Archives > February 2017

The First 5 Years

Medicine is many things. It is constantly challenging, humbling when you least expect it, stressful within an instant and rewarding in circumstances you would never anticipate. The ways in which medicine can surprise, and even fool you, is particularly evident in a physician’s first five years of practice.

The early stages of medical practice are met with beaming optimism as a long educational journey finally comes to a close. Despite this enthusiasm forging a new path can be outright terrifying at times (okay maybe even all the time). One often longs for the patiently observing staff to come forth from the shadows and peer over their shoulder once more.

One of the best ways to get ready for this exciting new frontier in one’s career is to quite simply—prepare. It may sound obvious but preparation can truly make a difference when starting practice and this most important step should start well before you even enter practice. While physicians are well educated for clinical roles and responsibilities, it’s all the other stuff that many of us tend to ignore which requires attention as we commence practice.

So Where To Begin…
Getting one’s privileges and licenses in order is one of the most time consuming and paper-work heavy aspects of the process. Considering that this has fun written all over it…many seem to stall on this opportunity at form completion nirvana. Yes, it will take forever to complete all the forms, and having them reviewed and signed off will take even longer than eternity, so it’s best to start as soon as you can!

The Alberta College of Family Physicians First Five Years Committee has a link to all the general privileges and licensing steps required for Alberta (applicable to FRCPC colleagues as well). This may be a good place to start to get one’s bearings on the process. Try to cover off all the forms and registrations at once as most require similar documentation and you won’t have to worry about it later should the need suddenly arise. (Link: https://www.acfp.ca/membership/first-five-years/transition-to-practice/)

Other important aspects to set in place include establishing your professional team. It is imperative to find a lawyer for your practice basics (for example, document notarization, establishing your professional corporation, etc.). In addition, finding a good accountant will be essential as you move through your early years of practice when there are a lot of financial changes occurring. A financial planner will also be crucial in this regard.

When searching for such professionals its best to ask around, as your colleagues will know competent professionals with experience in medical practice. Since physicians have unique accounting and legal needs, look for someone who has worked with several physicians, and has an interest in this area. Having trusted professionals in place from the start will help you ease into early practice.

Another essential element of early practice is having mentors. There are assigned mentors throughout training, often a primary preceptor or a program director; but what happens when you finish? Who will that be now? Unless you’re proactive, you might find yourself without a mentor. Having a more experienced mentor to talk to and advise you through the more complicated parts of medicine is of immense value. Inevitably challenges will arise, often not directly clinical, and having access to a trusted mentor you can call or text to ask questions can really make all the difference. Soak in the knowledge and experience of others.

Furthermore, whether with a mentor or a peer, when you confront a difficult or stressful situation try to debrief. It’s important to have a group of trusted peers or practice colleagues you can talk to when you’ve simply had a bad day. Knowing that others have gone through similar challenges or hearing their words of comfort can make a stressful situation manageable, or help to process a difficult experience.

Another important principle in early practice is “err on the side of asking.” If you’re not sure about how to manage a dilemma or scenario just ask. I often find that physicians are reluctant to call expert colleagues, designated lines or even CMPA. These services are there to help you, and even if you think your question is inconsequential or small, do not hesitate to call them. At minimum it’s a learning opportunity and at best, it’s rescuing clinical or legal advice on how to manage a challenging situation.

When establishing your practice, try to weave variety into your day to day work. Doing five days of clinic a week can be very draining and may burn you out. Having even a half day for an area of interest, procedures, or an administrative role can help keep your work schedule varied and fresh. Those with more diversity in their practice, and utilizing their full set of skills, are often more satisfied professionally. Furthermore, once you commence practice you can lose your skills very quickly if you don’t use them, so capitalize on opportunities to participate in many areas of interest early on.

It is essential for early career physicians to be engaged and involved. There is already so much on the go during this phase, and just keeping afloat with clinical medicine can be exhausting but in today’s environment new doctors also need to have a strong voice and participate in whatever ways interest them. If you’re interested in education, take on teaching roles, or if you have an interest in policy or advocacy look for leadership and administrative opportunities. Expand your scope beyond just routine clinical duties from the start, and it will enrich your career.

Do stuff that is not medicine. I don’t think I could close this article without also mentioning that you should have a life outside of medicine. The first five years are often clinically heavy, but be cautious not to burn yourself out as soon as you start. There is no need to pick up every last locum or every open call shift. Learn to say “no.” Spend time with your family and friends, travel, stay active, participate in activities you enjoy, or even take on new hobbies—because before you know it you’ll be the one looking back on your first five.

Dr. Jalil grew up on the Saskatchewan Prairies. She obtained her undergraduate and medical degree in Saskatchewan before moving to Calgary for residency. After completing her residency in Family Medicine, Dr. Jalil did an R3 year in Women’s Health.

Dr. Rabiya Jalil, BSc, MD, CCFP
Primary care for complex and vulnerable populations, surgical assisting, and women’s/ sexual health. Dr. Jalil serves on a number of committees and also takes an active role in medical education, teaching at the University of Calgary and as the Medical Director of the Alberta International Medical Graduate Program.

REFERENCES:
Friedberg, Mark W. et al. Factors Affecting Physician Professional Satisfaction and Their Implications for Patient Care, Health Systems, and Health Policy. RAND Corporation, 2013, www.jstor.org/stable/10.7249/j.ctt5hhsc5.

Article originally published in Vital Signs magazine.