I am one year out since fellowship and it has been an incredible year.
Quality of Life: no one tells you how great it feels to have a real job, to have weekends off, to finish work mostly by 5pm if you choose, to see and spend time with your family, and to not be in a constant servitude mode. The quality of life quadruples and is the single most notable benefit.
People: I found out over this past year how incredibly amazing people are and how willing people are to help you find your way and support your efforts (if you ask). I'm an Abdominal Radiologist and at our annual Society of Abdominal Radiology meeting this past year, I met early, mid and late career rads who are inspirational, kind, sweet, giving, super intelligent and just wonderful individuals with huge hearts. I loved most of the faculty I worked with as a trainee but the camaraderie from these new colleagues is different. It almost reminds me of being in a club in high school or college. These people are super energizing with a common interest to move the field forward. One of the individuals who I met was Amy Hara at SAR and then through Amy was Aarti Sekhar. If I used college as an analogy, Aarti is like the incredibly brilliant senior student, down to earth, president of the club who everyone knows and who get things done. I would be like a new freshman member equivalent, young and eager but probably naive. Meeting people like Aarti is the highlight of the year.
Mindset: going from a trainee mindset to a practicing radiologist mindset is like a light switch. All of a sudden, it's not just about getting the report dictated. You want to contribute in a meaningful way to the patient care. I want to dictate the reports as quickly as possible so that team can proceed efficiently and effectively. Technical quality and high standards become unquestionably critical. You become intolerant of anything less than standard. You care a lot about producing high-quality reports even if it means staying late to get that accomplished.
Residents: one of my attendings once told me if you found a job that you love, you never have to work a day in your life. I think a lot of academicians feel this way because of residents. The residents are incredibly diverse and add so much color to our world. The breadth of their knowledge (beyond radiology) and varying personalities keeps the day to day work interesting and fun.
Readjustment: Most of us end up moving and re-acclimating to a new institution, new city, new job, new system, etc. A change in both personal and professional life can be hard at first and was certainly the case for me. I'm still adjusting to the new life and hopefully, it will become easier with time.
Inefficiency: being slow and inefficient. I spent the first six months trying to figure out how to read out the residents and I'm still figuring a system. I was slow so I stayed till 8 pm every day and spent my academic days catching up. I'm probably 30% more efficient now and will probably get even more efficient over time but inefficiency is a hurdle that becomes very disruptive especially with increasing demand to read more in less time. The quicker you can figure it out, the happier you'll be. I was told by my former attendings that we learn and grow the most the first five years out of training. After that, the work becomes a second nature. Sometimes I find myself giving into less than the best quality because of a growing list or an unusually busy day. But our reports are permanent and "haste is waste" because we may miss significant findings. Balancing heavy clinical load with quality can be challenging because of inefficiency.
Burnout: I think it's incredibly easy to get buried in work. Finding time to rest and recover is essential but easily overlooked. At one point, I spent my two weeks of vacation time plus lots of non-vacation time writing a paper and essentially tipping myself over. I feel terrible admitting it but it happened and the paper was submitted on time. I'm told I should be able to write a paper in one day which I think is part of becoming more efficient. For sedentary people, this would be like asking non-runners to run a marathon. You want to cry just knowing where you are and where you need to be. If anyone calculated the time driven activity based cost of writing a paper for a radiologist, it would be incredibly high. The pendulum will probably swing multiple times before it hits the sweet spot.
Taxes: I'm in full support of social services to those who need it. My family got food stamps and Medi-Cal when I was growing up and it was invaluable for my family. Paying 45 cents for every dollar earned is still hard.
Rediscovery: I've spent the past 14 years of my life (4 years in medical school and then a tortuous path first in urology and then radiology residency/fellowship) to finally get to this point. During those years, you knew exactly what laid ahead and what came year after year. You figure out the process, learn how to master it, own it and keep moving forward. Now, the path is not quite as clear. Every decision comes with a price. As Matt Davenport eloquently explained in the recent JACR article on mentorship, making decisions becomes harder because we have to give up something as we become more differentiated and sub-specialized. I think that's where I am now, in the discovery phase of figuring out what I want to do. The better half of the year has been spent in "agony and vain" trying to accomplish this. But as you cannot expect a non-runner to run a marathon without training, I don't think I should impose the same expectation as a young rad to know exactly what I want. I'm finally coming around to accepting this realization. In fact, rediscovery is the most important part of this phase and should not be rushed but rather cherished. Being pluripotent provides a powerful opportunity to step back, assess the lay of the land and be strategic in our approach to one's path and identify areas of the most "cross-cutting" and impactful path. Being pluripotent allows us to think differently, to learn from experienced people, to question current methods, and to innovate. The rediscovery phase should be pursued thoughtfully with intention, patience, and careful planning because this is the process of drawing our blueprint. It's unsettling but if you are okay with uncertainty and open to surprise, it may be fun as well. Being pluripotent is the necessary wild card that drives medicine and radiology beyond the "bleeding edge" of our knowledge.