The (Not So) Magical Journey from Residency to Medical Director

By Darryl Wenner, MD, Medical Director at Bertrand Chaffee Hospital

Okay, so let’s just get this out of the way… I have it all. That’s right. I said it. I’m living the American dream. I’m 31 years old and in good health. I work in multiple emergency departments as a physician, and I am the Director of Emergency Medicine at a rural hospital. I have an absolutely gorgeous and amazing wife with whom I am currently building our dream home. We have a few nice cars, a beautiful piece of property, a couple of awesome dogs, a loving family, and the list goes on and on.

The funny thing is, if you ask the majority of people, especially those who are uninitiated into this cult we call modern medicine, how everything in that first paragraph came to be, they usually do not have the slightest idea. In fact, I have had this discussion with quite a few people over my relatively short career and it seems that most feel that all physicians grew up in a gated community with physician parents, spent our free time golfing and sailing until personal connections got us into an Ivy League medical school without any work or effort at all, and then, after sitting in a few classes, we were magically ready to be full blown physicians. And off we went (in the Ferrari we got as a signing bonus, of course) to live an easy, relaxed life in the lap of luxury. I’m not here to burst that bubble, but… POP!

I could spend days and write hundreds of pages describing my adventure from being one of three children in a hard-working middle class family to a Director of Emergency Medicine, but let’s be honest; you as the reader don’t care, and I don’t have the time. What I will do is give a crash course in the real world process of becoming a physician and medical director and some lessons I have learned along the way.

Medical School: it’s long, it’s difficult, it’s a giant pain in the rear end. You’re surrounded by a lot of really smart and interesting people, which enriches your learning experience. However, there is also a way-higher-than-acceptable proportion of self-absorbed, arrogant trust fund kids to whom you just want to give a wedgie. These people become “those doctors,” whom we will discuss later.

The best way to describe medical school is that it is a lot like driver’s ed. Driver’s ed prepares you to pass the test and go through the motions of driving, but it does not necessarily make you ready to go 70mph down the freeway with a car full of people who are entrusting their lives to your abilities. Medical school is the same way: we learn the theory of medicine, the information that clinical decisions are made on, and how to go through the motions of taking care of people. While I cannot express just how essential this training is, it still does not prepare you to be a high level clinical provider. That’s where boot camp, I mean ummm residency, comes in.

Residency is when the real fun begins. After you do four years of medical school, go on endless interviews and perpetually feel stressed while a mystical, magical computer decides what residency program you “match” into, it is finally time to hit the ground running. There is just one little problem with that…none of the new residents have any idea what the hell they are doing, or what is going on. This is perhaps the biggest misconception when it comes to medical training: that after hundreds of hours of didactic and clinical training, new physicians are ready to be solo providers–but that simply is not true. In general we are quite clueless and need direction from our attendings and nurses (who will either make your life much easier, or a living hell…be nice to them!).

WARNING! This is probably the part where I start to get some people all riled up and offended. Fortunately for me, this is my article and if you’re bothered or view this as a personal attack on you, feel free to contact me to let me know why I’m wrong. Or just stop reading. For the rest of you brave souls who are continuing on with me, let’s get into the real world of residency (Post-Graduate Medical Education) and not the whimsical picture that is often portrayed by television and by us physicians.

I have been asked several times what residency is, so for those of you who are unsure of the general premise, it is a kind of medical apprenticeship. You match into a program for a given specialty (i.e. Emergency Medicine, Family Practice, Surgery, Radiology, etc). In that program you are taught the ins and outs of being a “real doctor.” You are given some general training in all the different parts of medicine so you can use the aspects of that training which apply to your specialty. Then you have extensive training in your individual specialty. The hours are long, the pay is poor, your personal life often suffers, you are used as cheap labor, and yet you learn. That education is some of the most valuable that you will ever get in medicine, and unfortunately too many young physicians view it as a job, or “paying their dues”, instead of what it is: the chance to learn and improve your skills.

