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After the Match: 1,000 Days of Residency, 10,000 Days of a Career

Cook, Thomas MD

doi: 10.1097/01.EEM.0000462407.56672.bb
After the Match

Dr. Cookis the program director of the emergency medicine residency at Palmetto Health Richland in Columbia, SC. He is also the founder of 3rd Rock Ultrasound (http://emergencyultrasound.com). Friend him atwww.facebook.com/3rdRockUltrasound, follow him @3rdRockUS, and read his past columns athttp://bit.ly/CookCollection.

PART 2 IN A TWO-PART SERIES

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It's January as I am writing this, and we are winding down our interview season for the class of 2018. Sounds strange, doesn't it? That seems so far way, and yet I will be graduating these young men and women before I realize it.

Residency is a magical time. Rarely does a person perseverate over their expectations for the future as much as a fourth-year medical student after the match. They are happy. They are scared. They are anxious. They are excited. But most emergency medicine training is a little more than 1,000 days, a relatively short time in one's life. High school, college, and medical school are all longer, but none will have the lifelong impact when compared with residency training.

I know it is counterintuitive for applicants to think about their lives beyond residency. They have worked for a decade to be able to sit in offices like mine to reach for what has become a difficult job to obtain. Currently, 4,000 applicants are vying for 1,800 emergency medicine residency positions. They are entirely focused on getting into a program to attain the career about which they have dreamed. But when I meet with them, I make a point of saying that their vision is very likely myopic and out of focus. It is natural to scrutinize the present, but they also need to understand more clearly what lies in their future.

Sitting in front of me, they are roughly 1,200 days from their first day on the job as an attending physician. They will average about 1.8 patients per hour during residency, and they will see about 9,000 patients in the emergency department. About 1,000 of these patients will be critically ill, and 2,000-3,000 of their patients will be children. They will work about 450 shifts during residency to prepare for the 120,000 patients they will care for over a 30-year career.

Thirty days after graduating from residency, their employer will give them a check for $20,000. Until that time, no one has ever given them something like this. It will also be the first time that they see $10,000 has been withheld for taxes. Almost none of the applicants I meet will know anything about Social Security, malpractice insurance, stock indexes, pension planning, disability insurance, how to get an attorney, a financial planner, or an accountant, or what Schedule C is. To be a functional professional, however, they will need to know all of this.

The stark reality is that they have lived in an academic cocoon for the past eight years. Everything their parents once provided for them has been taken care of, including meal plans, housing, and health insurance. Once matched, they have a mere thousand days to go from glorified college graduate to attending emergency physician.

It's really kind of cruel when you think about it. After residency, everyone will see “MD” behind their names and think they are smart and rich and that they know it all. Most of them simply are not rich and do not know it all. As much as residents fear making mistakes in the hospital, it is the mistakes they make outside of it that will more than likely have the greatest impact on their lives. Buying the wrong house, marrying the wrong person, and not having adequate insurance can yield a lifetime of frustration.

Residents need to seize upon the idea that residency is a time for exploration in all matters related to their future. It is not just about their maturation as clinical professionals but developing habits that will allow them to succeed in all they wish to achieve. This means learning how to care for patients but also how to care for themselves. Residency is short. But the next step is not 1,000 days; it's 10,000. This is the number of days they will work over the next three decades of their career.

Next month: Tips on how to supplement your residency training to be ready for your life after residency.

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