Dr. Baxter

Ten years of surgical training prepared me for lots of things. I can take care of bad lungs or a barely functioning heart without batting an eye. Ruptured aorta - bring it on. ECMO on pressors in the ICU - barely working up a sweat. Unfortunately, the one thing I am not sure my training prepared me for was to carry the title "Attending".

The running joke around any Academic institution is that becoming an Attending in the words of Darth Vader is to "give yourself to the Dark Side". The perception is that one becomes obsessed with billable procedures, lengths of stay, potential malpractice and insurance companies; and loses site of important things like patient care. While I am not willing to concede this point entirely, I will admit that I think a lot more about the cost of health care these days. However, this is not the crux of my problem as an Attending.

I now have a whole week day dedicated to filling out paperwork, "developing an academic career", talking to insurance companies, patients, and I'm pretty sure random people my office digs up off the street. I have two whole days dedicated to clinic, and unlike during residency I can't claim a pressing OR case to get out of it. On the two days I get to actually operate (or more accurately watch the residents operate), I seem to spend as much time darting to meetings which never seem to reach resolutions, catching up on dictations, and preparing lectures for the residents. However, this still isn't my biggest issue with the Attending title.

The Attending issue that I feel ill equipped to handle is the perhaps subtle but distinct line that separates you from everyone else. When I was a resident/fellow, the hospital was a ready source of friends for me. I would go out with the RNs, NPs, PAs and my fellow residents. They had similar hours, interests, and complaints. I tried that same path to success here, but met quite different results.

I am no longer "Tammy" - i.e. one of us. Now I am "Dr. Baxter" - i.e. one of them. It is no longer a group of colleagues with stressful jobs going out to blow off steam. Now it is a group of colleagues and "her". Regardless of the surroundings, no one can forget that I play for the opposition. The stories must be cleaned up for my hearing, the complaints are filtered, and there is always the insidious believe that my life must be all roses and sunshine because after all - I am "The Attending".

Perhaps the easiest way to cope would be to hang out with other Attendings. People unlikely to yell "Hey Dr. Baxter" across a crowded restaurant. However, this isn't as easy as it would seem. I am a good 15 years younger than anyone else in my division, and at least 10 years younger than most people in my department. I have the opposite problem in other departments, as the singletons are all fresh out of training, but their training only lasted 3-5 years so they are much younger than I.

Another potential fix is meeting people outside of the hospital. I would love to do this, but haven't figured out how. All that surgical training has left me ill equipped to have interests in the outside world. Even at the gym the other day, I heard someone yelling out Dr. Baxter across the floor. It turned out to be one of the anesthesia residents, and a source of endless amusement for my trainer who has now decided to use the title to irritate me.

I'm not saying that being an Attending is all bad. I certainly love my new shoe budget, the ability to do things my way, and control over my schedule. It is also nice to have a whole team whose job it is to make my life a little easier, and to take care of many of the tasks I hated when I was a resident. I want to keep these things and the old ones too. I admit it - I want to have my cake and eat it too.