Top 10 Things I Wished I Learned in Fellowship

Nearly ten years of formal medical training could not fully prepare me for “The Real World: first year attending edition.” These are some of the things I learned in the first three months into my first year as an attending:

1. New Person Syndrome. This syndrome describes the phenomenon in which your opinion can be doubted because you do not have enough “experience”. Unfortunately, there is no single way to combat this misconception except to trust your instincts, and move on if you sense that the therapeutic relationship is not going well. The truth is that far more patients and medical professionals appreciate having another headache specialist around! As Taylor Swift would say, ‘Shake it off’ and keep trying to help the world one patient at a time.
    
2. Focus on the patient. There is a lot going on when you are new on the job. But no matter how busy I was, I felt the best when I just focused on helping the patient and blocked everything else out.
    
3. Code correctly. Do not feel guilty for hitting that “level 5 button.” Your time is worth it! While you are still in training, utilize your mentors, attendings, and the billing administrators to ask your coding questions. If you missed out on learning about medical billing and coding in training, do not worry! You can still check out the recordings of the 2023 Scottsdale Headache Meeting Sunday Practice Management lectures, or refer to the American Academy of Neurology’s Billing and Coding website, which includes links to case studies.
    
4. Assume that all your patients use ChatGPT or otherwise search for health conditions. Let’s be honest- we do this too! I found that telling patients not to Google search is futile (but I still do anyway). I saved more time by directly addressing their search bar questions in the room than to leave it for the phone calls after the visit.
    
5. Be comfortable with saying “I don’t know.” I used to be scared of saying this as a trainee but I now find that most patients appreciate the honesty and find it humbling. I remember seeing a patient whom I diagnosed with vestibular migraine. She went to her PCP, and told him about her diagnosis of vestibular migraines. He had been practicing in the community for decades. He confessed to the patient that he never heard of it, looked it up, and is now excited to send me more patients for vestibular migraine evaluation!
    
6. Protect your speaking voice. You will talk so much, to patients, insurance companies, colleagues, residents, family members, etc. Make sure you leave quiet time for your voice and try to avoid those late night snacks that trigger reflux!
    
7. Protect your time. It is important to know yourself and set limits to your work schedule so you do not feel burned out. While it is good to be eager starting out, medicine is a marathon and not a sprint.
    
8. Find your own style and stick with it. One of the most exciting parts as a first-year attending is finally practicing medicine in your own style. Sometimes preferences are just that, and it will be okay if some people disagree with your approach!  At the end of the day, you have to do what is best for you and how you will best care for your patients.
    
9. Keep asking for help as an attending. As a fellow, you are encouraged to ask questions and ask for help. As an attending, I still had a lot of questions but worried I might be judged for asking too many. In fact, I discovered the opposite and learned that my colleagues were expecting it. Going into my new job, I knew my colleagues were friendly but I was really grateful to discover that they are truly invested in helping out new attendings, often going above and beyond with offering advice and wisdom. The major difference is that as an attending, you might not be able to get a hold of your busy colleagues as fast as a fellow knocking on the door.
    
10. Don’t be afraid to say “no.” It is in our nature to say yes, but sometimes you have to say no. I remember saying “no” to seeing a new patient with complex tremors refractory to multiple medications. As much as I wanted to help the patient, I knew the presentation was beyond my expertise and recommended that the patient see a movement specialist. It felt weird to say “no” initially, but it is okay as long as you have a good rationale.