What's In A Job?

T minus 19 days to APA MEETING - HELLO NYC !!  It is going to be a busy week starting with 75 years after Freud and then leading into APA conference plus the chief meeting, before I come back home.  Last year when I was about to start my chief year, I had the opportunity to go to TARRYTOWN for the chief retreat.  As I think about wrapping up one year of this job leading into year two, I cannot help but realize how I have changed in this job from one year to the next.  The natural progression from a newbie to a more confident chief has come on it's own terms and in it's own time.  It has pains and gains and moans and groans.  Well more groans and pains at times, but nonetheless there it is.  Part of this also comes from the fact that transitioning to a 3rd year is terrifying at so many levels that I can't help but be aware of the need to expand my vision, not only as a chief but also as a resident who in 2 more years; is going to be an independent physician and may be also an attending physician to work with new residents.

When I started last year and went to Tarrytown as a spring chicken, I had no idea how over the span of the year with all the experiences and events; I will have a totally different view of what my job actually is.  Rewind to this post and I see how much I have grown up in just four months as well.
While for the most part the post I referred to above still holds true, esp the part where I talked about my amazing residents and how much I love being around these people.  But I have also learned that I do have a role besides being a liaison between residents and the program.  I do play a role in decision making with my boss and I do have a role in working with him to ensure program integrity.  There are times when I worry about the lines of authority i.e. should it come from him or me?  At times it is a fine line but at other times I know what to do.  I do believe that managing physicians is a very hard task.  

By nature we are annoyingly narcissistic with the added necessary devil of the learned and mostly productive autonomy needed for our jobs.  I am sure I do not need to elaborate.  If I have to choose the hardest part of my job, I would choose schedules any day, closely followed by the every day resident issues specific to our setting.  But many of those issues are beyond my scope and fan my own frustration as well.  I have learned to pick my battles carefully just so I can keep myself sane.

Back to the oh so lovely schedules.  I have lost count of how many hours I have spent on creating, recreating and tallying call hours and numbers.  Sometimes I look at the folder on my desktop at home and I become nauseous because I remember nights when I have mixed up master tally with master master tally and DONOT ALTER tally and still have altered the tally even though it was named specifically "DONOT ALTER" in ALL CAPS.  I have it all corrected now but I have had close calls bad enough to give me a heart attack.  Part of me is very proud that I have kept the Tuesdays, Thursdays and Fridays, fair and square between all of us because for our call purposes those days really do matter a lot for every one.  I have anxiety regarding giving up the call schedule duties in a few months but I will get over it because I have to.

I have also learned that I have gotten better at having a thicker skin to criticism and have learned to really choose my words wisely.  I advice everyone who wants to be a chief in any residency training program, work on being careful about what you say.  You are under a microscope and you will need to be able to absorb a lot of anger directed towards you directly or indirectly.  You cannot make everyone happy, not as a resident and certainly not as a chief.  What I can do is, be fair and approachable.  People for the most are aware of your fairness and availability even when a few won't acknowledge it.  At the end of the day that is all that matters.

If you plan to hold the chief's office start to expand your vision from a perspective 2-3 years beyond your current training year.  I have been guilty of tunnel vision and not seeing the bigger picture because residency is tough, tough, tough but these years no matter how tough, are still protected by the shield the program provides compared to when you are out and about on your own and have to be responsible for all and everything.  I do realize now that people are positioned from the beginning mostly unconsciously but at time consciously to hold positions of responsibility, either by themselves or by their superiors.  So if you have inclinations of doing the hard job of managing your peers, position yourself maturely.  It helps.

What's in a job you ask?  The maturity, ability and willingness to go above and beyond what is needed to get things done and understanding that your role; should you pursue this path, is vital for your program whether you realize this or not.  It's not as much as being a good or bad doctor in this role but really about being able to be a manager/leader.  Being effective without being insensitive and being available without being a push over.  What I have really learned is to finally realize that I am not a union leader but rather a resource for both sides to work through issues and concerns.  What I am is really a position that is able to voice frustration, concerns, at times anger from my peers to my program with the intention to resolve that frustration, with handling issues that need to be addressed to diffuse the frustration.  But I do see now that a big part of this job will be to present better vision and goals to better the program and consequently ourselves as physicians and role models for the next generation of residents.

Here is a great piece to read regarding what other chiefs found out and learned about their jobs.  What chiefs learned!

Until next time I leave you with this thought:

A genuine leader is not a searcher for consensus but a molder of consensus.

Martin Luther King, Jr.

WWW.Brainyquotes.com

Through Ups And Downs

Took me long enough to return here.  What can I say?  A lot has happened since the last post.  

