A Letter to the Residents

Hey there 👋🏻

Yes, you — Residents. This issue is dedicated to you.

This is the week many of you start your new chapter as a resident. You worked so hard to get to where you are: the research poster you did in P2, the volunteer hours, part-timing in a pharmacy after hours, being board members of a school club, and the GPA.

I was once a PGY1 myself. And I thought being a resident meant you do a harder version of whatever rotation you signed up for, you get more grilling, you toughen up for a year, and somehow, magically, you become competent.

And boy, I got that all wrong. I got “needs improvement” in so many rotations. My confidence was wiped halfway through the year. I was a mess. It wasn’t until the last quarter of residency that I finally understood what residency actually entailed. I wish somebody had told me some hard truths about residency so I could have had my mindset right from the get-go.

So here we are. If I could redo PGY1, here are 5 hard truths I wish I’d heard on day 0.

1. Nobody cares about your GPA anymore. Learn to get the job done.

I was that typical student with a 3.8 GPA thinking I could do everything beautifully. But here’s a reality check:

Being a good exam taker isn’t the same as being clinically smart.

I really can’t think of the last time somebody asked me what GPA I got in school. The questions I get at work are:

“How do you convert this opioid to another?” “Can you give me recommendations for this type of pain?” “Can you review the pain regimen for me?”

They’re technical. They’re about getting the patient or clinician from point A to point B. People care about how you solve their problems, so learn how to do the job, and don’t dwell on past triumphs.

2. You’ll value this opportunity more if you see it as an investment.

I hear both sides of the argument:

😈 Residency is a pay cut.

👼🏻 Residency is a once in a lifetime opportunity.

I’m not going to sugarcoat it. You’ll be able to cover your day-to-day expenses as a resident, but you probably won’t be buying Gucci shoes or eating out three times a week without stretching your wallet. That’s the amount of money you’ll make for the next year.

But perception is everything. If you think of this year as an investment, you’ll value every rotation as a chance to level up your skills — skills that would otherwise take months, if not years, to learn. Time is money. You’re choosing to invest in yourself this year so you can get further and faster than anyone else.

3. Residency is a year-long job interview.

If you don’t know it already, everyone is watching you — your peers, your colleagues, the physicians you round with, the nurses, everyone. And whether you like it or not, if a job opens up at your facility at the end of the year, you’ll be competing with your co-residents or other colleagues. It’s brutal. But don’t forget: you competed with other P4s to get the residency spot you have today.

So if you reverse-engineer the process, you should really be asking yourself today:

“What do I need to do this year so I’ll be a desirable candidate when I finish?”

Once you see that goal, you’ll have more clarity on how to approach the year.

4. Build your own system.

Five years from now, practice will likely change. New meds come out, guidelines get updated. You’ll be forced to learn new things. When suzetrigine, a new non opioid pain medication, came out, I had to learn it from scratch just like everyone else.

So now is the time to focus on building systems for learning. Pharmacy school only gives you enough information to pass exams, but there are so many nuances in all the disease states you’ll be managing this year. Whether you start with a review article, glance through UpToDate, or dive into the pharmacology of a drug — you need a system you can carry forward.

Learning efficiently is a skill. Start honing that skill now.

5. Take the time off.

Halfway into PGY1, I was so burned out. I thought powering through every day, reading a few articles at night, and studying more on weekends was the way to go. I can tell you now:

It doesn’t work. I felt like a zombie. I could hardly retain anything. That defeated the whole purpose of doing a residency, because I couldn’t function when I didn’t take care of myself.

Give yourself grace. Take time off when you need it. Your body will thank you for it.

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As I’m typing this letter, I have a lot of flashback of my PGY1 and 2 moments. I’m really fortunate to have really great mentors who saw my potential as I navigated the journey.

And I know it sounds really cliché to end this letter this way—

Residency really is just one year out of so many in your career.

I'll see you next time.

SP