Perspective from one year out:

Perspective from one year out:


Thinking back to residency a few of the things that seem to be universally dreamed about for the ‘it gets better’ phase is money, schedule, and stress. I certainly dreamed about the day when I no longer had to worry over paying the bills, more time together as a family, and being rid of the stress that comes with residency. Dreams of that final job, where DrH would be happy, content, respected, and well paid for working the ideal schedule for our family. Looking back, I realize now how little we knew navigating that murky water of starting the first job, what life would be like after training was complete, and how brutally similar that final job can be to residency. Life does get better after residency…in some ways.

Money and paying the bills every month is probably one of the biggest stressors in a resident’s family’s life. This is likely especially true of those families with only the resident income. We were a two-income family for 99.9% of residency, as I stayed in my job until a month before DrH finished residency. Even with two incomes and $100k+ joint income we still had hard months. We were working on paying off his student loans and providing for our son who was born during residency. Money after residency is definitely good. Thus far, at one year out, we have chosen to keep our large expenses very similar to what they were during residency. We have bought items for our home that have made life nicer but have not bought new cars or a new house, yet. We save heavily for retirement, our son’s education, pay heavily on student debt, and give ourselves a very generous monthly allowance for buying whatever suits our fancy at the time. We pay people to mow and weed treat our lawn. Our son is in a private, well regarded preschool just for the socialization. We have season passes to three theme parks, two out of state, and the local aquarium. We do almost monthly date nights, complete with a couples massage at our favorite spa and a fancy dinner, which the bill, many times, will run in excess of my monthly payment on my Mercedes.

Saying that the money is perfect would be an overstatement. DrH was 31 years old when he started working in his first job. He is young compared to many. We worry about the future and we worry about making a normal retirement age goal. The income level is almost necessary to catch up on just saving for the future. We feel incredibly behind already. However, we do not worry about how we are going to pay our electricity bill or buy groceries anymore. The money post residency is probably one of the biggest things that really does get better.


Not all things are as fun as the money post residency. DrH is an IM hospitalist so his schedule, admittedly, is better than many. He works an average of 16 days per month and most of his stints are in 6-9 day blocks. He is now facing working up to 4 nights per month. This is a recent change as the nocturnist in his group had a car accident that has put her out of working. It is not a welcome change, as he hates night shifts but we roll with it, as it is what it is, and there is nothing that we can really do about it except adjust. His schedule is only published some times a couple of weeks before the next month starts. It fuels the feeling that we are living month to month, just like in residency, moving from one rotation to another.


Working post residency can be frustratingly similar to in residency. Even though he does not have a residency program director he now has a medical director and assistant medical director. Time off, for my husband, has become his most valuable commodity post residency. One of the major perks of working as a hospitalist is longer stints of time off. This time off feels necessary, due to the long hours of working, simply to recover and to have some amount of family time. Calling in sick as a hospitalist places a burden immediately upon the others in your group who are off that day to come in and cover for you. It is not a job where your patients can be canceled for the day because you are unable to work. Post residency, in a position like this, there are still people who will call in sick. DrH has had to go in on his week off to cover for others. He is compensated financially for these days but the time off is lost. Weeks off have recently become a source of stress due to how frequently he had been contacted regarding work. He struggles to disconnect from work during his time off due to this possibility. This is an area that has been hard to adjust to and something that even a year out is an area of continued struggle. His time off is his time…unless something happens to prevent someone else from coming into work.


There are other stresses after residency as well. Residency had plenty of stresses associated with it. He was expected to complete a long list of procedures, attend journal club, do some minimal research, prep for and exceed expectations on in-service exams, read for a prepare for all of his rotations, know everything about his patients and his intern’s patients, maintain a consistent clinic schedule, teach interns, and endure morning report and M&M, to name a few. This list of demands on any medical resident is never ending. There is always more that each resident can do, even if not specifically required. Demands and stressors like this do not really cease post residency, however, they just take new forms. As a practicing attending he is now expected to bill as “effectively” as possible for each and every patient. This is a practice that is measured and reviewed monthly, pointing out to each physician publicly the amount they lost the group due to how they wrote their note. There is also a new and very real stress of practicing on your own medical license and malpractice insurance. The burden of practicing good medicine all while trying to not piss your patients off is a very thin line to walk sometimes. The reality of patient satisfaction surveys and threatened legal action bring a new level of stress to a new physician. Even though it may have been said in the heat of the moment, legal action has been threatened over something as stupid as him removing unnecessary narcotics from a patient’s med list, even though it was for valid reasons. When you stand in a room and have a patient or patient’s family say “if you do X, we are going to sue you” it jars the core of confidence which that physician practices. It is an unnerving statement and it has a profound impact, yet it is very much the society we now live in and the entitled attitude that the vast majority of patients have. This makes the REAL practice of medicine very different than the expectation that was there before medical school or even while in residency.


Just know that going from residency or fellowship to that grown up doctor job is in many ways great. It will offer more flexibility financially and allow your family room to breathe and ability to do things that you have been sacrificing during all of this training. In other ways, it can be worse. It can be painfully stressful, the schedule is almost neveras good as it sounds like it will be when you sign that contract, and the first job, statistically, will likely not be the last job, and that’s okay. Some things may be better and some may be worse. Nothing about finishing residency means that life will be easy from here out. Life is hard sometimes and it is up to you what you do with those lemons when they are handed to you.

Tasha