Last time when I took a leave from writing was when I was about to leave for the Forensic Center.  It was an incredible experience with a minor hitch that I would rather not get into.  I had the opportunity to work with an incredible attending physician who is now running our resident process group.  First time I sat through the treatment team with him, I was in for a surprise.  I found out about my own hang ups and anxieties that came into play in a different way with this teacher.  He is all about interpersonal dynamics.  You would think it is a given because I am training in a program that is more and more geared towards that but we still have ways to go and having this one week with him just opened my eyes to what I/we could learn from him.  So of course I put my chief hat on and am immediately thinking about how to have more access to him for other residents.  It would be great to have him as our own attending rather than just a week in one month but that is not happening.

I always wanted a process group for our residents and have a fairly decent amount of backing from my program director to go ahead with this.  Eventually with some discussion and persuasion residents agreed to have a twice a month group with his help.  I will have more thoughts about that when we have a few more of those.  I also had an opportunity to rotate at the county jail with another great attending.  What I found great about this month was that not only I had a good pool of patients to observe but I also had physicians who were eager to teach and were involved in making sure I got the best of the limited time I had with them.  I however did recognize that even though I enjoyed the rotation, I have no desire to pursue forensic psychiatry as my future once I graduate.

One of the star events of this month has to be having Pat Pantone come talk to us.  I am always amazed at these incredible teachers who come and talk to us and always leave us wanting more.  There are not many people other than my children for whom I won't mind staying up a Saturday morning after a "No shut eye" Friday night call.  This came neck to neck to the above.  Dr. Pantone is associated with William Alanson Institute, NY and provided us with an amazing two days of discussions, case presentations and provided much appreciated analysis of two of our own cases, including one of my own current therapy patients.  I did end up realizing that I do not suck as bad as I thought I did.  Of course having the Director of Clinical Education of WAI validate that, did help a lot.  


And then there was the chief election last month.  I didn't get fired and got to keep my job for one more year.  The election process in itself was rather anxiety provoking.  In the process I also had some not so pleasant days which I now realize come with the territory.  The invisible cloak I had referred to here doesn't seem to be just a novel product of my naive beliefs about being a chief before I was one myself.  I didn't coin this idea because it exists in other minds too.  I however now know after a year in this position that it doesn't exist.  

I titled this post "Through ups and downs" precisely because with all my ups this past month I had downs that dragged me down and caused a great deal of anguish.  I did make the mistake of giving the downs too much attention.  I always tell my patients that how they react when something or someone bad happens to them depends on how much value they put on their own time and energy.  I needed to remind myself of my own mantra.  Isn't it so easy to sit on the chair and talk to the person on the couch?

What I have learned over the last month is that my job as a chief is valuable to my fellow residents and I cannot lose the sight of that value because they did choose me one more time.  The ups and downs I face in this position are learning points just like in any mid management or management position.  I can't let the ups disconnect me from the normal and I certainly cannot let the downs make me lose my focus from what I do every day i.e. be there for the residents as their support and guide them when they need me to, while balancing that support with the role I have to play for the program.  I have another year before I turn my hat over to the next chiefs and I have a lot of work to do in this year starting with our brand new PGY-1 class starting in July.  So while I still have to be mindful of triggers that change a good day to a bad day for me, I have to keep the bigger picture in mind and learn to look at it with more focus rather than thinking about "At this time and point in time."  I think it is time to read Spencer Johnson, M.D. again.

So here is to becoming even better this year and continuing to work the very important job I was elected for, for one more year.  Because through valleys only you get to the peaks.  

Of Hiatuses And Such

I do realize I have been less than punctual about my writings but don't you know the dog ate my homework!  Incidentally I don't have a dog.  You get the picture right?

In the meanwhile I have finished most of my off campus rotations and am very happy to be back to the mothership.  PGY-3 is oh so close.  There was the vacation that now seems so far away and almost dreamlike.  I felt like January was the mandatory slow down month and a must have hiatus when the general trend is to start new year resolutions and start it with a bang so to speak.

So this is it for today.  I leave next week for part of my forensic rotation for 3-4 days.  Should be interesting since I am not sure what to expect.  Hopefully I will have some thoughts to reflect on afterwards.

Ciao 2013 - Bun Venit 2014

All good things come to an end; hopefully making way for better things.  Feels like it was just a blink of an eye and here comes 2014.  What a difference a year makes.  Last December I was counting weekends until my weekend calls or "Community Service" as I like to call them, were over.  The glorious PGY-2 was oh so close, yet so far.  This year the eternal countdown junkie in me is counting down to the majestic PGY-3 and guess what else?  Okay I will just humor myself and save you the suspense.  I have 18 more months of call left.  I will openly and shamelessly admit that I dislike call with a passion.  I don't know anyone who likes call.  If you happen to be one then I would like to see your "Men in Black" issued ID.  Yeah didn't think so!

