Lessons learned after a year in urology’s ‘real world’

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I was driving home from the office last week and realized that I have now been in the "real world" for over a year. As I looked back on the last year, I thought I would share a few of the lessons I've learned as I am curious if others have had a similar experience during their transition from residency to private practice.

First, nobody cares if you are “post call.” As a resident, it always seemed appropriate to look and act post call after a busy night. I remember many days in residency showing up to clinic in scrubs almost daring the attending to call me out on my unwashed hair or my generally disheveled appearance. Not anymore. While I certainly don't wear a three-piece suit to clinic, I have learned that patients expect a certain degree of professionalism from a physician. As a result, I quickly learned where the shower in the hospital was and I now keep a spare set of toiletries in my locker so that even if I am forced to go to clinic in scrubs, I look decent.

Second, being rude to staff, patients, and/or other physicians is not tolerated. In residency, I-along with most of my fellow residents-favored sarcasm as a defense mechanism. I quickly learned that in the real world, sarcasm is not well tolerated. Since arriving here, I have seen staff lose their jobs over inappropriate behavior and watched as other physicians were reprimanded by hospital administration for behavior that last year I would have considered simply sarcasm. While I would never have guessed it in residency, the real world is a very politically correct place!

Third, I couldn't do my job without the help of the staff, both in the hospital and in clinic. In residency, it always seemed that the resident was responsible for everything, from rooming patients in clinic to getting the supplies ready for a procedure. In the real world, that is not the case. Over the last year, I have worked with dozens of people from nurses to scrub techs to schedulers who do an incredible amount of work for not a lot of money. They may not have gone to medical school, but the good ones are truly indispensable. The level of efficiency I am able to maintain is not due to my skills but rather the combination of my work and the work of the team that I am blessed to be part of. 

Next: "Surgery is different when you are on your own."

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Fourth, surgery is different when you are on your own. A few years ago, my residency hired a group of new attendings straight out of fellowship and I remember operating with them and watching as they perseverated over the placement of a single stitch. I couldn't figure out why they weren't moving along. Now I get it. There have been nights after a big case-when I left the OR very happy with how things went-waking up in sweats wondering if I forgot to close fascia.

Finally, while I feel that I was well trained for the majority of my job as a doctor, I do not feel well trained for the business aspect of practicing medicine. Since leaving residency, I have read a book on accounting and one on medical billing, and I still feel that if it wasn't for the senior partners in my group, I'd be floundering or more likely bankrupt. I now better understand why some physicians sign up with hospitals or other large medical groups to concentrate just on patients. I still believe that joining a single-specialty group was the correct decision for me and I look forward to continuing my business of medicine education over the next few decades.

Overall, it has been a great year both personally and professionally, and I am thrilled with what I have accomplished. But it has been a year when I have become more aware than ever of what I can and can’t do as a urologist. If you have a lesson you’ve learned early in your career that you would like to share, please email me or fill in the comment box below.UT

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