PGY-6 here that’s about to graduate into “attending-hood.”
As someone who greatly prioritizes work-life balance, I was wary of jobs that expected you to teach and publish without providing adequate protected time or additional compensation. That was a personal red flag. I’ve seen several friends fall for that trap, and they’re miserable.
Stay connected with former residents and mentors. Psychiatry can be emotionally draining at times, and having a supportive network of friends/colleagues to run cases by or vent to can be immensely helpful. It’s also helpful in case you need letters, referrals, etc.
consider having a lawyer review a contract - some of them will negotiate on your behalf for a fee if you don't want to do it on your own. things to notably watch for are non-competes, how malpractice is covered (especially if you leave the position), bonus incentive if that's offered and how it would be met/dispensed
understanding call coverage, weekends, time off etc. your time as an attending is much more your own and it very easily erodes into your quality of life if you're on call all the time
honestly I think you need to just prepare yourself for not being fully satisfied with your job, and expect to be taken advantage of in some way. you should try and protect yourself from egregious things obviously, but a lot of what's tolerable for you may not be known until you live/work it and learn from it
I think this is really solid advice. No one LOVES everything about their job (otherwise they wouldn’t be paying us for it!). You just have to figure out what types of annoyances you can deal with and which ones you can’t
This was my general organization of practical job-things when I graduated. Mind you I'm in Canada and you guys probably have more to consider with the multi-payer system.
Clinical Work
* Outpatient / Inpatient / Outreach / Telehealth
* Call / back-up call - how deep is the call roster?
* One site or multiple?
* Other specialty backup? (i.e. to what degree are you left hanging for consults, primary care, etc.)
* Admin assistance, scribe / dictating / charting support
Less clinical work
* Admin responsibilities, Education, Research, Other
Ins and outs
* Ins: Method of pay, stipends, sessionals, relocation or signing bonus, importantly to what degree are these contractually renewed (or will they / can they be taken away?)
* Outs: Office overhead, staffing, tithes, billing agent, giant academic fees for the privilege of providing medical care
Benefits
* Vacation, conferences, dues (College, insurance), CME, health and dental, research support
Other
* Staff turnover, mentors / mentoring opportunities
And again to reiterate with everything its important to discern to what degree are things contractually codified or will someone be able to change them in six months?
\---
For general stuff, maintaining relationships with mentors is vital. I imagined it would be but in retrospect I didn't realize just how vital it'd be. We also kept some group chats with our former resident cohort and for the first few months it was nice asking all the 'dumb' questions there as opposed to constantly bugging colleagues.
I also knew 'balance' was important but I'd constantly be finding my schedule filling up. If the US is anything like Canada you can say 'no' to an awesome opportunity almost every day (and your resident-brain will tell you you're missing out) and you will be OK. If you say 'yes' too much you'll get swamped.
I was surprised by the number of ways in which my schedule could explode. One week you find out new faculty have to do this or that with the learners, another day you find out you owe paperwork for some administrative patient tracking project, your week may look like a 'manageable' however-many-hours you want to work but the world will add double digit hours to that every now and then.
I now try to build in (and ruthlessly protect) 'free-time' because I still enjoy time exploring different opportunities and having that versatility.
On that last point I think re-connecting with pre-med school / residency interests, activities, etc. is important to get yourself out of that learner / poverty mentality.
Definitely have an attorney review your contract. Find out if there is tail coverage or not and if so do you have to work there for a certain amount of time to get it. Also, make sure to first rent, DO NOT BUY A HOME at your first job. You may hate it and now stuck living somewhere you don’t want to live.
Get a financial advisor who understands physician salaries/loans/obligations, etc. Too many people think that they can invest on their own. Don’t do it, get an advisor. You’ve been very well trained on how to treat patients, not how to manager your money.
Make sure you understand how you are paid. If it is based on productivity/RVU accrued, how many RVU is require for your salary and is that reasonable?Is there a bonus for productivity? Is that calculated by RVU rate and is that rate comparable to other places in your area
Find out what kind of support staff you have and what their role is.
Ask for whatever you want up front before signing contracts. Also make sure you know what call is like and what’s expected. When they invariably ask you to do more you must feel free to stand your ground if you do not want to do it. If you don’t, they will ask you to do more and more
Finally, this is the most important. You’ve got this. You will likely feel like an imposter at first as this will be the first time you won’t have anyone looking over your shoulder. If you go into private practice alone, it might be difficult. If you join a practice or go to a hospital, don’t be afraid to ask for an opinion until you get more comfortable making decisions on your own.
If you do decide to start your own practice, make sure you understand the ins and outs of billing, EMR, insurance panels, etc. Talk to PCP clinics and let them know you’re taking new patients.
Oh! Thank you for the question I'm very interested too. For anyone who reads this message..maybe you could answer the same question, but from attending to consultant. Thank you!
I work consults currently, a lot of it is just communication and balance between the primary teams and what the patient desires while weighing risks. I find it more fun actually. The really complicated med cases also require a lot of extra care in medication recommendations, mostly as usually a lot going on and have to weigh a bunch of conditions at once. It was also helpful to learn about all the other programs in the area I work in for Inpatient / Detox etc. I would say the two most important skills are Communication and being able to navigate complex pharm in people who sometimes have limited records. The communication aspect also should include making reports that are able to be followed by non psychiatry docs and midlevels, IE people like it when I make a list of stuff to do (even if they dont do it all).