At the same time I cannot deny that the amount of confidence I have now after 18 months of being a resident is hugely possible because of being on call.  Despite my disdain for call, I cannot deny that I am lucky to be in a program that has a proper call like you are suppose to have when you do your residency.  But enough of being thankful for the call.  My happy dance tonight is going to have a bit of funky sway because the light at the end of the tunnel is at least a sliver now compared to the dark tunnel last year.  I will soon bid Adios to the pager that never stops beeping and the long nights where sometimes all I want is 20 min of shut eye just to feel less of a zombie and at times I have secretly wanted to find a hit man to take the pager out.  I can already see the welcome 2015 blog post.
        
PGY- 3 also means no more inpatient months.  This is mainly a 12 month out pt rotation with no off campus rotations.  I am so excited about being in clinic and most importantly being with my amazing classmates.  After two years of being scattered away from each other for various rotations we are finally going to be together for a whole year.  I am looking forward to more time with my favorite people and all the craziness some of us bring to the mix.  July is going to be a great month.
New year also means the match season is coming to an end and soon we will find out who joins our program for 2014 match.  Interview season was long and testing both for the candidates and the programs but it is finally over even though it really is never over.  It is more like taking a mini break for a few months and it starts all over again.

Here is to an amazing 2014, more laughter, more learning, more fun and more knowledge.  I close 2013 on a high note with an amazing group of people to work with, doing a job I love with all my passion with all it's challenges in a system that frustrates me to no end some days balanced with a family that keeps me grounded and keeps me going when I feel tired and down.
Happy New Year Y'all!!!

To Chief Or To Not?

I was reading a personal statement yesterday during the residency interviews.

"You don't choose Psychiatry; it chooses you."  Pretty deep right? 

Now this is exactly how I feel about being the chief resident.  It literally chose me while I was at my daughter's morning assembly one April in 2013, instead of being at the weekly Friday AM meeting.  Here I was taking adorable shots of my 1st grader singing and making videos because that is what moms do.  And then I got the text inquiring would I be interested in being the chief?  

This had to be a joke because the last thing I expected was to be handed the magic wand that I had imagined every chief had hidden under their invisible cloak.  If anything I was sure it was going to be the smart and fun AT to be named as the first ever PGY-2 chief for our group of croods, if we even succeeded having a chief from the 2s.    

Turns out my emails about wanting to do that and do this landed me in a hot pickle.  I used to think about, what my peers thought about my emails and I knew at least at some level they had to think "She has way too much time on her hands."  I admit that I am intense and as of yesterday I know for a fact people know that I am. Okay now if you know Dr. T, (No relation to Dr.T and the women, though Richard Gere has nothing on Dr.T in looks) you would know why I wanted to fall out of my chair, when he said that a particular applicant who we all liked reminded him of me because she was intense.  He is a man of a few words around residents for the most part.  I was kind of confused that he thought that.  Now I am hoping he meant it in a good way but I cannot be sure.  Darn you over thinking.   

Which brings me to the great part of being in this pickle.  The in between status of not faculty not resident, the Chief has it's own marination status.  Too tart to be a faculty and a bit more chewy to be a resident. Either way I want to assure everyone there is no magic wand and there certainly is no invisible cloak because if there was one, I would be unavailable at times for sure.  

Being a chief is like being a child who was suddenly allowed to stay up past bedtime from now on after the younger siblings have gone to bed.  It has it's perks when you get to find out John Stewart is really mad about the Pizza in Chicago and the reality shows on Bravo are really so good for one's self esteem but it also makes you at times miss the early bedtime and lullabies with the soft blue light in your room.  The great part of interacting with your faculty in a different capacity and finding out that they are not really that scary along with the painful knowledge of the fact that some people really are very hard to work with and there is no magic wand to make them disappear, it is an experience in it's own.  

Match season has it's own pains and gains.  It's the behind the scenes look that makes it all so incredible and sometimes I can't believe I am a part of that elusive scene whose mysteries haunted 3 years of my residency search.  I have found that there are no mysteries just pure cut throat competition.  I was told that "Chief year is the loneliest year of one's residency" or "No matter what, all chiefs are A--h*les."  It had made me somewhat weary of being one before starting.  I don't like being isolated and I certainly do not like failing.  

More doubt came as a spring chicken at the Chief Retreat back in May where I was met with a lot of skepticism (in a nice way) and sympathy because of being the only rising PGY-2.  I learned to make my year of training "a need to know" fact pretty fast just to avoid other chiefs trying to find horns sticking up my head.  I came back home quite defeated and literally considered walking up to the PD and telling him sorry I won't be able to do this.  But then I heard Phil Dunphy in my head "There is no Done in Dunphy" and I am not a Dunphy but I still listened to that voice in my head.  Yes I knew it was an imaginary voice, just so we are clear.  

