world of healthcare IT, supporting 3000 doctors, 18000 faculty, and 3 million patients
2. MD Whistleblower: When not performing colonoscopies, this physician is tacking big issues in the medical field through his blog. His passion for high-quality medicine is evident in the consideration with which he composes each post.
3. Not Running A Hospital: Advocate for patient-centered care, eliminating preventable harm, transparency of clinical outcomes, and front-line driven process improvement.
4. DB's Medical Rants: Will Pay for Performance improve medical care? Do physicians need to be trained in emotional intelligence? An educated opinion formed by years of hands-on experience.
5. Health Care Reform In America: Dr. Kenneth Fisher on problems that make health care so outrageously expensive.
6. Bad Science: Dr. Goldacre is an award-winning broadcaster and medical doctor who specializes in tearing apart dodgy scientific claims made by “scaremongerers.”
7. Doctor & Patient: An IVF specialist who believes in information therapy and runs the world's largest free patient education library.
8. Fixin’ Healthcare: Dr. Newberry is a physician, former Dean of College of Medicine and Academic VP & Provost at MUSC in Charleston, SC (retired) and currently at Nutritional Health Centers in Greenville & Spartanburg, SC.
9. Health Care Renewal: A variety of doctors contribute to this blog, which is focused on health care renewal.
10. KevinMD.com: Join the hippest, most happening doctor on the Internet today as he tackles health care issues from the lens of a primary care provider.
11. Medical Humanities: This blog, written by a slew of medical personnel, focuses on the intersection between medicine and the arts.
12. DB’s Medical Rants: Dr. Centor contemplates medicine and the health care system in this interesting blog.
13. MD Whistleblower: Get it while it’s hot! Dr. Kirsch enjoys writing about controversies in the doctor-patient relationship. When he’s not writing, he’s “performing colonoscopies.”
14. Notes from Dr. RW: Learn about strange happenings in the medical world, including the interface between medicine and politics, from this blog.
15. The Covert Rationing Blog: Learn about healthcare rationing in America from Dr. Rich, a former professor of medicine.
16. Wachter’s World: Dr. Wachter is MD is Professor and Associate Chairman of the Department of Medicine at the University of California, San Francisco. He also writes this highly popular blog for and about doctors and their environments.

Physician blogs around the world

Docs blog everywhere. Here are some great blogs from down under, across the pond, and elswhere.

1. Angry Doc: Angry Doc is anonymous, but he is located in Singapore, and his interests and opinions have garnered a large following over the years.
2. Practice What I Preach: Thoughts on writing and parenting from a child psychiatrist and writer.
3. Bad Medicine: This UK blog focuses on…yep, bad medicine; but, in a totally engaging way.
4. Bagga’s Blog: Dr. Paul Baggaley is a Christian family doctor from Perth, Australia with an interest in obstetrics and pediatrics.
5. Doctor Bloggs…The official online diary of Nasty Gnome Party: A highly political medical blog colored by a great British humor lens and focused on the British National Health Service (NHS).
6. National Death Service: UK NHS horror stories drip from this “gotta watch this train wreck” blog.
7. Nip/Fuct: ‘Dr. Vegas,’ located in the UK, tags himself as a “greedy doctor looking for job satisfaction.”
8. The Jobbing Doctor: Follow this UK general practitioner who works in a “large industrialized conurbation outside of London.”
9. The Junior Doctor: This junior doc is training somewhere in the UK and “loving it.”

Ok... Some nonclinical physician blogs too.

Although these physicians are practicing clinical medicine, their outside interests seem to take front stage on their blogs.

1. Freelance MD: Only the most awesome physician lifestyle community on the web.
2. Zdogg MD: Slightly Funnier Than Placebo - Zdogg's a hospital physician and purveyor of fine medical satire.
3. In My Humble Opinion: This blog is deeply personal. A primary care physician who shares what’s in his heart regarding medical reform and the future of the profession. 
4. Academic Life in Emergency Medicine: Emergency medicine doc at SFGH with an academic niche posting on technology and how it can transform the landscape of medical education.
5. The Doc's Almost Wife: A nursing student, engaged to an orthopedic surgery resident. Posts discuss illusive life balance, meeting prospective office partners, and miscellany.
6. The Heart Is A Lonely Hunter: Tales From the training of a physician.
7. Musings of a Dinosaur: if you want great writing and humor that makes you snort your coffee up your nose, this is the blog for you.
8. Notes of an Anesthesioboist: Combine a specialist with an oboe and this is what you get.
9. Suture For A Living: A plastic surgeon in Little Rock writing about medicine and surgery as well as sewing and quilting.
10. The Blog that Ate Manhattan: A "Gyno-Food Blog" which focuses on both.
11. The Doctor Is In: Dr. Bob is a Christian doctor who has a very popular blog.
12. Physician Law: Regulatory and transactional health care attorney blogs legal.
13. Medical Spa MD: Physicians in non-surgical cosmetic medicine.

Ok, if you're a math guru you can see that there's more than 59 blogs here, but round numbers always smack of contrivance and we hate that.

Think there's a physician blog that should be included in this list? Please add it as a comment. (Blogs that fit in this list only please.)

The Disappearing Independent Physician

In a recent post I noted the trend among physicians to sell their practices to hospitals.

