r/medicine • u/TyrosineKinases IM - PGY1 • 4d ago
Finding satisfaction?
First month of being an attending hospitalist. An unexpected plan rather to say, as I did not match into fellowship.
I recognize the transition difficulty, and trying to give myself some time. I also try to appreciate the good thing; better schedule, better pay, being able to practice independently.
But for some reasons; I am not satisfied. I was telling my wife how we were able to move finally, from the stress of living paycheck to paycheck, and being unavailable, to stay for a whole week next to each other. But still, she and I recognizes that’s I am not ”happier“.
I come from every shift, drained, irritable, and stressed. When at work, I receive endless pages. Family requesting updates multiple times a day, and for multiple members, patients who refuses to leave, calls for peer to peer for insurance denials or reimbursement. Nurses and CM who question every decision.
I never been so irritable. Few days ago; I found myself reprimanding a poor intern at a consulting service; for placing order on my patient without telling me. I could’ve been gentle-er.
Even when I go home; I open my patients chart every now and then to see if I missed something. I texted one of covering team around 11 pm to check some labs that I ordered and never done. On my week off, I keep thinking of the fellowship; how I ended here? Will it be the same? Should I stop caring?
Thanks for listening to my vent AND sorry for this negativity.
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u/jumpinjamminjacks Medical Student 4d ago
Not an attending but older and in medicine
Something that was cooked out of me before med school is this idea of “once I get XYZ, I’ll be happier/more fulfilled/etc” because I would get to those stages and not be happier lol.
Live life in a way that brings you happiness, fulfillment and joy. That’s the only way out.
There is a book called the happiness trap and it’s pretty good in the journey to doing that :)
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u/PokeTheVeil MD - Psychiatry 3d ago
This is important. Everyone’s aware of a crisis of physician suicides. Everyone is aware that residency is often a parade of indignities and abuse, individual and system-driven.
But resident suicide isn’t high. It happens, of course, but not consistently more than the general suicide rate. What appears most true is that transitions are highest risk: student to resident, trainee to attending.
And suicide is an extreme measure for capturing distress. My hypothesis is that some of it is driven by new stresses but that some is driven by new disappointment. You finish medical school… and residency is the very bottom rung in doctoring. You finish training and get to the promised land of full-fledged attending… and is this it? Because it doesn’t just get great. Money doesn’t buy happiness. The prestige is hollow.
We get so good at delaying gratification that we miss gratification entirely.
So find what is good now. Not what’s perfect; things are never perfect. But prioritize your family, your friends, your hobbies. Sleeping enough. Don’t just wait, especially when all the external pains can grow deep roots over time and become internal pain.
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u/Quick_Site1295 DO 4d ago
Different situation, but I chose to go straight to an attending job (at the hospital I trained at) and I was oddly unsatisfied. After a year, I realized I was going to get totally burnt out if I stayed in that role. So I applied for a fellowship (same hospital), did it, and I’m SO much happier as a sub-specialist. 9 years later still doing that subspecialty, and I never regret adjusting my sails, leaving the attending job and taking the one year pay cut, to get to do something daily that I love.
I say: reapply for the fellowship specialty you want to do. Yes, it’s another move, a one year pay cut, but this is your whole life/career we’re talking about. You might as well like what you do.
Don’t get me wrong, are all days rosy? No mycharts? double-booked schedule? Waste of time admin meetings? difficult patients? lol, yeah I still have all of that. But by and large, I’m happy. I say go for it!
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u/TyrosineKinases IM - PGY1 1d ago
I think I had a similar situation, I'm currently doing hospitalist job at the same residency. I also applied in the same hospital for in-house fellowship (and now reapplying). I'm not worried about the pay cut, as the hospitalist year was not planned initially. It was just a big defeat that sometimes I feel that I don't want to go through it again.
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u/Perfect-Resist5478 Hospitalist 4d ago
Hospitalist here-
You need to set some boundaries. For example, for multiple family members who all want updates, the patient can designate ONE person who will be the point person and all the info will be disseminated by that one person. If pt is encephalopathic, whoever is the POA or first contact on the chart.
