NewJobYou are super-excited to get your first real job as an emergency physician after residency. Then this immediately turns into a nauseating, super-terrified feeling, right?

After posting two entries to help medical students do well on their EM clerkship rotation, a commenter suggested that I provide a list of tips for doing well as a new EM attending physician. Although there is slightly variation for community versus academic faculty, many of the basic tenets hold true:

1. Be an accurate charter.

Let’s face it. In the end, departments are driven by money. Don’t let the department leadership think that they are losing money on you. So, if you do the bedside ultrasound, do a critical care resuscitation, or suture a simple laceration, chart it. It’s good for billing, and it’s good for medicolegal reasons. Documentation is key. I’m not saying to overbill but rather to be accurate in what you chart.

2. Be nice to the nurses.

This is the same advice I always give to students and residents on the EM rotation. Coming into a new practice environment is difficult by itself. The nurses can make it less… or more challenging. Take a minute to introduce yourself to those who you don’t know. Be approachable. Keep them apprised of the patient’s overall plan. Personally, I brought candy on my first shift, and that tradition has never quite gone away.

3. Get to know key players in and out of the ED.

Over time, get to know the consultants, radiologists, radiology technicians, custodial staff, and ancillary staff. This smooths-over many of the intangible hurdles that we encounter on a day to day basis in the ED.

4. Be a role model.

You now represent the face of the department for patients, nurses, consultants, and residents/students (if you have any). Don’t be late. Be cognizant of where you voice informal comments. Someone impressionable is always listening.

5. Familiarize yourself with the resuscitation equipment before starting your first shift.

You may be the world’s intubation expert, but if you can’t figure out where the spare endotracheal tubes and laryngoscopes are, things go bad quickly.

6. Realize that you are working in a different ED.

Every Emergency Department has its little quirks. Nothing irritates people than someone new, who constantly reminds others that “When I was at _____, we did it this way.” Try to figure out how your ED handles different scenarios. Examples at my hospital include:

  • Patients with pancreatitis often get admitted to our Surgery service and not Internal Medicine.
  • On the weekdays, trauma airways are managed by an Anesthesia resident and not an EM resident.
  • Our ED tends to prescribe only vicodin and percocet (and rarely oxycodone or darvocet).

7. Decide on how you want to access clinical information.

You won’t know the solution to every problem in the ED. There’s something that surprises me every day. That’s the upside and downside of EM. I admit that in my first year, I called my residency program’s ED to “curbside” an attending once. Decide on how you want to be able to look up information. Will it be by using:

  • PEPID?
  • Epocrates/Micromedex mobile app?
  • UpToDate?

8. Keep up to date with the literature.

It is all about lifelong learning. Learning does not stop after residency. Devise a plan to keep apprised of the major updates. This might include doing one or several of the following:

  • Subscribing to a few journals. I personally read Annals of EM, Academic EM, and EM Clinics of North America.
  • Attend an occasional national meeting.
  • Subscribe to various podcasts, videocasts, or online websites such as EM-RAP, CME Download, or, respectively. [Disclosure: I am not affiliated with any of these products.]
  • If you are a community emergency physician, attend a few EM residency conferences in your area. I’m sure they’d appreciate your insight from a non-academic site perspective.

Any other suggestions that you can think of?

Michelle Lin, MD
ALiEM Founder and CEO
Professor and Digital Innovation Lab Director
Department of Emergency Medicine
University of California, San Francisco
Michelle Lin, MD


Professor of Emerg Med at UCSF-Zuckerberg SF General. ALiEM Founder @aliemteam #PostitPearls at Bio:
Michelle Lin, MD