Let me just say that modern day residency training is a complete and utter joke compared to what physicians used to have to go through. I’m probably one of the few people from the new generation of medicine that will tell you that, but it is true. Yes, it is still hard. However, in the world of duty hour regulations, the ability to get the amount of experience to be able to make it as a solo practitioner without the benefit of an overseeing attending providing you a safety net, is hampered. I, to this day, believe that my success as a physician is based on not wanting to be just okay, not wanting to be just another white coat. I wanted to be better. It is possible to get through by doing the bare minimum, in which case you’ll be just another one of “those doctors.” “Those Doctors” are the stereotype, holier-than-thou, pompous physicians who are seen everywhere in popular culture. I hate “those doctors,” and I became a doctor wanting to change that stereotype.

I received a simple piece of advice a long time ago, from someone very special to me, that changed my outlook on things: “Work Harder.” And that is what I did. I would clock out for the day and then go to all the floors in the hospital looking for something else to do, something else to learn. I took that old saying to heart, and made sure I was the first one in every day and the last to leave. The key to success is to work harder than you think you can, try harder than you think you can, set your goal and when you achieve it, don’t stop, just keep going. Be the one who is always there, the one whom everyone turns to when things are going bad and they need someone to set things right.

During residency I noticed something interesting. I realized that when you are surrounded by the high performers who have made it all the way to residency, there isn’t really a way to stand out as a leader. With that in mind, I went about just trying to do whatever I could to get better, to learn more, and all of sudden, 6 months into residency, I was made the Assistant Chief Resident. A little while later I found myself as the Chief Resident. What I learned is that you can’t choose to be a leader; you can’t make people follow you. But if you focus on working hard and excelling at everything you set your sights on, people will naturally follow you. You will find yourself suddenly a leader, and success will follow you.

Out of residency I was fortunate enough to have several job offers. Most of them were exactly what I just said: “a job.” In case you haven’t figured it out, “just a job” wasn’t what I was looking for. I didn’t want to punch a clock and be a pair of scrubs that filled a spot in a chair and not make any difference. I wanted a career, I wanted a chance to excel above the status quo. Fortunately enough I found an amazing company, Keystone Healthcare Management, which has the same philosophies I do. They provided me not with just a way to pay the bills, but a way to truly succeed. I started with them and kept doing what I had done in residency: I worked harder. I didn’t do it trying to be a leader, I didn’t do it to be a suck-up, I didn’t do it for attention. I did it because it had become a habit, so it was easy.

After a short time I was made the Assistant Director of Emergency Medicine. During this time I continued to put the work and research in to try and find ways to improve the department and myself. This work didn’t go unnoticed and I was promoted to the position of Director of Emergency Medicine. I continue to look for ways for us to improve and further the department.

So there you have it…that’s how a clueless resident became a Director of Emergency Medicine in just a few short years. But I left out the biggest factors. The story above makes it sound like I did it all myself and that it went off without a hitch. Let me be the first to tell you there were a few hundred times I screwed up and made a lot of really bad decisions/mistakes, and unfortunately I learned way too many lessons the hard way. I also want to make it clear that I didn’t do any of this on my own. The only thing that I did was put in the work and effort. Without the support and help of my amazing (and understanding) wife, my family, and the incredible people I work with, I would never have made it. It is because of their help, guidance, and, more than once, their bailing me out of some predicament I’d gotten myself into, that I can finally say “I have it all.” Just remember: stay grounded and don’t forget to live. Work should give you a sense of accomplishment and satisfaction, but it should not be your life. My wife makes sure that I do not get too caught up with work and that I remember to enjoy life. She’s also a nurse, by the way… like I said: be nice to the nurses; they will save you!

Just a little recap for those of you who prefer skimming to reading:

Lesson #1: Thou shalt not make the Nurses angry.

Lesson #2: Don’t be one of “those doctors”

Lesson #3: Work harder and put the time in

Lesson #4: Push yourself to be the best, and leadership and success will find you

Lesson #5: Make success a habit and things suddenly become easy

Lesson #6: Surround yourself with supportive and intelligent people

Lesson #7: Have fun and let work support your life, don’t make work your life.