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Internship to Attending: Choosing A Road Less Traveled

Christina Migliore, MD, FCCP
Newark Beth Israel Medical Center

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christina miglioreThis month brings the first day of spring: a time for new starts and new beginnings. During medical school, this meant where you would match for residency, where you would spend the next several years of your life. During residency, it meant where you would do you fellowship. Nothing compared to the decision that awaited you in the spring of your final year of medical training ... where you would begin your career as an attending physician. All of these decisions were of great importance. They would determine who your mentors would be, where you would live, how you would mold your medical career.

Most attending physicians I know have made these life-changing decisions., But what if you didn't make a change? I mean, what if you started, continued your medical training, and eventually got your first job as an attending at the same institution? Just imagine—the same place where you started as an intern, became a resident, graduated, became a fellow, graduated—is now where you work as an attending physician. For those of us who traveled such a course in our medical careers, being "home grown" can have its rewards and challenges. What I learned after being an attending for 3 years is that I wouldn't have done it any other way. I would want anyone considering this road to have an overview of the positives and negatives of such a decision.

I will start with the negatives because I think every article should end on a positive note. There will still be some hospital employees, nurses and physicians who will ask you, "Didn't you graduate yet?" When you do your first bronchoscopy you will be asked, "Which attending will you be doing this case with?" My favorite is after doing my first consult on the pulmonary service, the attending asked me, "Who is the attending on service with you?" I was initially disheartened by this and began to question my choice. Would I ever be seen as an attending physician? Could I ever go into the attending lounge and not feel awkward? How could I learn and grow in this environment after all this time?

It was during this period that an attending for whom I had an enormous amount of respect said to me, "I don't envy your decision, attendings will see you as still a fellow and residents will see you as still one of them." He had experienced this himself since he became an attending at the same institution where he did all of his training. The advice he gave me next I only recently have begun to realize. He said, "Give it 3 years!" In that time, residents and fellows will have graduated, and attendings will have vaguely remembered your training days. He advised me to focus on my own referral base with other attendings who were recent graduates. I began to realize just this past year how true this really was. I cannot say precisely when this occurred, only that it has come to pass and that it was indeed worth the wait.

With that being said, of course there are the positive aspects. Besides knowing the obvious—where is radiology, how do I log on the computer to get labs, what not to eat in the cafeteria—you have learned how to gets things done quickly and efficiently. But, can you grow and learn in a place where you feel so comfortable? Do you have to "move on" to grow? Comfort is a strange thing. It can be a disadvantage if you become static or it can be your biggest advantage. You have the basics part of the institution behind you and you can hit the ground running! Take pride in being "home grown".

Remember Robert Frost's famous poem:

I shall be telling this with a sigh
Somewhere ages and ages hence:
Two roads diverged in a wood, and I—
I took the one less traveled by,
And that has made all the difference.

Disclosure Statement:
The author has no conflicts of interest to disclose.


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