I transitioned to attending status immediately after I completed my residency. One day, I was chief resident. The next day, I was an attending physician -- at the same academic center. Transitioning from a resident to an attending physician is both exciting and rewarding. After years of rigorous training, doctors are finally able to practice independently. However, this new role comes with its own set of trials. Many of them are psychological in nature.
The Challenges Ahead
One of the biggest changes is the shift in responsibility. As an attending physician, you are the final decision-maker in patient care. While the autonomy can be liberating, it can also be daunting as the full weight of patient outcomes rests on your shoulders. There is no longer a safety net of a more experienced doctor to double-check decisions or to turn to for immediate advice. This can sometimes lead to "impostor syndrome," where you may doubt your abilities and feel like a fraud, despite your qualifications and training.
Another challenge can be managing time. Balancing the need to guide and teach a team of residents and medical students, while also ensuring high-quality patient care, can be a difficult juggling act. If you are obligated to do research to fulfill the tripartite mission of your academic medical center, time pressure will become even greater and may overwhelm you.
Don't be fooled into thinking that the workload will decrease because you can rely on the house staff to ease the clinical burden. Recall that the Fat Man in The House of God suggests that the best thing a medical student can do for a resident is to not do anything at all. The implication is that medical students, because of their lack of experience, may unintentionally create more work or complications for the residents, hence not saving them time. The same is sometimes true regarding the relationship between residents and attendings.
Furthermore, any time saved by doing less direct patient care may be offset by the administrative demands of patient care that fall to attendings, including paperwork, meetings, and dealing with insurance companies. This can lead to long hours and potential burnout if not managed effectively.
A Fine Balancing Act of Leadership and Responsibility
Navigating the politics and hierarchy of academia can be tricky. Building relationships with nursing staff, administrators, and other physicians is crucial for success as an attending. Ultimately, you want to be known as a "triple A" doctor, one who is Able, Affable, and Available, proud to add "AAA" after your MD or DO degree. The display of a happy façade and genial demeanor does not come naturally for some doctors.
Because I chose to stay at the academic center where I was both a medical student and a resident, my issue was not forging new relationships as much as it was wanting to be viewed as an expert in the eyes of those who had trained me. I did not want to disappoint them or fall short of their expectations. However, after years of being a low man on the totem pole -- an attending 8 years in the making -- I found it difficult to work my way up.
Nurses and other attendings still tended to relate to me in their default mode (i.e., as if I were still a trainee). I felt pressure to demonstrate my competence and dispel any prior misconceptions about my abilities. In order to be seen in a new light, I had to act with authority and assume the role of an opinion leader.
At the same time, I had to check my ego at the door. Sure, I wanted to wax eloquent with students and residents on rounds and refer them to the latest research articles to justify my treatment recommendations. (And I did that -- the residents nicknamed me "Article" Lazarus.) But I also had to demonstrate humility and not lull myself into thinking I knew more about the practice of medicine (psychiatry) than I really did. I had to remind myself I, too, was learning, and that although I was well-versed in the clinical treatment of disease, I was still figuring out how to best manage patients' expectations and those of the people I worked with.
As a newly minted attending, you must take on a leader's role and orchestrate a multidisciplinary team of healthcare professionals. Leadership requires a shift in professional identity and extensive practical experience to adapt to the new role of attending. There is no way to rush the process. Yet, identity formation can take time and may involve introspection and mentorship. Most physicians do not receive regular, structured, professional mentorship or coaching. Leadership is simply expected of attendings from the beginning, like flipping a switch, which is unrealistic. The pairing of a new attending with a senior mentor who provides regular advice and support could be invaluable.
New attendings often have a difficult time seeking clinical consultation. I was reluctant to ask for advice lest it make me appear less competent or knowledgeable. When a new attending asks for help it may be perceived as a weakness, whereas help-seeking behavior initiated by a senior physician, one who has already proven themselves, is often viewed as a sign of strength and camaraderie. You will have to go it alone for some time to earn your stripes before you can join the ranks of the privileged and comfortably eat with them at the faculty dining room.
An Opportunity for Learning and Growth
My transition to the attending role coincided with life changes that are typical at this early stage of career development, such as starting a family, paying off student loans, and studying for specialty boards. All of these events can cause stress. Many doctors take up attending positions in new cities or even new countries, and adjusting to a new location, building a new social network, and navigating a new healthcare system or hospital can be an additional source of anxiety. This is yet another reason to seek a mentor or coach, someone who can help you navigate the complexities of your career.
Overall, the shift from resident to attending physician is a significant milestone that brings about many personal and professional changes. It is rarely seamless and, in fact, often accompanied by worries and self-doubt. Navigating these psychological challenges requires self-awareness, resilience, and support from mentors, colleagues, and loved ones. With appropriate support, this can be a time of growth and learning, both in and out of the hospital.
While the transition from resident to attending can be challenging, with time you are bound to adapt to your new roles and responsibilities, solidifying your position while finding your own style of practicing medicine.
is a former Doximity Fellow, a member of the editorial board of the American Association for Physician Leadership, and an adjunct professor of psychiatry at the Lewis Katz School of Medicine at Temple University in Philadelphia. He is the author of several books on narrative medicine, including and .