I'm not a resident anymore; I'm the boss, and I'm cancelling your case.

Courtesy 20th Century Fox Photos

The patient had arrived for a urology procedure with a blood glucose in the 400's. He suffered from a recent stomach bug and had gotten off schedule with administration of his meds. While his GI symptoms had subsided, he was feeling crappy overall. I decided to cancel his case and went about initiating treatment to get his blood sugar under control. When I informed the urologist of my findings and decision, he said, "Who's your attending physician today?"

"I am the attending." (Translation: I'M THE BOSS, today and every day!)
::: crickets ::: crickets :::

I work at the academic institution where I trained, and because of my sick leave I finished my training at a different time of year than most residents, the news of my status change has been slow. Gradually, the surgeons and nurses and techs are starting to learn, but I still get this kind of thing occasionally.

There is a slight shift in the way that surgeons and other team members treat you when you complete your training and become one of "the bosses". The difference could be one day from pre- to post-graduation, but you will suddenly feel much more part of the decision-making team and less of... well, a worker-bee. Don't get me wrong, I have never been mistreated by an anesthesia or surgery attending, but residents are not the ultimate decision makers on the team. 

The transition from resident to attending physician is full of challenges, not the least of which is fully accepting the mantle of your new status. It doesn't matter your specialty (or even your profession, as many career paths involve long periods of apprenticeship), this role shift can involve a great deal of stress. How have I dealt with my transition? A few key ways:

1. Check the ego.  Even though you have earned your newfound status, you still suffer from a lack of experience. Like asking for beta from a climber who has mastered a route before me, I (unapologetically) ask the opinions of my more senior anesthesia colleagues in equivocal situations. It is a difficult balance to be direct in your intentions without being perceived as making a power play. But if extemporaneous speech is not your forte, read on... 

2. Be confident.  I'll admit this is sometimes a challenge for me, one that I got dinged for during residency and still struggle with occasionally. When asked off-the-cuff patient management questions by my attending supervisors, I would know what I wanted to say but sometimes stumble on the answer. With a case cancellation or any other anesthesia-related decision-making, you must be confident in your reasoning and able to communicate that effectively to the other team members. This skill is the cornerstone of our Anesthesia Oral Board exam (coming up for me next spring)! How to work on confidence? Practice your explanations in your head, on paper, to your spouse/dog/mirror, etc. If you ever catch me daydreaming during an uneventful case or a grand rounds presentation, it's likely that I'm doing this in my head!

3. Focus on the basics.  Although residency might be (thankfully) over, we as physicians are never finished with training and learning. There are still days when I am humbled by a challenging case, and I don't expect this to change. It inspires me to reference a text or review the latest practice guidelines. Focusing on "doing anesthesia" and making the right choices for my patients will lead to the best outcomes for everyone.

4. Foster relationships. A nice consequence of my change in status has been getting to know the medical team members (especially the surgeons) on a more personal level. Whenever possible, I greet them in the morning and try to spend a few minutes going over some details of patient management for the day, which makes for a smoother, more efficient flow overall.

5. Remember professionalism. My Professionalism APGAR applies not only to interactions with patients but also to any member of the healthcare team. And of course, when in a stressful situation, this is the first thing that suffers. While as an attending you may be interacting with the medical team more directly, you still must maintain some air of separation.

What about you? How does your current role cause you stress, and how do you overcome it? If you've recently transitioned from trainee to "a boss", what changes (good or bad) have you noticed, and how have you dealt with them? Share them here!


  1. When I finished my otolaryngology training in the late 1980's, I stayed on as faculty at the institution where I'd done my training. It took a full cycle of residents- ie, the ones who were PGY1s when I was a fellow, graduating- before I felt like a real faculty member.

  2. Karen, Thanks for your input! Another woman in my group has had the same experience. I don't know what component of this is a "young female doc" thing... I should ask some of my recently-finished male colleagues and find out how much it happens to them!


Post a Comment

Popular Posts