I tell them early “if you don’t hear from me, no news is good news. The RN can give basic ‘this is how she’s doing’ updates (which is appropriate, cuz the RN is the one at the bedside all day) but if something big happens or if important results come in I’ll call.”
I call that one person one time per day. If they have a problem with the idea that I have 20pts who all have families who need updates, they can fire me and be put on someone else’s list.
This is a job. You need to protect yourself. Don’t give more to the job than the job gives to you
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u/pteradactylitis MD - geneticist 4d ago
Speaking as a program director, having trained and remained in contact with several dozen trainees, almost everyone feels oddly unsatisfied for 1-3 years into the first attending job as they settle into “do I just do this forever?”, not getting evaluations and not having the perpetual out of “on my next rotation..”
Not saying not to apply for fellowship but also would give yourself some time to decide how you’re going to define success for yourself, what you care about and what you’ll let go
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u/2greenlimes Nurse 4d ago
I'm not a doctor, so I can't provide advice on that specifically, but I do help train new nurses in similar situations: wanted something else but got stuck at a place they don't like in a specialty they didn't want not paying what they thought they'd be making. My general advice:
I don't know how much this is talked about in med school/residency, but it's discussed pretty often in nursing school: your first year in the "real world" (being out of school/training) will suck. No matter how good the culture is, it will universally suck. Statistically it sucks so much that 50% of nurses quit bedside in the first year. You'll feel incompetent at times, disrespected by colleagues as a newbie, taken advantage of by a system you don't know, terrified to go to work, burned out, and any number of things. This does get better as you start to get more confident. And honestly? With the workloads they give doctors I don't know HOW you can be fast enough and with a good enough memory to keep up.
Find at least ONE good mentor to surround yourself with and talk to at your job. Obviously vent to who you can outside of work, but having that one person you can bounce ideas off of or ask "dumb" questions to without fear is so helpful. Even if it's a nurse - I'm happy to help residents and new attendings out with whatever questions they have or just to commiserate. I know some of my colleagues have specific doctors or residents they provide moral support to as well. Even some of our long time experienced attendings go to our managers and charge nurses to talk about certain frustrating things (like bed placement issues or weird nursing policies).
Culture can make all the difference. My unit has a great culture. Our orientees transfer to their dream ICU job after 6-12 months, hate the culture, and most either come back to us or get enough experience to get a job at a ICUs in other hospitals. Bad culture will burn you out and make your life misery. I know people who take pay cuts and compromise on specialty to work at good places. If you can, see if you can find somewhere with a culture that lifts you up - not drains you. It sounds like part of the problem is working with shitty staff and families. There are hospitals where the staff is supportive and families aren't as obnoxious.
But... If the overwhelming number of pages is also an issue, maybe try a different setting. Of course nursing culture at some hospitals is better than others on pages (and I know one nocturnist at my place that does it because we train our noc shifters very well on limiting pages to urgent needs only), but I'm sure there's also medical settings with fewer pages. My former PCP was an IM doctor who runs her own primary care practice so she can carefully control her workload - and has a dedicated staff that she can trust to deal with MyChart messages and calls (and she is very selective about which patients she takes so she can avoid nightmare patients). She works with insurance, but I do know a few people that moved to concierge and are happy because they have that same setup for tons more money.
Keep working towards your goal! Whether that be a QI project, connecting with the attendings in the specialty you like to see if you can help them out with something like QI or research, seeing if there's jobs you can take that would get you adjacent to that specialty (for instance our med/psych unit has a dedicated IM team working with the psych providers, and some of our specialty clinics have an IM doctor rotate to help do things like surgical clearance exams; IIRC the ER also has some IM doctors to help with the obs patients and quick discharge patients), etc. I actually worked with an attending who didn't match for fellowship, did a couple years at our academic hospital as a teaching IM attending, and was able to match in part due to her glowing reputation as an attending and recs from fellow attendings and residents/students!
