At this point in the year, third year cardiology fellows and advanced fellows all over the nation are making the transition from trainee to an attending physician. By the time that we have reached cardiology fellowship, we all have made several big transitions: medical student to intern, intern to medical resident, and medical resident to fellow and trainee, and beyond. But perhaps the most daunting transition is the transition to attending physician – becoming the ringleader. The shot caller. For many of us, this is the first time we face the reality of making decisions on our own. What is the best way to make this transition? Below is some advice for making the transition from fellow to attending physician as smooth as possible.

Use Your Connections
For starters, the most important thing to remember is that you are not alone. Now is the time to call upon all of those connections that you have made during your fellowship training. Remember that you are graduating with a cohort of peers who are all entering new roles and who will each be dealing with their own difficult clinical scenarios or workplace challenges. Keep that group chat active and lean on each other. This is also a good time to learn from new colleagues if you are starting at a hospital or practice outside of where you trained. These connections not only facilitate camaraderie in the workplace and introduce you to different practice patterns, but also allow you to build a network of people nearby when challenging situations occur.

Ask For Help and Think Ahead
As a new attending physician, it is important to know when to ask for help. This is particularly true for those going into a procedural specialty. There will be difficult cases and complications, and it is important to know when you are in over your head. One way to prepare for these difficult cases is to use the last months as a fellow to think through each case ahead of time – the supplies you would use, what complications may arise and how you would manage them, and how you would plan follow-up for the patient. Thinking ahead will help to make the transition easier when you are the one making decisions about case materials and how to proceed while also instilling confidence each time you enter the procedure room.

Learn the Billing Basics
Another important aspect of becoming an attending physician is learning how to bill. Most of us have not undergone formal training or instruction by the time we graduate on how to bill for the services that we will provide. Now is the time to learn – and for good reason! Many hospitals may have a course or introduction to billing that can be useful. If you are entering a smaller private practice, ask a partner of the practice or colleague to spend some time walking you through basics. There are also other ways to get involved, such as learning about Current Procedural Terminology coding and watching videos online to ensure you are coding appropriately.
Find more coding and billing resources here.

Be Patient
It will take time to adjust to your new role, so be patient with yourself and your trajectory. This includes establishing a new work-life balance and building relationships with those around you. We all have career goals; whether it be research, education or ongoing procedural expertise, you will not accomplish everything right away. Furthermore, throughout training we are lucky to build friendships with co-trainees and have opportunities to talk with others in the fellows' room, but often times the initial transition into an attending physician can be lonely. Get to know the members of your care team. Soon enough you will have built a new network of colleagues to turn to and to help ease the transition.

This article was authored by Heather Wheat, MD, a FIT at the University of Michigan in Ann Arbor, MI.