The recession coupled with the passage of the healthcare reform initiatives has pushed many physicians into simply throwing in the towel and walking away from the independent practice model.

This month in Smart Money is an article entitled Say Farewell to the Family Doctor.  It's an interesting read.

The articles continues the discussion about physicians becoming employees of hospitals and describes the impact this change is having on the physicians, patients, and the economics of medicine.  

I enjoyed the article, but the last paragraph really gripped me. Here it is:

Still, Mikell acknowledges, "doctors don't want follow-the-directions, cookbook medicine." And for many physicians, the idea of following new rules triggers a much larger unease at giving up their independence—a feeling of loss, both for the businesses they built and for their patients. Back in Bozeman, Blair Erb, the sole cardiologist in town, is a picture of resignation as he prepares to sign a contract with Deaconess. "I feel defeated," Erb says, looking around at the office furniture he and his wife, Liz, chose from a catalog years ago. The weathered ranchers and bundled-up women that come through his door mostly express disbelief when they hear that this frank-talking Tennessee native will sell his practice. His staffers say they're not looking forward to the questions the hospital's medical records system will soon prompt them to ask patients. (Do you wear a bike helmet regularly? Do you have a smoke detector?) "We'll try to retain as much professional independence as possible," Erb says, gazing at the hospital building, whose bulk he can see through his window. "But the fact of the matter is, we'll have a new master."

This paragraph was especially poignant to me since Dr. Erb is a former president of the Wilderness Medical Society and an author in our Expedition & Wilderness Medicine textbook.  

Regardless of one's stance on all the healthcare reform initiatives, it is difficult to watch this generation of physicians enter the twilight of their careers with frustration and disappointment. These men and women-- and their loyal patients-- deserve better, and our society will soon feel the impact of the loss when they and  their practices are gone.  

Update on Apr 15, 7:42 AM by Greg Bledsoe MD

Note:  I wanted the readers to be aware of a correction to this post.  The Dr. Blair Erb who is mentioned in the Smart Money article is the son of the Dr. Blair Erb who was the president of the Wilderness Medical Society and an author in our Expedition & Wilderness Medicine textbook.

It's The Hard Docs Life

Clinical medicine still has some humor left.

I ran accross ZdoggMD (Zubin Damania MD) on LinkedIn. He's a doc that has a rather specialized niche in medical comedy and produces music videos like this one. 

Thanks to ZdoggMD.com

Yo, ZDoggMD dropping some mad verse ’bout the struggles of being a hospitalist. Strictly for my homies!

Here are the lyrics.

It’s the Hard Doc’s Life for us
Hospital Doc’s Life for us
Specialists, they got it made
We do the work while they get paid
It’s the Hard Doc’s Life

From standing on the unit roundin’
To learning some of the thickest charts a doc has ever seen
and hearing some of the sickest hearts a doc has ever heard
Do the weekend, working nights and, all the shifts between
You know me well from Pull & Pray and the Ulcer Rap
Still I take crap from insurance and the housestaff
Eff that

To PCPs treatin’ sick folks
Mad props
While the consultant’s tellin’ dick jokes
That flop

I fill out paperwork all day long
No doubt
Then nurses tell me that I did it wrong
White out

See 20 patients but get paid squat, uh uh
The radiologist just bought a yacht, what the?!?
Nurses be laughin’ at the ties I bought
Shop frugally and save money at Marshalls and Ross
Payless
They call a code when I come thru
Just don’t be asking me to run it, man, I got notes to do.

It’s the Hard Doc’s Life for us
Orthopods consulting us
See their train wrecks every day
They fix the bone then walk away
It’s the Hard Doc’s Life

I flow for those gomed out; sundowning
Locked down in the Posey vest, just tryin’ to bust out
I roll with old folks, got no veins for IV pokes
Septic and found down, in stool, a Code Brown
Yellow gown itchin’, deep in debt from med school tuition
c diff, MRSA, up in my kitchen?!?

Intern’s bitchin’ bout work hours, he’s checkin’ the clock
But I’mma be on call whether I’m on call or not
We went from lukewarm to hot; fillin’ the hospitals with docs
Who practice evidence based logic like Spock
Straight talk from my homies who work in the ED
Mad luv, ‘less you’re calling ’bout another syncope
I disagree with the phony UM docs, mess with my homies
I’m like still, y’all don’t control me, s***
I like to bill, but when my patient census ain’t improving
I’m tryin’ to dispo everything moving

It’s the Hard Doc’s Life for us
Too many patients for each of us
Try to discharge, make ‘em pack
Overdo it, they bounce back
It’s the Hard Doc’s Life for us
Hospital Doc’s Life for us
Hardest job we’ll ever do
Next to cleanin’ baby poo
It’s the Hard Doc’s Life

About: Zubin Damania MD is a physician specializing in inpatient internal medicine and a member of the multi-specialty Palo Alto Medical Foundation. He practices at Stanford University Medical Center and Washington Hospital (in Fremont, CA). His current project merges his medical background with his extensive experience teaching and performing stand-up comedy for diverse audiences. As ZDoggMD, he writes, performs, produces, and distributes satirical yet educational videos and music relating to important topics in healthcare.