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Join obstetrician-gynecologist Roshni D. Patel for an engaging discussion on navigating the challenges of the medical field. With firsthand experiences, Roshni shares valuable insights on overcoming underestimation, persistently advocating for what you need and striking a balance between compromise and non-negotiables. From the importance of lending a helping hand to maintaining professional worth and planning for career transitions, this episode offers practical advice for physicians and professionals alike.

Roshni D. Patel is an obstetrician-gynecologist.

She discusses the KevinMD article, “8 things I learned in my first year as an attending.”

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Transcript

Kevin Pho: Hi, and welcome to the show. Subscribe at KevinMD.com/podcast, and get CME for this episode by clicking on the CME link in the show notes. Today we welcome Roshni Patel. She’s an obstetrician-gynecologist, and today’s KevinMD article is “8 things I learned in my first year as an attending.” Roshni, welcome to the show.

Roshni Patel: Hi, good morning. Thank you for having me.

Kevin Pho: So let’s start by briefly sharing your story and journey.

Roshni Patel: Sure. So I grew up in New Jersey, I was born and raised here, I did my training here. I come from a family of physicians, no OB/GYNs though. And I was attracted to the specialty of obstetrics and gynecology pretty early on. I thought it was an interesting place where clinical medicine kind of combined with advocacy for patients, and that’s kind of how I got started.

Kevin Pho: Perfect. And how are you enjoying your career as an obstetrician-gynecologist? What are some of the rewards and challenges of the specialty today?

Roshni Patel: So the rewards, they range from small little victories of helping your patients just in the short appointments, explaining to them what’s going on with their bodies, explaining medical conditions, and having your patients walk out with a sense of reassurance. And then there’s some really great victories, being involved in patients’ lives when they want to welcome a child, and those memories are really enriching.

Kevin Pho: All right. So we’re going to talk about your experiences as a relatively new attending. Your KevinMD article talks about that, “8 things I learned in my first year as an attending.” Now, for those who didn’t get a chance to read that article, tell us what it’s about.

Roshni Patel: Sure. So at the point that I wrote it, it was a couple years back, I had been at two different positions. One a more classic private practice model, and the other sort of a more corporate model. And in both instances it was a pretty steep learning curve, almost like a crash course experience.

And so I was inspired to write this article sort of as a primer of sharing what I wish I had known, what might have made it smoother. And I highlighted some examples of things that are not unique to OB/GYN but other specialties as well, of when you’re kind of getting acclimated to a new environment and what you can look out for.

Kevin Pho: Obstetrics and gynecology residency has a reputation of being pretty demanding. So what would you say are some of the biggest surprises that you experienced making that jump from residency to being an attending?

Roshni Patel: Sure. So some of the things that were new were the time spent counseling patients, specifically obstetric patients, about prenatal care. That’s not something we did a lot of as residents. Usually in residency you’re jumping between labor and delivery and GYN and the ER. So the opportunity to sit down and have a conversation with the patient was a little bit new, a little different, and surprising in a positive way.

Also the sort of independence, and I kind of talk about this, attending hood is a little bit lonely. So you’re independent, but you’re also alone a lot. In residency you’re on a team, you’re covering a group of patients with other residents. As an attending you kind of have your panel of patients, and on your call day you do your deliveries, and it’s a little separate in that way.

Kevin Pho: All right. So you mentioned that there were things that you wish you had known that you know now. Share some of the wisdom that you know now that you want to share with these early career physicians.

Roshni Patel: Sure. So I think one of the big things is transparency. And that’s not just between yourself and the employer, but between yourself and your own aspirations.

We jump out of residency sometimes not fully prepared for what attending life could entail. You might have to move across the country, you might have a large extended family, children, how do we juggle and manage all of the responsibilities that we have? So really knowing what you’re trying to accomplish in whatever job you’re taking on.

And transparency with your employer as well. Being open to having the discussion of what your professional goals are, how you’re trying to manage your professional contributions with your lifestyle. Those conversations, I think, are more helpful early in the game than later.

Kevin Pho: All right. So give us an example or a scenario or story where you had to apply some of those things in action. What would be an example of that?

Roshni Patel: Sure. So one of the examples that comes to mind, I have two small children, and the juggling between child care and office hours. Sometimes you need to get out at a certain time to make sure you’re at home for your children, or to pick them up, or that kind of thing. And I don’t think that’s a unique issue.

But there are days where I would know that I need to work late, and then there’s days where I need to leave at a certain time. So getting ahead of that, rather than being frustrated or trying to finish faster than you can, that’s not a really enjoyable experience. So kind of that planning ahead, and that open and honest conversation, I can do some late days and I can’t do all late days.

Kevin Pho: So how was that conversation with your colleagues or with your office manager? Let’s say there was a time where you had to leave early, and you mentioned that you had to get ahead of that rather than that coming up to you. What were those conversations like?

Roshni Patel: Sure. So I approached it from the standpoint of, I would like to honor all obligations, to my children, my family, and my patients. So I said, these are the days where I can stay late, or I can take a longer patient case list or what have you, and these are the days where I can start earlier so I can leave earlier. So it’s a little bit of applying the art of compromise and figuring out what your boundaries are.

Kevin Pho: And did you find that your workplace was receptive whenever you brought that up, whenever you had commitments outside of clinical medicine, like to your family?

Roshni Patel: Sure. So I’ve had a chance to explore some different job opportunities, and some were more welcoming to have that discussion than others.

And that’s another point I want to share for those recently out of training. If you’re in an environment where your employer, office manager, is open and receptive to having that conversation, that’s a great thing. If you’re in an environment where they’re putting off that conversation, they’re delaying it, or they’re not really seeing eye to eye, that could be a red flag that there’s other things that maybe you’re just not speaking the same language about.

