Life After Residency

The residents have been holding panel discussions on a variety of issues. An upcoming meeting will focus on life after residency. The panels are composed of visitors invited to provide interesting and helpful perspectives. I have high esteem for the trainees as well as faith in their creativity, practicality, and tenacity. They’re also tech-savvy. They can google a ton of information about most topics like this on their smartphones—which made me wonder how helpful a geezer’s perspective might be.

I was curious about the topic, given that I’m now in phased retirement, so I googled it myself. I found a few pertinent articles on the internet using the search term, “life after residency.” I’m sure the residents are aware of them.

Most of them are about the financial challenges, some of which are consequences of physicians being in training for about a decade or so before they begin looking for a job. Most of them are in their late twenties or early thirties. A few are somewhat older, as I was. There were a forums with a lot of questions and answers about salaries, although they also mentioned quality of life.

The financial foundations according to the American Medical Association are:

  • Consolidate medical education loans
  • Fund retirement plans to the maximum possible
  • Avoid credit card debt
  • Buy disability insurance first, and then term life insurance
  • Make tax-deductible investments in the practice or investments in training

Try to avoid spending on big-ticket items the first year or two out of residency so that more money can go toward insurance and debt.

There’s good counsel on common mistakes to avoid after graduation from residency:

  • Apply for fellowships at least 18-24 months before residency ends
  • A high salary is not the only priority; happiness about where you work and what you do are also important
  • Consider hiring an attorney to look over your job contract
  • Find out as much as you can about malpractice insurance, including tail coverage

The water is a little murky about academia vs private practice. My own experience has been mainly in academia, with very brief forays into private practice which might be best summarized in the quote “Sometimes you win, sometimes you learn”–John C. Maxwell. I haven’t read Maxwell’s book with the same title. I probably should, although hard knocks have taught me a thing or two, even if the lessons were a little late.

There are a number of role and lifestyle changes that occur after graduating residency, among them adjusting from being a student to a clinician and from following an academic curriculum to building your own lifelong learning program through systematic reflection and reviewing the medical literature. Board certification is another landmark (maybe I should say landmine) of life after residency. One online article described board certification as a “voluntary” process.  I’m not sure when the article was written but I can say that many physicians, including me, doubt that what is now called Maintenance of Certification (MOC) is truly voluntary, especially as physicians have been protesting against it for years. It’s  a complicated and expensive recertification program that costs a great deal of money and time away from practice, whether you’re in academia or private practice.

I have always believed in the principle of lifelong learning and I also believe that physicians are in the best position to judge for themselves how to implement that principle. That said, despite the decision by the American Board of Medical Specialties (ABMS) to convene a panel to revisit the MOC structure, which has  been called dead, I suspect some form of recertification process will continue for the foreseeable future. Residents will need to stay in touch with their respective specialty certification boards to stay informed about the evolution of the process. The American Board of Psychiatry and Neurology (ABPN) has recently added an alternative recertification protocol (MOC Part III) which will, not surprisingly, cost the same as a 10 year recertification exam.

Speaking of alternatives, residency graduates should be aware of the National Board of Physicians and Surgeons (NBPAS), which does not require participation in MOC or recertification exams.

It will be up to the graduating resident to decide whether to broach the MOC subject with a prospective employer. Some organizations do not require participation in MOC or board certification at all.

As far as making a decision about how to choose between a career in academia or private practice, I can point to one of our ophthalmologist’s view about the important role of mentors.

Finally, the political and corporate landscape of medicine has been and will continue to evolve, influencing physicians’ practice. It has been described in it’s early history by Paul Starr in his book The Social Transformation of American Medicine, which I’m still trying to finish reading. Some credible observations about the book can be found here and there. Many doctors have tracked the changes in medicine and psychiatry, including my colleague, Dr. George Dawson, specifically on managed care. By now, it has become readily apparent that the health care reform debate has become a critically important issue for patients, physicians, hospitals, and insurers–as well as politicians.

You can’t get this far into a sort of electronic book  report on life after residency without mentioning physician burnout. It’s important to remain aware of it and know where the helpful resources are. You’re not alone.

And it’s also true that life after residency can be exciting, worrisome, puzzling, fun, and very successful in many ways. As I approach retirement, which is yet another life stage, I look back on my career with gratitude.

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