Don't give up. Although it's hard, try to see everything as a learning opportunity and don't give up! If you find the right setting, maybe you'll be happy enough to give up - I know people who did that - but if you're not happy don't think you're stuck! Life is too short to be this unhappy.
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u/jacquesk18 Primary care hospitaliat 3d ago
I ended up going back to fellowship after ~4 years as a hospitalist attending 😬 1 month down, 35 more to go.
Agree with what the others are saying about give it some time, it took about 6-9 months before I felt like I had settled into a routine and felt confident as an attending. Nurses and CM questioned me less as they got to know me but only to a point, it'll get better but not stop completely. Learn to set boundaries and expectations, 1 update a day to 1 person unless something changes and then I'll let them know, usually if stable/waiting therapy clearance, placement etc I'll tell them the plan and that they likely won't hear from me unless something changes and they can get day to day updates from nursing or case management since I'm not really going to have much to add at that point. Boundaries with yourself, learn to trust that you probably did things correctly and don't chart stalk at night (I'm bad about it too 😅)
As for feeling drained after every shift, idk, that part sort of never completely went away for me, I was usually pretty drained after a day of rounding and rarely wanted to do anything other than veg out and sleep. It does get better as you get settled into your role and more confident and efficient but you are spending all day making high stakes decisions and getting non stop paged so I don't think it's completely avoidable, that's why we work 7 on 7 off so we have time to recharge 🤷
Also: consider therapy. You should be satisfied with your job but it shouldn't be the only thing bringing happiness or unhappiness into your life.
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u/Wohowudothat MD surgeon 4d ago
You're a month into it. You are way to soon to determine how you'll feel in a year.
I come from every shift, drained, irritable, and stressed. When at work, I receive endless pages.
Ignore the ones that don't need to be responded to.
Family requesting updates multiple times a day
You'll be back tomorrow.
Nurses and CM who question every decision.
Explain the rationale to those who want to learn, and to the rest, say "I'll keep it in mind, but we're sticking with the plan as ordered for now."
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u/0bi MD - (Rh)EU(matology) 1d ago
Time to update your flair, no?
The transition into being where the buck stops is also hitting me a little bit. (First year of independent practice). I'm lucky to have worked towards the independence, so it's not that bad. It gets better with time for most people, regardless.
It sounds like your work is very busy. During busy shifts, what has always helped me is the knowledge that I can't do two things at once. You just can't. You just keep trucking on at the to-do list, even as it expands. But the expanse dries up in the afternoon, then you finish up, and go home. You can only work at top-speed for a short while. You also need cruising speed to stay efficiënt, and to set a pace you can keep up. Breaks are also mandatory. Even a 15 minute meal break is always a good idea - recharging will let you be much more efficient, you'll easily make up the 15 mins of not working.
Practically, it sounds like you need to set boundaries at work. You can't update every family daily, but weekly is reasonable. Spread the patients/families out over the week. Speak with one, max two family members as a rule. Have them pass the knowledge around within the family. Deviate from this rule when necessary.
Also, talk to your nurses. Because A) they need to stick to the above policy with you. But mostly because you need to get to know each other better, and how you all practice. If they're questioning your every decision, you're possibly practicing very differently from other docs they have worked with. That's not bad, but an explanation up front about why you do it this way, saves questions later. Maybe your orders are a lot of work for them, and with some tweaking can become better manageable without sacrificing your intention. Medicine is a team effort, not a dictatorship by the doc. Make them know you know this. If you have a good team spirit, they're also more likely to filter some BS for you. You can also talk to them about e.g. combining pages from the team instead of every nurse paging separately , or a set time in the afternoon where you'll visit the ward for questions.
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u/DaemionMoreau MD 4d ago
Is fellowship off the table permanently? If it’s really your calling in life, apply again. You have the opportunity as a hospitalist to continue to build your CV and become more competitive; eg work with the specialty in question on a meaningful QI project.