Monday, August 6, 2012

Taking the Plunge or Taking Off? Advice for Starting as a Family Medicine Resident

Have you ever seen a B-52 Bomber flying in mid-air?  If you haven't - just humor me and imagine a big 'ol plane soaring at about 10,000 feet :)

How do you think it gets up there?  Well, we know it certainly doesn't just pop up in mid-flight, ready to rock and roll.

There is a lot of work that goes into getting one of these 500,000 pound planes off the ground.  First - original design plans are drafted, followed, tested, and reviewed.  Sounds a bit like college, huh?  I'd like to think of it that way - a college student is a blank slate, looking at all the different models they can choose to build of themselves.  Whether one strives to be a lawyer, a doctor, or even an elementary school teacher - the first step is to start by sitting down and drafting plans.

From here, I like to think that medical school is the period of assembling the plane.  Parts and pieces are gathered from all over and combined to build this perfect machine with a directed purpose.  While the pilot is reading the instruction manual, the fuel tanks are being filled (with knowledge! Sorry, I couldn't help but throw in a little cheese).  Medical school is all about making sure the plane is ready for that first flight.

Residency is like take off.

As a new intern in family medicine this year, I have spent the greater part of the last year trying to gather advice from my predecessors.  Over and over I have heard comparisons of residency to "taking a big plunge" or "stepping into fire" or worst of all - "being pushed off a cliff".  Wow. 

This is why I like to think of my first two months of residency as the start of my "Take Off".  My plane is built, I have all the equipment ready to fly, and I've got the manual down (mostly).  I just need a short period of going down the runway, building up speed, and checking all the instrument panels, before I'm ready to take flight.

So my plan in writing this post isn't to rehash any of the same recommendations that you've likely read before, i.e. - "be nice to the nurses", "be on time" etc.  I'm writing this to invite you to consider residency from a different perspective, one opposed to the pessimistic downtrodden black hole that many of us have been trained to believe it will be.  Rather, think about it this way - if you were fully prepared to be a practicing physician on the day of medical school graduation, then why would we need a residency period?  These three years are a time to grow, a time to test your limits, and most importantly - a time for you to build up speed for your big take-off.

Certainly, the hours and days will be long.  But you can do much to prepare yourself for that.  Dedication to sleep, nutrition, and exercise will go far in combating the evils of prolonged and straining work requirements and environments.  My previous post on advice for first year medical student, still holds very true.  After all, this is a building process, and we cannot neglect our foundations.

At the risk of reaching hyperbole, I'll stop just there.  But allow me one more indulgence on the analogy.  While I like to think of myself as a B-52 bomber -sturdy, reliable, and loaded with firepower :) Maybe you are a different sort of plane - an F-15, or stealth bomber, or even a Zeppelin! Ha.  The great news is that in the world of family medicine, there is a residency (or runway) perfectly built for each of us.


  1. Great post. We have a challenging though provocative relationship with the airline industry. Pilots, much like physicians, were once very independent professionals who got to fly the plane wherever and whenever they pleased. Patrons were fortunate you weren't drunk as their pilot and knew how to fly in bad weather. Lots of accidents, lots of deaths. Move forward 100 years and pilots and physicians are on different planets. Protocals are everyday for pilots, an oddity for most physicians "cook-book." Pre-determined routes are a must for pilots and mere guidelines for physicians. It can take a decade or more for best practices to penetrate our profession---whereas they are routinized in pilot realm soon after discovered. So, I'd still rather be a physician, yet important to see how one industry went from incredibly unsafe to the safest in the world and the other (medicine) went from unsafe to, well, pretty unsafe still. That's sad for us, yet doesn't really fairly depict reality we face. You see, as with your analogy to B-52, the airline industry is a machine industry, we are a people industry.
    I often like to compare medicine to airline industry in this way.

    The PATIENT is the Plane and the Pilot. Physicians and healthcare teams parachute INTO the plane, which often is burning, has low cabin pressure, perhaps an engine down before we get into the cock-pit. First, we have to assess whether the pilot is actually flying the plane or completely unconscious at the wheel, quickly assess the situation and jump in to help in whatever ways we can.
    At some point the plane is either going to make it to the next port or crash. If it's going to crash, then we must parachute our team OUT of the plane before it hits the ground, without abandoning ship too soon.

    So, if pilots had to get in a plane with unclear mechanical history, water in the fuel lines, hydraulics down, torn wings....that would begin to match up to our work in medicine.

    Yes, we must get better in developing safer health environments and systems for our patients (and ourselves)......and having more B-52 bombers like yourself join our ranks can only help.

    I'm a family physician and an organizational leader and I can tell you we need thousands more family physicians if we are going to re-design healthcare to meet patient's needs.....

    Jeremy Fish, M.D.

  2. What a wonderful post, great analogy. My son is thinking of starting his own family practice. This will be very useful in his decision making.