How to Make Your First Day on the Job a Success (PATHOLOGY EDITION)

by | Jul 25, 2017 | Education, Residents | 1 comment

Finish Fellowship Strong

This may be the last time you are ever in an academic institution so make the most of the resources still available to you.

Wrap-up Research Projects

If you’ve got unfinished research projects that you know you won’t be able to work on, hand them down to more junior residents or fellows who can finish the work for you. Tell your mentors and coauthors about how you are planning the hand-off.

I’ve still got two manuscripts under review but at least the majority of the writing is all done.  I didn’t want to be distracted or occupied in my first private practice job by previous academic endeavors. Since private practice is a big unknown space for most of us coming out of training, I wanted to be as focused as possible and be able to deal with anything that comes with starting something totally new.

Preparing for Work Outside of your Subspecialty Training

Call ahead to find out what your group’s needs will be.  Your lab may receive a higher volume of cases from an area of pathology that you are less familiar with.  Calling a few months before you start and asking what you can get more experience in might help you be better prepared when you start.  For example, in private practice you may be required to sign out hemepath or cytology cases. Are you expected to perform FNAs? You might be able to do mini rotations with faculty in certain subspecialties while you still have access to academic pathologists right next to you.  This wouldn’t apply to someone who will strictly focus on their fellowship subspecialty, but for the rest of us in general pathology practice, you may need to brush off a few books that have been neglected during your fellowship. This is the time to ask your attendings all those “dumb” questions you were too embarrassed to ask before. These lingering questions will come up again once you are in practice and you might feel even more foolish asking these questions to your new colleagues.


You might be surprised how much you rely on templates at your academic institution.  These probably won’t be available at your new job.  Consider making a database of all the comments and common diagnoses that your faculty use.  You don’t have to use them but they will help you remember how cases were signed out where you trained.  They can also remind you about parts of the report you might overlook if they were always provided in your previous institutions templates (i.e. “No evidence of malignancy”, “Clinical correlation recommended”). This might also be a good time to write down how “ditzels” are signed out at your institution. Figuring out how to word the easy benign cases is often the biggest struggle. Having a premade list of how it was done at your old institution can save you time later.

Don’t Shirk the Paperwork

A successful first day in your first pathology job is built on an enormous pile of paperwork.  From the day you sign your contract to your first day of work, the amount of paperwork is tremendous.  I’m really glad I got a head start because I needed all the time possible so I could hit the ground running on day one.  Even with a nearly six month head-start, there are still a few loose ends that I’m wrapping up in the first couple days.  Here’s a summary of all the paperwork I had to go through:

  • Licensing for multiple state medical boards
  • Hospital privileges for numerous different hospitals, including:
    • Verification of identity (4 different times)
    • Verification of training (FCVS can help make this a little bit easier)
    • Health, TB, and vaccination history
  • Accreditation with payers (insurance companies)
  • Malpractice insurance
  • Billing services
  • Accessing computer systems
  • Parking
  • ID Badge
  • Changing health insurance
  • Finance and investment

Office Staff Will Make Your Life Much Easier

Make friends with the staff members that you meet because they will make your transition into practice a whole lot easier.

I have to give a big shout out to Kandi Marsh, one of the staff members here at MAWD Pathology where I started working.  She did a ton of leg work to make sure everything was filled out, signed, and sent.  If it wasn’t for her I would still be months away from becoming accredited and licensed.


Finding a place to live and moving there can be a huge pain.  If your job will allow it, see if you can postpone your start date to give you time to settled into a new place. Ask if there is a moving stipend. During the first month of my fellowship I had to wrestle with a terrible living situation that was very difficult to deal with. I didn’t want that to happen at the beginning of my job so I took more precautions and got suggestions from my group about where to live. I also got a recommendation from the group about a realtor I could work with and he ended up being really helpful.

Transition Business Cards

Bring a stack of transition business cards on your first couple days of work.  This is a unique idea I had that turned out to be helpful and fun.  If you bring cards from your old academic institution, odds are all the information is incorrect. You probably don’t have any new business cards from your new job though either.  Try making a simple business card with basic information about yourself that you can use to introduce yourself to people.

On my first couple days I brought a business card that wasn’t specific to any workplace (How to Make a Pathology Business Card Look Like a Glass Slide).  Every new person I met, whether it was a histologist, lab tech, IT person, chief medical office, staffer, or even people I already knew, I would introduce myself, give them my card, and let them know I was there to help if they needed anything.  You will be needing a lot of help at first but this helps even things out by letting people know you are there to help them as well.

New-in-Practice Committee Resources (CAP)

There are several helpful articles from the CAP New-in-Practice Committee that I found very helpful.  A couple articles are free and a few more behind a membership firewall.  If you like the first couple articles, consider maintaining or renewing your CAP membership.

I particularly liked this article from Nicole Riddle, MD, FCAP.  She gives a great list of Do’s and Don’ts that I’m trying to follow in my first few weeks of practice.

Still Don’t Feel Ready? That’s OK!

Even after doing everything right to get ready, you may still not feel prepared. That’s ok! There’s always going to be something you’ll need to get used to. Just don’t be afraid to ask questions.

I had dictated thousands of cases in residency and felt like a pro. The first day on the job I tried to use a new dictation system and it felt like I was right back in my first year of residency. I stumbled over every other word. It didn’t even matter because the transcriptionist came over to me and kindly let me know I had forgot to push the record button!

Are you New-in-Practice? What would you wish you had done before you started your first job? Residents and fellows: What worries you the most about starting that first job? Comment below!


Justin D. Richey, MD

Justin D. Richey, MD

Pathologist, MAWD Pathology Group

Rashna Meunier, MD

Rashna Meunier, MD

Pathologist, Glens Falls, NY