1. You will be underestimated. This can look like many things: Little jokes about how young you look, having to correct how others say your name, having your orders questioned or not completed.

What got me through this was reminding myself why I was there: I am Dr. Patel here to take care of Patient X, and this is what we need to do. Make sure your badge works where it should. Make sure you know how to contact your department and the medical staff office. Introduce yourself to nursing managers. Make sure you have all the things that you need in order to do your job effectively. If others feel the need to make jokes about how young you look, that’s their issue. Plan ahead with what you’re going to say. Sometimes, I say, “Thank you, it’s nice to be a part of this hospital.” A confident reply can refocus a conversation.

2. You will have to ask … and follow up on that ask. This is sort of a carryover from above. When I started doing gynecology surgeries at a community hospital, I had a tough time getting space in the OR locker room. I called, emailed, and visited the OR manager multiple times. Each time she made some joke about how I was new and that “she’d get to it.” This went on for weeks. Eventually, I got my locker. I don’t think this was the best use of my energy. But I kept asking for what I needed. These tactics didn’t work every time. I never got computer access to the fetal monitoring program. That particular manager was more elusive. So I created a workaround — every time I had to evaluate a fetal tracing, I signed and dated the paper tracing and noted that in the EMR. Sure it wasn’t ideal, but I hit my energy expenditure limit. I had enough in place to do my job well. I moved on.

3. Know what you’re willing to tolerate. Here is where you may apply the art of compromise. Signing fetal monitoring tracings on paper was a compromise. Not having my own hysterectomy tray was also a compromise. I knew my partners had trays, so I just asked for them when I did my cases. The cases were done, the patients were managed appropriately — and my ego survived. I would call out for whatever I needed or whatever wasn’t in the tray so I could take care of the patient. I won’t work with the wrong instrument; that is not a compromise worth making.

4. Know what you won’t tolerate. At this same community hospital, cases went late. Orders were done whenever they were done. That was the culture of the place. I had a patient being induced who wanted an epidural but never had a CBC. An obstetric patient undergoing induction is at risk for hemorrhage. I accepted “her labs are OK” when her admitting nurse gave me an overnight update. I apologized to the patient, who now had to wait for appropriate pain relief. I voiced my concerns to the nurse. I made an online complaint, and it went nowhere. Do I wish it was different? Yes, but I learned from it and have modified my practice. I won’t tolerate incomplete information on a patient. I will express grievances where they impact patient safety. Changing the culture of a place is a different battle.

5. Help where you can. The statements “That’s not my job” or “That’s not my patient” can be problematic. Sometimes, people avoid taking on additional responsibility. Sometimes, they are stretched too thin. No matter your specialty, as a physician, there will be a time where you will be called to jump in and help. This could be wheeling a patient into radiology, participating in a precipitous delivery or giving an extra hand in the OR. You get to decide how you want to show up in those scenarios. If you can help, I would encourage you to do so. This doesn’t mean compromising care for another patient or sticking your nose in where it’s not needed. One day, you will hear someone call out from a room, “I need some help in here,” and it’s probably not your patient.

6. Lunch becomes lonely. I was in a private practice where I was much younger than the other physicians in the practice. It was a contrast to residency, where you’re usually working with contemporaries. I felt this the most at lunchtime. These meals were usually quick, quiet, and alone. I would usually just eat when the exam rooms were being turned over. I missed resident lunches, those trips to the cafeteria when there would be Taco Day or some holiday-themed event. I missed having a chat about who was binging what on Netflix or who was booking cheap flights for their next vacation. I missed the involvement we had in each other’s lives. In attending-hood, professionalism sometimes means isolation or distance. Camaraderie is an important part of the human experience. Yes, even attendings need friends. It is valuable to find a network where you can build friendships where you discuss your experiences as you foray into the attending world.

7. Know your worth; ask for value. Value is how we are paid or compensated. Value is somewhat standardized across your practice and specialty. It can depend on how many patients you see, how much training you have, etc. Value doesn’t reflect our worth as an individual. (Although the process of medical training is somewhat reductive.) Your worth is who you are as a person. Your dedication, your bedside manner, your dependability all speak to your worth, and these are harder to quantify. If your compensation doesn’t reflect your actual clinical expertise, do not be afraid to negotiate. If you believe you’re bringing more value to the practice, find a way to quantify it and ask to discuss your compensation. Ask for the value you bring. Only you know how much you’re worth, and only you can decide what value you’re willing to accept.

8. Have an exit strategy. An attending in residency taught me this very valuable lesson: “The contract only matters when you want to leave a job.” I’ve left two positions within two years. It is important to know how you can leave once you make the decision to leave. Clarify before you commit. This is where an employment attorney can really help. Departures can be contentious, but they don’t have to be.

It’s been almost three years since I completed my training, and I’m still looking for the right professional fit. I anticipate the lessons will continue.

Roshni D. Patel is an obstetrician-gynecologist.

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