Tips for a Successful Early Clinical Career for Residents, Fellows, and New Board-Certified Clinicians

Paul Griner, MD, MACPClinical Pearls, Emergency Medicine, Family Medicine, Internal Medicine, Medical News, Medical Schools, Nurse Practitioner, Nursing Programs, Nursing RN/PN, Pediatric Emergency Medicine, Pediatric Medicine, Personal Education, Physician Assistant, Residency Programs, Urgent Care

tips for a successful early clinical career and starting clinical practice

Tips for a Successful Early Clinical Career for Residents, Fellows, and New Board-Certified Clinicians

How to get off to a good start in your clinical practice.

Completion of residency or fellowship training is an important step in one’s early clinical career.  Equally important is getting off to a good start in your chosen branch of medicine once you have completed training. Whether you have joined a primary care practice, a subspecialty group, have become a hospitalist, or have completed training in some other field, there are a number of things you can do to help your transition into your medical career go smoothly.  Here are some important tips for a successful early clinical career.

Find a Mentor.

tips for an early clinical career - find a mentor

In Homer's Odyssey, Mentor was the name of the person to whom Ulysses entrusted his son when he (Ulysses) left on his Odyssey.  This is where we derive the definition of a "mentor" today - a trusted friend with a wealth of knowledge who was kind, supportive, non-judgmental, practical, and ethical.

Once you’ve been in the practice environment for a few months and have come to know your colleagues, identify one of them who you respect and ask if he or she would be willing to be an advisor for you. The person who you identify need not be in the same field of medicine since your interest is for a person to give advice on a host of professional challenges that are not specialty specific.

Examples of inquiry and counsel between your mentor and yourself might include questions such as:

  • “How do you plan weekends with your family when you are not on call? Do you plan ahead or just wait until you have the time?” 
  • “When I take work home to complete it, I find that I’ve spent the whole weekend on the homework. How do you handle take-home work?”
  • “I have this patient who.....  What would you tell her?”
  • “How important is it to become involved, early on, with the American College of.....”

Most colleagues are honored to be asked to be an advisor, and many have served in this role for years.  It's important to ask questions throughout your clinical career and asking questions is a sign of a curious and industrious new colleague.

I had the pleasure of starting a mentoring program for physicians on the staff of two hospitals some years ago, and I continue to hear from past mentees how helpful they found our sessions to be.  If developed, the mentor relationship is one that typically lasts a lifetime and can serve you in surprising ways.

Communicate and Socialize.

This may seem self-evident, but once you become engaged in the care of patients, independently, it can be all consuming. Isolation from colleagues due to constant attention to your patients is a recipe for early burnout.  You don't want to stuck alone on an island - and you don't want to keep a working colleague stuck alone on theirs.

I recall a young internist with whom I was having a first mentoring visit.  Minutes after the session began she broke down in tears. I offered a handkerchief to dry her tears and then asked what had caused the tears. She looked at me and said, “You are the first person to ask me about myself in 15 years.

She had been seeing her patients in relative isolation for all this time with little interaction with her colleagues.

Share the stories of interesting or challenging patients with your colleagues.  In fact, there are important parts of providing good care that don't necessarily involve a patient.  Sharing a story - clinical or non-clinical - allows everyone a chance to grab some much needed perspective and shed some stress.  And again, as the years roll on, your concern for and connection to colleagues will come back to you in rewarding ways.

Demonstrate Ethical Behavior.

Do the “right thing” for your patients. Avoid unethical practices.

One of my medical colleagues, after joining a primary care practice, was told that he was not ordering enough diagnostic tests. When he asked for clarification, he was told that reimbursement for primary care visits was so low that the practice decided to develop its own laboratory so that the payment for patient visits could be enhanced through the ordering of tests, whether the patients needed them or not.

The practice had actually established a quota of tests that should be performed each month on each patient according to the patient’s diagnoses. This arrangement was not only unethical, it was illegal.

My friend made the right choice. He left the practice and struck out on his own.  He soon was very happy being able to spend the time needed for each patient and ordering only tests that were deemed appropriate and necessary, albeit with a lower net income.  

Well, time and questions eventually caught up to that specific practice group.  And unlike those who justified unethical practices simply to remain employed at the practice for a slightly higher income, my friend's name and practice history remains untarnished.  Do the right thing even if you face a momentary inconvenience or disruption.  It will pay off in the end.  It has for my friend.

Plan for the Long Haul.

If you practice as long I have, you'll come to recognize the recurring cycles of education and board certification and how they can drain your time and resources over and over.  Plan for it as you're starting out with limited resources and funds.  You can get by time after time, but it becomes tedious.  It's nice to have resources that will remain available over time - and of course, stay up-to-date.  A textbook can't do it.  Buying a one-shot, one-exam, board review question bank can't do it.  There's a difference between a purchase and a wise investment.

Given the myriad of continuing education and maintenance of certification requirements, the best thing I can recommend is to invest in solutions that are designed to support you and adapt through time - like your own clinical knowledge will need to.  Consider too, you'll likely have a number of specific state and workplace specific CME needs and most "board review" companies just focus on one exam at a time.  

One vendor that I know is designed for the complexity of a long varied clinical career and the simplicity of having everything you need in one spot is Med-Challenger (and for full disclosure I've been a contributor to Med-Challenger for some time, hence my familiarity) but the initial and lasting, long-term personal education and convenience value is very real in my opinion.  There are a lot of great resources out there, but from someone who's navigated their career's practice requirements for decades, their subscription-based solution just works out better than the endless buying and runaround, for me.

I'm simply saying, you will have requirements to complete every year,  You don't have to make it more difficult or expensive than you have to.  

Good luck, And happy practice!

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