The clock is ticking. The number of days left in residency is dwindling.
On the horizon awaits the holy grail of medicine: independence as an attending physician. It is the culmination of years of grueling effort. I have long dreamed of life as an attending—not simply for the better hours and salary, but for the freedom to exercise my own medical judgment.
Of course, this independence comes at a cost. As an attending, I will bear the full weight and responsibility of my patients’ care. There will be no senior colleague to catch my mistakes. The buck stops with me.
This thought increasingly preoccupies me as the end of residency draws near. I find myself haunted by a single question.
Am I ready?
While I trust in my training, it’s hard to shake off the anxiety of practicing alone. Emergency medicine residents are expected to master a dizzying array of medical and procedural skills before we “fly” as attendings. These include physical skills— like lumbar punctures, joint reductions, vaginal deliveries, surgical airways, and chest tubes— and a nearly-endless spectrum of medical pathology, from cardiac arrhythmias to strange and itchy rashes. It is a daunting skill-set to learn in just three years of residency.
I’m left wondering, who could possibly feel comfortable stepping into this field as a new attending?
Thinking back on my residency, though, I realize I have no reason to feel insecure. Hasn’t all of residency been a continuous exercise in living outside my comfort zone? Beginning in my intern year, I faced a slew of skepticism from my patients about my age and inexperience. As a new resident, I remember how difficult it was to convince patients to let me perform procedures on them. When I reviewed the risks aloud—from collapsed lungs, to strokes, to possible death—I often found myself sweating alongside my patients. I was wracked with insecurity and paralyzed by my own empathy. I knew that if I were in their shoes, I wouldn’t want a rookie doctor puncturing my spinal sac.
And yet, I survived.
I learned how to take a deep breath, steel my nerves, and get the job done. Yes, I made mistakes. And yes, I offered apologies. But I never lied. I never offered false assurances, and I never embellished my experience. I learned to be uncomfortable, to embrace uncertainty, in order to maintain my honesty.
Residency is designed this way. It is meant to push you beyond your comfort zone, knowing there is always a safety net beneath you. If you fail, there are more experienced hands who can finish the job.
Next year, though, that net vanishes for me. There will be no seasoned doctor to step in and rescue my difficult intubation; no grizzled clinician to recognize that my sweating patient is in a thyroid storm. It’s just me. My mind. My hands. My gut.
That’s why I feel a fire burning within me, urging me to grab every procedure and critical patient who comes my way. I am spurred on by my fear of inexperience, knowing that inexperience can kill patients. There is no shortcut.
How to Be Ready to ‘Attend’
There are lessons, that I’ve learned from residency - from living beyond the comfort zone - that may help prepare for life as an attending physician.
Don’t Overreach
First, know your limitations, and practice what you know. Don’t be cavalier about new procedures or new medications without the proper understanding for what you are doing.
Don’t Overlook
Know your resources. Know which pocket carries your critical medication list, and how to quickly troubleshoot those pediatric emergencies.
Don’t Be a Loner
Trust your team and delegate tasks. Don’t try to shoulder the entire department alone. The nurses, techs, and pharmacists around you are your greatest assets and your strongest allies.
Don’t Guess or Gamble
Ask for help when you need it. There is no shame in asking consultants, nurses, or even patients themselves to explain unfamiliar concepts to you. Don’t be proud. Humility saves lives; hubris costs them.
Don’t Fear Uncertainty
Finally, and most importantly, don’t be afraid to say, “I don’t know.” Recognize the limits of your knowledge and cherish the ethos of honesty, even if it costs you your pride. Remember that patients don’t expect us to be perfect. They expect us to be human and kind. Compassion, sincerity, and humor will save you from many embarrassing situations and keep you anchored in your humanity.
---
These are my tools from residency. They have taught me that I don’t need to feel comfortable to do my job. In fact, I’ve been thriving outside the comfort zone for years.
The clock is ticking. As graduation draws near, the same question haunts me with a singular obsession. Am I ready?
No, I’m not. I never will be. But I realize now, no one ever is.