Dear Millennial Physician

Heidi A. Waldorf, MD

Private practice, Waldorf Dermatology & Laser Associates

I appreciate that medical training and the early years of practice are stressful. Patients consider you an expert but you still have many years ahead of you before you will build the knowledge and experience to be truly confident in your expertise. You are balancing work, study, family, and friends. Many of you are burdened with overwhelming financial debt. You worry about the future of medicine and whether you will be able to create a long and satisfying career. I know. My colleagues and I were once where you are now.

My job as your attending, mentor, employer, and editor of this magazine, will be done if you learn from your experiences and use the knowledge gained as you move forward in your career. So I now offer a few take-home points for you to incorporate into your clinical and academic training and practice:

1) Never speak badly about your attending physician or employer to their staff.

2) Never do “favors” or other work-arounds to treat your program's or employer's staff or your family and friends without the physician in authority's express consent—doing so without permission is, in fact, stealing. This even goes for freebies from pharma reps—offices have policies monitoring their use and must comply with federal pharma regulations.

3) Never copy educational pamphlets, instructions sheets, or other work product from someone else's workplace without asking their permission. There can be ethical and legal copyright issues.

4) Never suggest to a patient that you are better than someone else with whom you work or who is senior to you and works elsewhere. Do not state or imply that another physician's recommendations are incorrect or dangerous or try to entice a patient to switch to you…You can certainly give a second opinion that differs from someone else's, but be sure to preface it with, “I respect Dr. Smith's opinion. There are many ways to get to the same outcome. In my experience, I might do it differently.” Explain your alternatives and suggest the patient speak with the original physician again before deciding. And then reach out to that physician personally to give the heads up.

5) When joining a new practice, don't expect to be handed patients. The senior physicians who founded the group went out and shook hands, joined organizations, and gave lectures to meet physicians and potential patients in the community. You should do the same.

6) Never promote yourself as an expert in the press or on social media without the permission of your program director or employer. You are their representative and your outreach should be done under the umbrella of the organization, not you individually.

7) Never use a patient's photos without express signed HIPAA-compliant consent. And consent is given only to the physician of record.

8) Never suggest, even in passing, that someone else's work is yours. If your experience is limited, be honest. Patients in particular will often agree to be your teaching patient for a free service or at a significantly discounted fee.

9) Never dump your complication on another physician. If you need help, ask for it but, then be available to speak with that physician and to take further responsibility.

10) Never submit or present anything—a poster or presentation to a meeting, paper to a journal, or press release—you've done with anyone else without discussing it with those colleague(s). You may not be aware of proprietary information or agreements regarding where it will first be presented.

11) Never leave anyone's name off a presentation or paper unless you have been specifically told to do so by that person. Many groups even include everyone in the lab or office on their papers and presentations. Ask the senior investigator who to include.

12) The acknowledgements list in a presentation or paper is meant only for support staff who performed a function that was part of their job, like preparing slides. However, there are times they are included as investigators, also, so ask their boss/supervisor how to handle it.

13) Always err on the side of directly crediting the work of others, including things borrowed or taken from publications.

14) Never use anyone else's work without getting their approval for that specific use.

15) Never lend anyone else's work to other people without the express approval of the creator of the work.

16) Make sure you can summarize the take home points of your paper or presentation in one to three sentences. Prepare your presentation so that it tells that story. But don't fudge the facts to make your story. If there are problems, explain them. The audience considers a presentation great if they can take home even one pearl of knowledge.

17) Always give attendings, mentors, collaborators, and employers clear information about your deadlines in advance, and then remind us if we don't get back to you in a timely manner.

18) Don't tell someone more senior than you when you will meet them—ask when they are available or if they are available during several times you know you can make yourself available.

19) If you schedule a time but then can't make it, always reach out to inform the person with whom you were speaking/meeting.

20) Do not call a mentor or senior colleague during or after dinner for a nonemergency unless he or she has specifically asked you to do so. Certainly do not call after 9pm for a nonemergency without an appointment to do so.

21) If a training or employment situation is not working out for you, be constructive in trying to improve it. Make a list of positives and negatives and discuss them with someone you trust who has more experience than you do. Are those negatives truly bad things specific to this physician, practice, or program or simply expected unpleasantness everyone must face in the real world? Consider what role you might be playing in creating or aggravating it and whether it is fixable…plan a calm adult conversation with the appropriate person. If you decide to leave, give the amount of notice required in your contract or more if you are already buying or leasing space elsewhere.

22) Recruiting patients from the office you are leaving to your next is frowned upon, unless they are clearly patients you brought in the door. It takes two to five years to build a practice. Before that, most patients have come to you because of the practice. After that, they are coming for you and should be considered your patients. The caveat is for trainees: Never directly recruit patients from your program or attendings.

23) Don't dismiss it if any colleague, physician, attending, or employer, is upset with you. Take the time to consider if you may have acted inappropriately or done something wrong. If you believe you did nothing wrong, is it more important to prove you were right or to apologize for how you made the other person feel? Consider the overall impact it could have on your career.

24) You are not a colleague or peer of your mentors, directors, and more senior physicians. You may be some day, but not now. This isn't about calling someone “Dr.” You can always call me by my first name. I called my attendings by theirs. But always show clear respect.

There are laws regulating how many hours trainees can work without a break, and attending physicians are required to supervise or at least sign off on your work, so they carry most of that liability.

If you join an established practice, you are entering someone else's “house” that was built on their sweat and tears…You arrive and are able to function from day one.

If you did any of the above in the real world…you could make permanent enemies, hurt your career, and permanently mar your reputation. On the other hand, acting with respect to others above and below you will certainly lead to lifelong, trustworthy friends and colleagues.

All is not lost. You would not have gotten this far if you were not smart and pleasant. If you base your future decisions on appreciation rather than entitlement, you will do very well. I think about a derm attending at the Philadelphia VA who admonished me as a med student for chewing gum while seeing a patient. I was mortified but I took it to heart and extrapolated to be sure that I showed respect to my patients. Her admonishment had a positive effect on my future. I hope you take this in the same way.

Best wishes for a long, happy, successful career,
Heidi

Watch Dr. Waldorf share her advice to millennial physicians. Visit modernaesthetics.com/heideas