New Grad Advice 2008

Shadowfax started a nice thread, and the impressive 10/10 added to it today, a list of advice for new EM grads. Read their advice, but here’s mine:

  1. Lease, don’t buy. Way more than half of new grads change jobs within two years. I know, it’ll never happen to you, but here’s the thing: I was you. I got my ‘dream job’, bought a beautiful home in a perfect neighborhood. I sold and moved in 10 months. It’s a really nice way to lose a lot of money. It can happen to you.
  2. Be humble. True, you’re at the absolute top of your game, you know the best literature on every subject, and can intubate with your off hand in the dark, blindfolded. Your new colleagues have been practicing EM for a very long time, and while they’d be interested in your incremental knowledge of the state-of-the-art, they’re not itching for you to enlighten them. Open your ears, listen, and learn. (Use your filter: there’s a pony in there somewhere).
  3. Practice good medicine. I was unimpressed when my new colleagues told me I was too liberal with opiates (“Dr. x. always treats femur fractures with Toradol”, and that’s not a joke), I said thanks, and kept treating patients appropriately and well. Some of what you’ll see isn’t right, and it’s disappointing.  Sorry.
  4. Spend a while with the EM docs that will tell you about the medical staff. In no particular order, they’ll tell you about who’s helpful, who’s not, who to call only if you have no options, who to avoid at all costs, the politically connected, those that need to be told what to do, and the trickiest, the docs who need you to say the opposite of what you want, knowing they can never agree with the EM doc, and they’ll do the right thing paradoxically. Trust me, it’ll save you some grief, and your patients a lot of time.
  5. Nurses. You’re the New Guy, and while they’re interested in you you’re still Green as a Christmas Tree, and need to be tried a bit. A few will help you overtly, a few will help and a few will not (covertly), and a lot will just wait and see. Just like in your residency joint, eventually you’ll earn your reputation with them, and you need to take them seriously.
  6. You have a weakness or two, and you don’t know what it is. You’re about to find it/them, and usually when you have no time to read. Ask for help when you need it: Primum non nocere.
  7. Where you trained talent was a mile wide and 1000 feet deep; in your community hospital, you’re in a wading pool, comparatively.  Don’t despair, you’re well trained, but perhaps your partners have some skills you don’t.  Ask them to help when you need it.
  8. Business.  You (most likely) know less than nothing.  Get an accountant who works for docs, listen and learn.  Your income is about to explode; make sure your debt is in the same zip code.
  9. Get a hobby.  Enjoy your life.  You went into EM for a reason, it’s so you had a life outside the hospital. Enjoy!

Sorry if thay was preachy, and I’m not sure it would have been taken to heart by me when I was a new grad, but I need to try.


  1. With regards to nurses, I recommend bringing donuts for the morning shift. Not always, but fairly often. Same with pizza for the night shift. Candy for both shifts.

    That shortens the “feeling-out period” a little.

  2. Nurse 1961 says:

    Listen to the nurses, especially the more experienced ones. They can save your butt and keep you out of trouble even though you don’t think your in trouble.

    Be open to joining in on the fun like telling the staff you were a band nerd, or that you tried to blow yourself up.


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