Real World Transitions by Dr. William A. Ross

Wow. The end of your extended period of “delayed gratification” [i.e. Residency] is rapidly approaching. At this time, it is easy to start looking ahead to the car or home that you’ve been dreaming of or the places that you’ve always wanted to visit. Unfortunately, the end of your residency is NOT the time to start thinking of ANY of those things. Your transition from “Resident” to “Attending”, “Professor” or “Partner” can be made a lot smoother if you follow these general guidelines:

Know EXACTLY How To Do What You Know How To Do

As you become a brand new orthopedic surgeon, you will be asked to discuss what your preferences are for the set-up and execution of any and all manner of orthopedic procedures. It is imperative that you actually have preferences to discuss. Right now, today, start recording your preferences. The easiest way to do this is to ask for the “preference card[s]” [usually on file in the operating room] for all of the cases that you regularly participate in or anticipate participating in. If you have a certain way that you like to set-up a case, then take a picture of your set up [or draw a diagram]. Know the specific contents of the trays that you use most frequently. A photo of those contents helps here as well. You will discover that the “ankle fracture” tray at your current institution may not resemble the similarly named tray at another institution.

Know your favorite instruments by name and size. Know your favorite sutures and gloves. Know patient and bed position, monitor arrangement, and the name and placement of your drapes. Copy or somehow record and store your pre- and post-op order sets, drug regimens and doses.

The more information that you bring from your residency, the more comfortable you will be and the better you will be able to perform. Your next OR will only do it the way you like it if you tell them exactly how you like it.


Know Thyself

Now [right this minute!] is the time to make an accurate and honest self-assessment. If you are not any good at this, then get a friend or family member to help. This is a crucial step in getting yourself into the right situation. Think about the aspects of your residency that you absolutely hated and/or, more importantly, those things that you weren’t very good at. For example, if you know that you suck at completing paperwork in a timely manner, then you may seek a situation where a physician assistant, nurse practitioner or scribe is responsible for this. If you know that you want nothing to do with “selling yourself” to build a practice, then choose a situation that allows you to concentrate on the work only. Knowing your own likes, dislikes, strengths and weaknesses is a critical step in picking the right environment for you to truly grow and develop into the happiest, most productive orthopedic surgeon that you can be.


Get A Financial Advisor and Plan

Your last years of your residency are the best time to get help mapping your financial future. If you have any debt, this is the time to create a plan for resolving it. DO NOT put off resolving your debt if you can help it. The folks who own your student loans will be more than happy to allow you to pay “later.” For you, paying later simply means that you will end up paying more money over a longer period of time. This is the best time to get disability insurance as well as your own malpractice insurance – which you should absolutely have. If you don’t know where to start to find a financial planner, ask your attending or a recent graduate of your program.


Maintain Your Current Lifestyle

Over-extending yourself financially is a common post-residency mistake that you do not have to make. Commit to at least one year of residency-level living, regardless of the spectacular contract you have just negotiated. Living way below your means allows you to settle your debt AND to begin a comprehensive savings plan. Continuing to live as a resident also prevents you from tying yourself to a specific location by purchasing a house before you truly know whether your brand new work situation is a good fit. Please refrain from the big new purchase until you have truly made a dent in your debt and a good start on your savings, you will definitely appreciate it later.