Junior, but Not Inferior
The Real Secret in the Transition from Fellow to Attending

Early Career FOCUS | Andrew M. Freeman, MD, FACC

I don’t know about you, but for most of my residency, we idolized those who could “win the game.” What game were we playing? The one in which if we could arrange all the testing, treatment, and rehabilitation for a patient we could get them discharged sooner. For some, I vividly remember residents wheeling their patients down to CT scanners and actively working the logistics to get their scans done in any open spot. This would result in a smaller census, and, for those lucky few, could result in a “zero census,” often referred to as “winning the game.” This was, of course, not intended to reduce the learning experience, but was intended to have a relaxed day of teaching, study, and learning without the usual hectic pace of a busy service. In fellowship, the goal was always to “sign off” of a patient the millisecond there was no more “cardiology” to prescribe.

This all changed once I finished my training. The very notion of not being “busy”—that is, with a full patient load—was completely foreign to “the real world” of cardiovascular medicine. While I was well-trained at dealing with complicated patients and working hard to see them all and provide excellent recommendations, I now needed to do this at full speed day in and day out. I accomplished this by completely changing the paradigm: I became the new cardiologist who was available for anything.

My recommendation to all of you who are relatively new to the world of practice is to do the same. Being available and affable (friendly) will serve you well. In my academic practice, my colleagues who were non-cardiologists knew that I would happily and willingly see any of their patients at any time with a text, phone call, or EMR task/message. Through this routine, I could count on a steady stream of patients, and I pushed myself to be as thorough and complete with each and every one of them—just like when I was in training. This approach gained me a very large practice in just a matter of months, and I continue to solicit new business in this way.

The other side of this valuable suggestion is tone. You might be the smartest and hardest-working of the lot, but if you don’t do it with a smile and a sense of comradery, it will be all for naught. As such, when you get a call or a message from someone, always return it, and do so quickly. Demonstrate that the person who made a request is important and their patient is important too. Show the patient and the referring caregiver that you mean business and will get the work done. Most importantly, be sure that you include the referring caregiver in your reports and follow-ups so that they also know what is going on with the patient they sent to you.

Finally, try your best to answer your phone when you can, and don’t be afraid to give out your cell phone number. Nothing infuriates caregivers more than when they need to call your practice’s main numbers and wade through an endless series of button pushes only to be transferred six times to the person who might be able to find you. If you can make referrals painless and effortless, that will be your success. Find ways of using your practice’s schedulers to quickly get in referrals simply by giving them their name and phone number. Your scheduler should be able to then get insurance and demographic information, making it easy on you, the referring team, and the patient.

Why should one consider practicing this way? As a new clinician in any practice—even a part-time clinician—your colleagues will know just how good and hardworking you are when you show them. As you know, first impressions mean everything, and I would suggest you always show them the “I-can-handle-it-with-a-smile” side of you that might have gotten a bit dusty in fellowship. It will serve you for your entire career—be it research or clinical or both types of work.

Andrew M. Freeman, MD, is the former chair of the ACC Early Career Section Leadership Council.

Keywords: CardioSource WorldNews, Internship and Residency

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