Medical Students, Advising, Workplace, Medico Legal, Burnout

When the Dust Settles: A Look After the Match

Part III: Professional

Congratulations, you’ve matched! Now what? Let's examine the transition to residency with three articles: Housing, Finances, and Professional.

We sat down with Gregory Tanquary, DO, MBA, an emergency medicine resident at Ohio Health Doctors Hospital, to get his perspective on some topics to consider as you transition into residency.

LICENSING
"Hi, my name is Dr. ___." - You in a few months

As an intern you are granted a “training license.” This is not a full practitioner license. After you match, you get a boatload of paperwork to fill out from your new program director. I can’t speak for all of them, but our PD is phenomenal. She gets all of that paperwork together and submits your application. You may have to pay $50 or something for it. So hopefully, your PD will arrange most of that stuff for you.

After intern year, you can apply for your full medical license, DEA number, etc. For that, you will have to do most of the work. It’s costly. The advantage is it allows you to become credentialed at outside hospitals to moonlight. Each program has different requirements and rules for their residents to moonlight, so ask upper levels. But nothing to worry about until  after your first year.

EMRA & Residency Leadership
"Onward and upward!" - CS Lewis

You should be involved as much or as little as you like. I believe it is an ACGME requirement that every resident sits on a committee of some kind. Some are more involved than others. Your program will be able to speak more to their hospital’s specific committees. As far as residency specific leadership, I would think most all programs offer roles. We have residents in charge of simulation, oral board case review, M&M within our program and many more.

Some residents are perfectly content with showing up on time, leaving on time, fulfilling their requirements, and graduating as a board-eligible physician. There’s nothing wrong with that. Others want to get involved on a local or national level. Our program encourages any and all involvement as long as you are in good standing. We have multiple residents on EMRA positions, former presidents of ACOEP, and much more.  This is certainly program-specific, but most programs encourage and help you cultivate your area of interest. I have experienced a benefit to getting involved. It makes you more a part of your profession and the emergency medicine community as a whole.

Vacation
"Ahhhhhhhhh....." - Your body during a vacation

Use it! Every program/hospital is different, but we get 20 days. There can be some nuances about when and how to use it, but your chiefs and PD will explain that during orientation. For example, at our program you cannot use “true vacation days” when you are in the department. However, they allow you to request 4 days off when the chiefs make the schedule. Then, they will do their best to honor your requested days off when you are in the ED. Your "true vacation day" requests are used during off-service rotations.  Plus you will likely have restrictions on how many you can request off in a row.  This is a hospital policy they will explain during orientation.

MAKE SURE YOU USE ALL OF YOUR VACATION DAYS. They likely will not roll over.  You need to take time for yourself.  You will get tired, angry, impatient, and worn down throughout residency. So, take vacation when its available. Do what you love, do nothing, or do whatever it takes to recharge. I’m an active person. I go to a friend’s lake to water ski, and I’ve been snow skiing. Just make sure you get away.

Conferences
"Club going up on a Tuesday" - iLoveMakonnen

(Disclaimer: I have no financial disclosures from any conferences mentioned in this article.)
Most programs will require you to attend at least one conference throughout your residency. A lot of people make it the ACEP Scientific Assembly. I think conferences are a great thing. Sure, some lectures are boring, but it provides you with an excellent opportunity to network, hear about policy/political issues within your college, and, of course, meet potential employers. You will also walk away with more conference swag than you know what to do with! Plus, you can learn stuff, too. 

I recently went to ACOEP and presented a lecture in a competition. I won, so I got to talk in front of the entire ACOEP EM College. It was fun, it got me out there, and I actually met an individual who could be pretty helpful in finding a job back in my hometown. I would not have met this person had I not gone.

Conferences are a time commitment for sure, and most places will require you to use personal vacation to go. However, I think it is worth it. Don’t use all of your vacay on it, but conferences are fun.  Plus, if a group of residents goes, you guys can go out at night. ACEP always throws great parties at their conferences. Popular ones in no particular order: ACEP, ACOEP, Essentials of EM. You should get a “personal educational fund” from your program that  allows you to use money on conferences.  This fund can go fast when you use it to pay for Step 3, ACLS, ATLS, and other certifications, but some money is there.

Feeling Comfortable for First Shift
"Hakuna matata... it's our problem-free philosophy!" - The Lion King

This is a tough one to answer. You may get mixed responses, but I bet if you asked enough residents their responses would end up being the same: Do nothing to prepare for your first shift. I know that sounds crazy, but I think it is the best advice for a couple reasons.

First, you’ve earned this time at the end of medical school to relax and have fun. Take some fun, easy rotations. Get away from the textbooks and question banks. Residency is long and tough, so it is important to come in fresh.

Second, you can read Tintinalli’s or Rosen’s cover-to-cover but it won’t prepare you for your first shift. It’s one thing to shadow residents and attendings and remember how you saw that awesome thoracotomy. It’s a whole different ballgame when you’re the doctor making the calls. I doubt you will remember much of anything when you’re holding that needle over someone’s neck the first time, or when the whole room is watching you do your first intubation. When you start, you’ll be nervous about ordering Tylenol, trust me. So, don’t worry about memorizing the antidote for sulfonylurea overdose or what size French chest tube should go in.  What I’m trying to say is, no amount of pre-reading or video watching will prepare you for the chaos of your first few months. DON’T WORRY, everyone was there. 

You’re not supposed to know everything. If you did, we wouldn’t need residency. Your peers are feeling the exact same way as you - remember that. They are questioning their knowledge and abilities the same as you. You will quickly learn you are all in it together. And if your class/program does not foster that culture, do it yourself. Because you are all in it together.

If you can't relax and you MUST do something with your time leading up to Day One, read something easy and common. Simple chest pain work up, belly pain, shortness of breath, or another bread-and-butter case would be good ideas. Listen to EM Basic, a great podcast for med students and interns. Tune in casually while working out or driving. But don’t sit down and do questions or read chapters every night. Enjoy your time!

Must-haves on Shift

  1. Food. Bring something to eat and drink. Hopefully your place lets you eat at your station, because it’s hard most times to leave for food.
  2. EMRA Antibiotic Guide and PressorDex. (These are in your EMRA Resident Member Kit.)
  3. Worth investing in a good set of trauma shears. Not cheap but worth it in my opinion
  4. Pen light. Strangely it comes in quite handy when you’re looking at pupils and don’t have a convenient otoscope attached to the wall nearby. Alternatively a good headlamp is also useful for looking at lacs, cervixes, or eyes.
  5. On my computer I always have WikEM, MD Calc and UpToDate pulled up.
  6. EMRA’s list of recommended blogs and podcasts.

Take-Home Points

  1. Figure out your personal loan situation how you are going to repay it.
  2. Figure out where you want to live and how you are going to live.
  3. Take vacations, and lots of them.
  4. Bring yourself, your on-shift guides, and some food to your first day, and run with it! 

Read After the Dust Settles - A Look after the Match, Part I: Housing

Read After the Dust Settles - A Look after the Match, Part II: Finances

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