We are not in Kansas Anymore!

“Toto, we are not in Kansas anymore”. This was said in the 1939 movie The Wizard of Oz (urbanized in the 1978 remake The Wiz with some soul) by Dorothy to her dog.

“We are not in Kansas anymore” has come to mean stepping outside of what is considered normal into an unfamiliar or uncomfortable place.

Congratulations to the new medical school graduates as you embark onto the yellow brick road; you can now officially be called “Doctor” (by more than just your grandmother) and even better if you have secured a categorical residency position in the specialty of your choosing.

For many of you that means packing up and moving to a new city and your greatest worry is finding a new grocery store. If you were like me June is the last month before adulting when you have to begin your duties in your new hospital. I spent the month backpacking through Europe (I highly recommend it if you have a love of travel and adventure). I was not concerned about starting residency as I have always been a good student, it was the one skill I had mastered, and was not residency just a continuation of medical school? Even the vernacular was familiar I was part of the intern class of SUNY Downstate Surgery.

But the reality is that residency is not the artificial world of the classroom, it is your first “job” in medicine. You are now an employee of the hospital and instead of paying the medical school, you will receive a salary; have a 401K, and will pay taxes.

Residency is not an extension of school and as such you will need new skills to survive and thrive. And if you are a new graduate of color, your residency experience will not be the same as your White counterpart, but neither was medical school.

Black residents either leave or are terminated from training programs at a far higher rate than White residents. The flying monkeys appear without warning, and you need to be prepared or your fate will be less that of following the yellow brick road and more like that of the wicked witch when the house falls on you without warning.

So just call me Glenda and I will do my best to give you safe passage to the Emerald City.

First, you must look the part

Dorothy needed the ruby slippers and for you, always wear clean scrubs, dress for clinic, wear a clean white coat, and have your badge visible. Even with that you will be asked if you are the unit clerk (when in street clothes) or cleaning staff (all the time) by those who don’t look like you and sometimes by those who do. Just take a deep breath correct them and laugh.

Second, find a mentor

Glenda here but you will need to find one more accessible than in the land of Oz. A mentor will give you a map of your destination and help you to avoid potholes. If you are lucky, one will present themselves, but if they don’t then this is your first and most important quest as a good mentor is like a magic well and will nourish your career even after residency.

Third, don’t go it alone

Residency is isolating and you will miss birthdays and family holidays and the loneliness make you bitter and callous. Find your cowardly lion, tin man, or scarecrow — those that have your back and you theirs. Those who will make you better because they challenge you and make you think and care. Also, build your own army: one friend in each department that you have their personal cell — an ER resident, medicine and radiology, and any specialty you consult regularly. I still have those numbers for late-night consults.

Fourth, document EVERYTHING and over-communicate

Write a note in the chart when you see a patient, even if you can’t write a full note — document that too. When you see a patient communicate the plan with the patient’s nurse and make sure your patients understand the plan, your role, and what to expect going forward. The hospital is a scary place, but it is even worse if you don’t know what is going to fall from the sky.

And lastly

If you get in trouble, remember residency is a job that is bound by the same employment rules as any other. So, find a good employment lawyer to review your contract and fight.

When Dorothy got to the Emerald City, she realized that the wizard was just a little man, and he had no power without the belief of those in Oz. You earned your place at the table, it was not a gift to be taken away.

Don’t give away your power to small men (or women) who hide in boardrooms, behind kabui courts of “peer review” while you are in the arena.

In the original 1939 movie, Kansas was in black and white, and Oz was in full technicolor — you are not in Kansas anymore, but this new land is full of color, welcome to Oz.