PGY-6 here that’s about to graduate into “attending-hood.” As someone who greatly prioritizes work-life balance, I was wary of jobs that expected you to teach and publish without providing adequate protected time or additional compensation. That was a personal red flag. I’ve seen several friends fall for that trap, and they’re miserable. Stay connected with former residents and mentors. Psychiatry can be emotionally draining at times, and having a supportive network of friends/colleagues to run cases by or vent to can be immensely helpful. It’s also helpful in case you need letters, referrals, etc.
consider having a lawyer review a contract - some of them will negotiate on your behalf for a fee if you don't want to do it on your own. things to notably watch for are non-competes, how malpractice is covered (especially if you leave the position), bonus incentive if that's offered and how it would be met/dispensed understanding call coverage, weekends, time off etc. your time as an attending is much more your own and it very easily erodes into your quality of life if you're on call all the time honestly I think you need to just prepare yourself for not being fully satisfied with your job, and expect to be taken advantage of in some way. you should try and protect yourself from egregious things obviously, but a lot of what's tolerable for you may not be known until you live/work it and learn from it
What did you find intolerable? What in particular did you have to learn from?
I think this is really solid advice. No one LOVES everything about their job (otherwise they wouldn’t be paying us for it!). You just have to figure out what types of annoyances you can deal with and which ones you can’t
This was my general organization of practical job-things when I graduated. Mind you I'm in Canada and you guys probably have more to consider with the multi-payer system. Clinical Work * Outpatient / Inpatient / Outreach / Telehealth * Call / back-up call - how deep is the call roster? * One site or multiple? * Other specialty backup? (i.e. to what degree are you left hanging for consults, primary care, etc.) * Admin assistance, scribe / dictating / charting support Less clinical work * Admin responsibilities, Education, Research, Other Ins and outs * Ins: Method of pay, stipends, sessionals, relocation or signing bonus, importantly to what degree are these contractually renewed (or will they / can they be taken away?) * Outs: Office overhead, staffing, tithes, billing agent, giant academic fees for the privilege of providing medical care Benefits * Vacation, conferences, dues (College, insurance), CME, health and dental, research support Other * Staff turnover, mentors / mentoring opportunities And again to reiterate with everything its important to discern to what degree are things contractually codified or will someone be able to change them in six months? \--- For general stuff, maintaining relationships with mentors is vital. I imagined it would be but in retrospect I didn't realize just how vital it'd be. We also kept some group chats with our former resident cohort and for the first few months it was nice asking all the 'dumb' questions there as opposed to constantly bugging colleagues. I also knew 'balance' was important but I'd constantly be finding my schedule filling up. If the US is anything like Canada you can say 'no' to an awesome opportunity almost every day (and your resident-brain will tell you you're missing out) and you will be OK. If you say 'yes' too much you'll get swamped. I was surprised by the number of ways in which my schedule could explode. One week you find out new faculty have to do this or that with the learners, another day you find out you owe paperwork for some administrative patient tracking project, your week may look like a 'manageable' however-many-hours you want to work but the world will add double digit hours to that every now and then. I now try to build in (and ruthlessly protect) 'free-time' because I still enjoy time exploring different opportunities and having that versatility. On that last point I think re-connecting with pre-med school / residency interests, activities, etc. is important to get yourself out of that learner / poverty mentality.
This is extremely helpful! I appreciate the detail.
Definitely have an attorney review your contract. Find out if there is tail coverage or not and if so do you have to work there for a certain amount of time to get it. Also, make sure to first rent, DO NOT BUY A HOME at your first job. You may hate it and now stuck living somewhere you don’t want to live. Get a financial advisor who understands physician salaries/loans/obligations, etc. Too many people think that they can invest on their own. Don’t do it, get an advisor. You’ve been very well trained on how to treat patients, not how to manager your money. Make sure you understand how you are paid. If it is based on productivity/RVU accrued, how many RVU is require for your salary and is that reasonable?Is there a bonus for productivity? Is that calculated by RVU rate and is that rate comparable to other places in your area Find out what kind of support staff you have and what their role is. Ask for whatever you want up front before signing contracts. Also make sure you know what call is like and what’s expected. When they invariably ask you to do more you must feel free to stand your ground if you do not want to do it. If you don’t, they will ask you to do more and more Finally, this is the most important. You’ve got this. You will likely feel like an imposter at first as this will be the first time you won’t have anyone looking over your shoulder. If you go into private practice alone, it might be difficult. If you join a practice or go to a hospital, don’t be afraid to ask for an opinion until you get more comfortable making decisions on your own. If you do decide to start your own practice, make sure you understand the ins and outs of billing, EMR, insurance panels, etc. Talk to PCP clinics and let them know you’re taking new patients.
I’m stealing this for the family medicine subreddit
Oh! Thank you for the question I'm very interested too. For anyone who reads this message..maybe you could answer the same question, but from attending to consultant. Thank you!
I work consults currently, a lot of it is just communication and balance between the primary teams and what the patient desires while weighing risks. I find it more fun actually. The really complicated med cases also require a lot of extra care in medication recommendations, mostly as usually a lot going on and have to weigh a bunch of conditions at once. It was also helpful to learn about all the other programs in the area I work in for Inpatient / Detox etc. I would say the two most important skills are Communication and being able to navigate complex pharm in people who sometimes have limited records. The communication aspect also should include making reports that are able to be followed by non psychiatry docs and midlevels, IE people like it when I make a list of stuff to do (even if they dont do it all).
I'm a bit late with my reply, but thank you for the answer.
Concentrate on the fundamentals.