Eight Critical Steps to Take as a New Attending (They Don’t Teach This in Residency):

(Doximity recently published this article of mine emphasizing eight critical things for a new attending to do. It originally appeared here, but some of you are not on Doximity so, with Doximity’s permission, I have republished it on my site for your reading pleasure)

Here are eight things to do as a new attending that I didn’t learn as a resident (and wish I had).

Establish a Budget

There are two times when a budget is a very important tool: when you are struggling financially and when you have a large income or expense change. Now that you have graduated to your new attending income, it’s important to intentionally decide how you will invest, save, pay off debt, and spend your new income. If you don’t make a plan to ensure your money will be doing what you want, it will all slip away, and before you know it, you will be playing catch up. Likely, with your high income, you will not need to budget forever, but budgeting is a great place to compile all your important expenses so you realize all the different things your income needs to cover before you start spending your money on toys. You must account for your new housing, insurance, retirement savings, and student loans before you start spending that new income on cars and vacations. Make a plan to proactively use your money so you will get exactly what you want in life, including the cars and vacations.

Rent a Place to Live

Fight off the desire to own a house for a couple of years. Nearly half of all new attendings decide they do not like their first job and will begin the job hunt anew. If you turn out to be one of them, you will love the fact that you do not have the burden of selling a house after recently purchasing it. Selling a house within two years of buying it is usually a money loser, due to the costs of buying and selling houses. After a couple of years, you will know if you are happy with your job and will be staying, or if you will be relocating to a new job. Once you are sure you will be staying, then you can start your house hunt with a better understanding of the city and without time pressure. This will lead to a better long term housing choice for your family.

Max Out Your Retirement Plan, Starting with the First Paycheck

With a new higher income, you will be able to begin a retirement savings plan. If your investment is made as an automatic payroll deduction from the first check, you will never miss the money. One of your most important new expenses will be accounted for and you will not even notice. If you don’t invest in your retirement plan from your first check, you will likely spend all of the money as it comes in and may end up in a situation where you feel you don’t have enough money left over to invest in your retirement. Pay yourself first, then when you reach retirement, you will have the money to live a nice life.

Pay Down Student Loans — Aggressively

The largest financial burden you usually face as a new attending is your student loans. Many people feel overwhelmed by the prospect of paying off their student loans. Before you get used to spending your new, higher income, make a plan to aggressively pay off your student loans. If you will not be in a forgiveness program, refinance the loans at a lower interest rate and start making large payments right away. Set up a plan to have them all paid off in the first five years as an attending. Once they are paid off, you will be able to redirect that money for some really great things in your life. You will also be getting a monkey off your back, leading to reduced stress. Life in medicine is stressful enough without the added stress of student loans.

Update Your Insurance

With every major change in your life, you should reevaluate your insurance needs. As your income increases, so does your insurance need. Since most people increase their expenses with their income, evaluate your disability need based on your new salary. Make sure your family is protected in case you become disabled. Likewise, your life insurance needs will increase. Since you will have a target on your back for lawsuits, get some additional cheap protection by adding an umbrella policy. For a very small sum, you can have an additional million dollars of liability protection for your family.

Join Only One Committee

As a new addition to the medical staff, you will be placed into the committee system. Your main priority is to learn to be a good attending. Concentrate on learning the ropes of your job and taking care of your patients. When you are asked to join committees, pick one. Do not add multiple committees to your plate at this point in your career. During the first five years as an attending, do not accept the chairperson position of any committee even if they beg you. Give yourself time to grow and learn as a committee member first. It may seem prestigious to become the committee chair, but you are not ready yet. Establish your new life first.

Start an Exercise Routine

During training there are two things people tend to sacrifice: sleep and exercise. Now is the time to get them back. I gained 30 pounds during residency and didn’t get rid of it until I started a regular exercise program. Look back at what exercise you used to relish. Did you like to run, do aerobics, lift weights, ride bikes, practice martial arts? Before you fill your schedule with other things — and believe me, your schedule will fill up fast — get exercise back in the mix. We are always telling our patients to get more exercise, so let’s practice what we preach. You will feel a lot better if you are working out regularly.

Become an ‘AAA’ Doctor

The things you do in the first year will establish your reputation for the rest of your career. Be sure your reputation is great. You should be known as Able: A good doctor who has the ability to handle the cases in your specialty well. Available: When others need you, they can find you right away and you will promptly work their request into your schedule. Affable: Likeable as a person, as no one wants to work with a disruptive or rude physician.

If you take these eight steps, even before the first day of your new job, your life as an attending will be as spectacular as you thought it would be when you decided you wanted to become a doctor. 

Dr. Cory S. Fawcett can be found blogging at DrCorySFawcett.com and his award winning Doctors Guide book series is available on Amazon. He is a 2019–2020 Doximity Fellow.

Illustration by Jennifer Bogartz

If you are looking for more helpful things to do as a new attending, pick up a copy of my book The Doctors Guide to Starting Your Practice Right, so you can get the right start on your first job out of residency.