Kevin Pho: So when you’re looking for positions, perhaps during the interview process, are there any questions that you could ask, or any clues that you could pick up, to see whether that position is more amenable to commitments outside of medicine?

Roshni Patel: Sure. I think an important question that all of us can ask is, what’s your onboarding process? Because there’s lots of little nuances when you join a new hospital system, like where’s the OR and how do I change my scrubs? And we kind of think of these as little things, but they can really impact the quality and flow of your day, especially when you’re in a specialty that has emergencies.

So if they have an onboarding process that is reasonable, detailed, has some flexibility built into it, has some room for questions, then there’s great opportunity there. If they sort of throw their hands up in the air and they’re like, well, this is what it is, that might not work for some people.

Kevin Pho: All right. One of the other issues that you brought up in your piece was the feeling of isolation and loneliness. Because during residency you have that camaraderie, of course, in an academic or community medical center, and all of a sudden you’re thrown by yourself, more or less, into an attending role. So talk about that transition, and talk a little bit more about that feeling sometimes of isolation and loneliness.

Roshni Patel: Sure. So different people may pick up on this in different ways. I like being around people, so that stark contrast from having the camaraderie of residency to kind of being on your own as an attending was a little bit more jarring for someone like me.

So then you work around it. You make time to meet with your mentor in the practice, or create a mentorship in the practice, and take that step of approaching someone, say, hey, what’s working for you, what’s not working for you, can we sit down and grab lunch one day? Small gestures like that.

And then I think it’s also really valuable to stay in touch with your residency colleagues. I’m in touch with some of mine, they’re very close friends, and we chat about interesting cases and how we juggle the various responsibilities we have in our own lives. And I think there’s opportunity for growth there.

Kevin Pho: So you mentioned that you’ve worked in several different environments as a relatively early career physician. So talk about the different environments that you’ve practiced in.

Roshni Patel: I’ve had a chance to work in the classic private practice model, where you’re in the office and that’s where you’re kind of more on your own. You see your patients when you see your patients, there isn’t a lot of physician overlap unless you go ahead and make that effort to communicate with your colleagues.

In this sort of more corporate model, there is a little bit more of a connect, because that room for individual flexibility or office based flexibility isn’t really there. So you have to be a little bit creative about finding that sense of camaraderie and teamwork.

Kevin Pho: So a lot of young physicians are going into that corporate model, and as you know, private practices are becoming less and less prevalent today. So when balancing commitments outside the hospital, work-life balance, family commitments, do you find that a little bit more challenging in a more corporate environment?

Roshni Patel: It can be, because the corporate environment sort of has this umbrella framework that we all have to follow, a set number of days off, set number of days for CME and what have you.

But there might be room in your day to day to have that flexibility. Creating an office schedule where you sort of have templates, so you get your quicker visits at the end of the day, so you’re not spending all the time at the end of the day charting. Little hacks like that can make your day a little bit more streamlined, because we’re all looking for ways to get out on time.

And then the other thing is, again, making that time to connect with your peers and colleagues. If you’re consistently finding an issue that just doesn’t work for you, look at those around you who are doing it in a more successful fashion, and we can borrow from each other.

Kevin Pho: Now, as you reflect on your attending journey thus far, is there anything that you wish you could have done differently?

Roshni Patel: You know, I don’t think so. I think I’ve done things the way I have for a reason, because I’m really trying to find what works for me. And almost every year or two that can kind of change, and I welcome that, I think that’s really refreshing. So I wouldn’t change anything. I think I’m opening my mind a little bit more to what’s possible.

Kevin Pho: And during training, did they give you any instruction in terms of the different practice environments that obstetrician-gynecologists can practice in? Or do you feel like you had to experience these practices on your own first, and make career transitions, and find one that fits you best?

Roshni Patel: I think it’s more of the latter. I think a lot of residency programs don’t give a lot of guidance to what private practice could be like, what the corporate models could entail. A lot of residents don’t have knowledge about contract negotiation, how to use an employment attorney, things of that nature.

So it was a little bit trial and error, and for me that’s OK. I think we can do a little bit better for our young trainees in terms of preparing them a little bit more.

Kevin Pho: Another thing that you mentioned in your article was that tension between determining what you’re willing to tolerate versus something that you won’t accept. So tell us a little bit more about that. Maybe give an example or a story, and how you would navigate that tension.

Roshni Patel: Sure. So when it comes to the care of a patient, whether it’s a medication, monitoring their progress in labor, their postop course, something that could really go wrong really fast, I find that it’s better for me to really have as many details as I can, to take better care of the patient.

So if you’re getting report from your colleague during turnover, or a nurse is calling you with an update, that’s where I really want as much information as possible. If I’m not there, or I’ll just see the patient myself. And I think that’s really important, so that you get the best clinical picture.

In terms of what you could let slide, or you could tolerate, general things that aren’t, for me at least, tied to the direct care of the patient. So, I can’t think of a good example, but sometimes there’s meetings and things like that, that if you can’t be there because you’re in office hours, that’s OK. I’d rather be involved in patient care than some of those things.

Kevin Pho: We’re talking to Roshni Patel. She’s an obstetrician-gynecologist. Today’s KevinMD article is “8 things I learned in my first year as an attending.” Roshni, as always, we’ll end with some of your take-home messages that you want to share with the KevinMD audience.

Roshni Patel: Sure. So I think the message that I really want to leave is, communication. Know what you want, and talk to the peers around you, and talk to the professionals that are handling it well and maybe not so well. And I think in opening up some of these avenues, we can do better, have better lives as physicians, and take better care of our patients.

Kevin Pho: Roshni, thank you so much for sharing your story, time, and insight, and thanks again for coming on the show.

Roshni Patel: Thank you very much.