By Katrina Winsnes, MD, MCR
I graduated from my pediatric hematology and oncology fellowship in 2018. Prior to graduation, I heard countless times how hard the first year after fellowship is. Multiple people warned me to expect it to be the hardest year in my career so far. They said it was “normal” and “everyone goes through it.” The cognitive part of me believed this. I’d be making independent decisions for severely ill patients for the first time in my life. That was terrifying. The emotional part of me thought, No way can it be harder than my first year of fellowship. After all, attendings get more time off, don’t take as much call, and they have more money to spend when they are off… right?
July 2018 rolled around and I was hired as an instructor by the institution where I attended fellowship. I took a month off, then dove in head first. Within a few weeks I realized how accurate the warnings were. This year was definitely going to be just as hard as first year of fellowship, maybe harder. My days were similar. I saw patients, I had service weeks, and I was expected to contribute to research and education. The difference was how I felt going into each day and leaving each day. I was drained, physically and emotionally. Imposter syndrome weighed heavily. I thought about potential mistakes I might have made daily. I spent so much time worrying about my clinical duties that research and education fell by the wayside. Although I was on call less and seemed to have more days off, I never really felt “off.”
Before I was halfway through the year, I was exhausted. For the first time ever in my career, I considered quitting. Thankfully, I have a handful of trustworthy colleagues and when I told them how I was feeling, they all responded, “Oh yeah—that happens and will happen again.” Great, I thought, that’s really reassuring.
I didn’t quit and, much to my surprise, I also wasn’t fired. I was hired as an assistant professor and head of our solid tumor program. Over the last year and a half I’ve thought about why I stayed and why I struggled. To be fair, I still struggle daily, though I haven’t thought about quitting for a while.
Although plenty of people told me this was going to be hard, I never fully understood why and certainly never asked anyone what I would be able to do to make it easier. After all, “everyone goes through it.” Hindsight is 20/20, so for graduating fellows, I’ve taken the liberty of sharing some of my biggest challenges paired with tips to overcome them. The years will never be easy; however, maybe they can become slightly more manageable.
Challenge 1: The weight of the responsibility to patients and their families is unrelenting.
The days of leaving work at work, if they ever existed, are hard to come by. If you let yourself, you can think about work every day, all day. The decisions you made and didn’t make, the delivery of your new diagnostic talk, the items on your to-do list that didn’t get crossed off. These thoughts are often unhelpful and unhealthy.
Tip 1a: Schedule something, anything, unrelated to work.
Commit to something outside of work and hold yourself accountable or have someone else who can hold you accountable. Join a knitting club, volunteer, attend an exercise class. Anything that is not work. If it’s scheduled for after work, it forces you to leave work. Once you have successfully left the building, you are quickly forced to focus your attention on something entirely different. Even if it’s just for 1 hour, you will get a respite from the unrelenting stress. I assure you the stress will still be there waiting for you when your activity is done.
Tip 1b: Remember the “life” in “work-life balance.”
As the months of the first year pass, it becomes easy for work to consume your life. Residency and fellowship have a way of making us forget past hobbies or joys we used to have. Now is the time to rediscover your life. Personally, getting engaged to a man I love as much as my job and buying a house far from the hospital have been constant reminders that even when the job is at its worst, I have an incredible life that I have built to help me recover.
Challenge 2: Institutions don’t love you back.
This is true for any job; however, since physicians spend the first 12 years of adulthood preparing for our first job, we learn this lesson later than those in other professions. Hospitals have a bottom line and, like it or not, that is the top priority. You are hired for a specific job and that is the expectation. There may come a time in your exhaustion when you want the tiniest acknowledgment of your blood, sweat, and tears. For someone to recognize the effort you are putting in. The truth is, though, you are simply doing what was asked of you and odds are the acknowledgment you are looking for isn’t going to come.
Tip 2a: Reward yourself.
Don’t wait for someone to acknowledge your effort when you can acknowledge it in yourself. As physicians we are trained to keep learning, aim higher, work harder. You’ve done that. You’ve learned, and aimed, and worked. Now stop and reward yourself. Set small goals and when you achieve them, take the time to treat yourself.
Tip 2b: Remember why you chose this job.
There will be days, maybe weeks, where you lose sight of why you chose the career to begin with. Write it down and put it in a place that you see daily. On your toughest days, make a point to remember why you show up every single day and why quitting is not an option.
Tip 2c: Surround yourself with supportive colleagues.
Supportive colleagues are invaluable. They have been where you are and likely remember what you are going through. Rely on them. When they ask you how you are doing, answer them honestly. Most likely they aren’t going to fix anything and that’s not important. Having someone who understands simply listen to you goes a long way to validating the emotions you are feeling.
Challenge 3: “I’m the ‘expert,’ and I don’t know anything.”
Know that this line, or something quite similar, will run through your mind at least daily. You will wonder when you’ll be found out and when they will take your medical license away. Surrounded by colleagues who have years of experience on you, it can be challenging to see yourself as an expert and intimidating to admit that you don’t know what you think people expect of you.
Tip 3: Be patient with yourself and show up.
To the community, you are an expert. You’ve had 15 or more years of training and experience and know way more than you think you do. Within your division, no one expects you to be an expert, they expect you to show up and learn. If there is a tumor board, go. Schedule meetings with your mentors. Sign up for projects and committees that interest you. You don’t have to be the expert to get into the room, schedule the meeting, or join the committee. Show up, listen, learn, and contribute when you can. Over time, so I am told, you will become the expert.
Dr. Winsnes is an assistant professor of pediatric hematology and oncology at Oregon Health and Science University. She specializes in treating children with sarcoma and other solid tumors. In her free time, she enjoys working on her tree farm, spending time with her soon-to-be husband, and, when there is no pandemic, traveling.