Now at midpoint in my chieftain year, I do admit that it has been a stressful half year and I have fleeting thoughts of quitting next year but I have a Dunphy at home too.  I know he won't let me quit if the early bedtime group won't decide to harness my late bedtime.  I have no idea what they will decide but my half year has been anything but isolating and I don't think my peers think that I am that other thing I was told all chiefs are.  But then again I work with an insanely wonderful group of residents.  I think angels sing when we are all together or at least they want to sing.  I think the envy gods of chief town get green in the faces when I feel anything but isolated, well for the most part.  Okay well I do feel isolated when I make the call schedule and when I have to ponder for hours on the tally sheets just to keep track of all the call numbers but that comes with my territory.  If I get to wear the big girl pants, I have to keep the spiky itchy belt attached to the pants with superglue.  

To chief or not to chief is not merely because it is a feather in one's cap because it definitely is a feather and very colorful one from a distance.  But it also is at times a difficult task of being a reliable human bridge between the program and residents and no matter how many times it is crossed there will always be some people left on the either side who won't like the bounce or distance the bridge had to spread.  Nonetheless at the end of the day if you are able to make them believe that the construction is sound and the bridge won't fold when the either side needs it to be there, they will walk you and walk you with camaraderie and care.  

That is the essence of being the chief and that is what should drive the decision to be or not to be.  

PRITE Scores Are In

I was dreading this day for days.  I mean let's be honest; who am I kidding here?  Just because I am in second year of my residency, doesn't mean that I have miraculously stopped sucking at standardized testing.

C.S Lewis says "If we find ourselves with a desire that nothing in this world can satisfy, the most probable explanation is that we were made for another world.”  

Guess what my desire is?  Yup you got it. I want standardized testing to choke on it's own saliva and die.  I think it's time for me to find the wardrobe and may be I will find Narnia.  

Rewind to last year December when I broke all records of doing terrible on a test.  I had to search high and low to console myself that I have done worst but I couldn't.  Even my Mount Everest of USMLE looked like a sand dune in front of my epic and colossal bad performance on PRITE as a PGY-1.  Okay well I had a few silver linings as in my Neurology/Child and Psychosomatic scores but I am sure you get the picture.  Anyway I had big plans to change things in 2013 but I am not sure when I fell off of that train.  I do remember getting on it but it must have been a very bumpy start because I don't remember anything else. 

I blocked the shame and went on with my first year.  July brought euphoria as I became the "Upper Level Resident" and the weekend call grind came to a screeching halt and along came Polly the post call day.  I remember August brought back the panic partially because I realized that I was still dozing off at the train station and also because I had more luggage this time around with increased responsibility of being a chief. Those bags are pretty heavy let me tell you.  I am a sucker for punishment as my therapy supervisor says because why else would I agree to be a chief in 2nd year?  Who does that?  

Generally when residents prepare for in service exams they tend to concentrate on past exams and questions.  Seems pretty simple and does wonders for most people but I'd be damned if my brain worked that way.  I wish it did but it just doesn't.  So I found my Kaplan and Saddock in a box sitting in the garage of my new home that I had just moved into.  Yes I moved - twice - in 4 months.  I told you I am a sucker for punishment.  I dusted it off and promised the study gods that this time it's real.  
And what do you know the gods must really have believed me because right before I was supposed to start another month of inpatient in September; my awesome program coordinator asked me about switching it to a study elective because some one had to switch their elective for a different rotation.  You can't ask for a better alignment of stars now can you?  Alas I need more than just stars aligned and double rainbows and unicorns eating jellybeans. Really, where is that darn wardrobe?  

Long story short, the dreaded 2 days of testing left me completely dazed esp. the second day. Who writes this exam?  I cannot believe that I actually missed USMLE after taking this torture spanned over 2 days. I actually missed the insane logic of those questions, though at that time they seemed worthy of being tossed into the Bermuda Triangle never to be found again.  It took me days to overcome the assault on my senses after those two days in October.  

And then I got the envelop.  It was staring at me in my inbox.  I opened it and instantly remembered why I hate standardized testing.  Too bad it can't choke and die nor can I ship it to Bermuda.  There is no Narnia for me either.  But I found my silver lining this time as well.  I don't have to spell it for you.  You have probably figured out that I didn't do particularly well this year as well but my misery has some solace in knowing the even though I sucked but I did it more knowledgeably this year.  The euphoria I felt as an upper level has gradually transformed into a mature awareness that I know more this year than I did last year and that I have started my ascent to the top of Mount Impossible.  

This year I will stay on the train and make sure it gets me where I need to go next October.  And really I don't want to end up eating a whole packet of Dove chocolates again after the onslaught that is called the PRITE.  Because if there is anything that I hate more than standardized testing, is having to buy elastic waistband pants for work because my real wardrobe may not lead me to an unknown world but it sure does keep me happy in my own.