I am a serious fan of HBO's “Real Time with Bill Maher,” and I hope he doesn't mind my commandeering his “new rules” format. About 1,400 emergency medicine residency graduates will be starting new jobs next month, and while these rules are mostly directed at the newest kids on the block, they easily apply to any experienced emergency physician starting a new job.
New Rule: First Impressions Take Minutes to Make and Years to Break: The last thing you want to do on your first day of work is start on the wrong foot. Be yourself, be humble, and be pleasant and friendly to everyone you meet from the highest medical authority to the lowest orderly. Be open-minded and prepared for the fact that you will feel like a fish out of water for the first few days until you get the procedures down. That's what your director and colleagues are there for, so use them. Just don't abuse them. A question every five minutes might become a bit trying by the end of a shift. If at all possible, arrange to observe for a shift or two before you start. It's amazing what you can learn when you just hang around and pay attention.
New Rule: Listen to Learn and Watch to Win: To be blunt, keep your mouth shut, your ears open, and your eyes peeled. You will be given ample time to learn the ropes. You don't have to try to do it all on the first day. Listen and learn, and watch how things work and soon enough you will be going with the flow like a pro.
New Rule: Nurses Are Your Best Friends: You want to know something about anything? Ask a nurse. In 16 years of placing emergency physicians, it's often the nurses who get the kudos for those first days, no matter what the level of placement, from graduating resident to chairman of the department. Nurses do it all, see it all, and are a super source of guidance. A physician who is a great team worker is the best asset to any ED, and to be a great team worker, you have to work well with the most integral part of the team — the nurses. Give them the respect and consideration they deserve, and they will do the same for you.
New Rule: Neither Rome nor Your Reputation Were Built in a Day: You may very well be a hotshot, but in the first few weeks of a new job, you're the baby on board. The fastest way to turn people off is to expound on your past brilliance. Keep your opinion of yourself to yourself, and give your colleagues time to form their own. When you were hired, it was assumed that you could do the job, so do it, just don't talk about how well you can do it. Actions speak louder than boasts.
New Rule: Watch Your Phraseology: Remove from your vocabulary the phrase: “We didn't do it that way.” Wherever “we” was, you aren't there anymore so how “we” used to do it doesn't amount to a hill of beans. You are now part of a new “we” so learn how “we” do it there. If, down the road when you have established your creds, you believe you have something to offer in the form of improvement, write it up as a business proposal showing cause-and-effect and present it through the proper channels.
New Rule: Lose the Remote; Don't Change Channels: Emergency departments and hospitals function very much like a corporation or even the military. There are lines of reporting and channels of hierarchy. Learn what and who they are and use them. Going outside a channel or over someone's head with an issue can cause grief you don't want and certainly don't need. If you have a legitimate gripe, go to your director and discuss it. That's what the director is there for. Sometimes you'll get satisfaction. Be smart and choose your battles carefully, particularly during the first year on a job. If that job provides entry into a partnership track after the first year, is it really worth rocking the boat for minor issues before that year is up?
New Rule: If You Want Overnight Riches, Play the Lottery: It is understood that most emergency medicine residency grads come out of program with enormous debt. I know grads want to make the money they've worked so hard to earn, but don't get crazy and try to earn it all in the first year. The first year in most jobs is a trial period. You will earn a nice paycheck while paying your dues in the eyes of your employer and colleagues. Budget, keep your spending at a reasonable level, and consider renting for the first year instead of creating massive debt in the form of a mortgage.
New Rule: The ED Isn't the Peace Corps: Keep volunteerism to a minimum until you have your feet squarely under you. Certainly, you want to become involved with programs within the department as well as in the hospital and the community. But you are one person, not Kali, the four-armed goddess. Make sure you have the job down before you start spreading your energies around.
New Rule: Embrace Your Spirit of Adventure: A new job is about change. As human beings, we tend to resist change because it upsets the comfort levels of the known by introducing elements of the unknown. This not only applies to physicians but to the families that make the move with them. Alter your way of thinking before the move, and help your family do the same by working together. Focus on the positives. Change is good. Change is opportunity to improve every aspect of your life. So approach your new job as an opportunity, and that spirit of adventure that lives inside each and every one of us will come shining through.
New Rule: Smile and the World Smiles with You: Enough said.