Within the realm of the unknown, a physician’s first practice is full of uncertainties. Some of it might be addressed by the recruiter, some during onboarding and some by your mentor. The rest falls under the Dunning-Kruger effect: we don’t know what we don’t know.

To help improve your performance and reduce the learning curve, here is what physicians should know after medical training.

Your online presence will always be a target

In an attempt to hold individuals and institutions accountable for sometimes the slightest perception of harmful or insensitive behavior, everything you like, share, post or comment on will forever be scrutinized. As a result, you must diligently protect your online presence—and by default – your reputation. Making your social media accounts private won’t always protect you, because malicious, shady or jealous people within your network can betray you.

You might think it will be easier to just delete your online profile, but that would be a mistake. Social media is a great way to decompress, stay connected with friends and build your professional network. Instead, consider removing volatile individuals from your contacts list, explain the importance of respecting your online identity to the rest of your contacts, take an implicit bias course so you can better understand sensitive triggers and instruct friends not to tag you in vacation, party or social photos.

People use reviews extensively when making important decisions. You could have ten 5-star reviews and just one negative review, but that one review might make someone pause and consider another provider. Staying on top of the reviews that are being posted is critical for responding appropriately and initiating damage control.

Identify your personal and professional ethics, surround yourself with friends you can trust, and avoid liking or sharing content that could be considered biased in any way. Remember, bias isn’t just about race—but can also include culture, gender, weight, perceived intelligence and social standing.

You will get bad reviews

It can be frustrating to see an unfair, bad review. Not only can they ruin your day, but enough of them can cause you to question your interaction with patients and can do as much to tarnish your reputation as social media.

Additionally, depending on the portal used to post the negative review, your salary could be affected. In general, quality, honest patient surveys—even those that are negative—can help organizations improve patient care.

However, patient experience surveys are sometimes the basis for value-based reimbursement. Since 2012, Medicare reimbursement and bonuses have been calculated based on how facilities maintain basic care standards and obtain high patient satisfaction survey scores. Some insurance providers do the same. Because of this, hospitals can lose hundreds of thousands of dollars a year because of bad reviews.

Many sites allow you to respond to, dispute or even remove negative reviews, but they come with rules. Follow the rules. Anything else will likely backfire or get you banned. Responding in anger or sharing specific information about the patient’s case can also backfire.

One option is to conduct a mini survey of patients before they are discharged. Have a patient care advocate discuss their concerns. By doing this, unreasonable patients will get their chance to vent without affecting the hospital’s bottom line.

Reporters are friendly but are not your friend

This is worth repeating. Reporters are not your friend. Having said that, not all articles are hard news, and not all publications are associated with traditional media. With traditional mainstream publications such as The New York Times, The Wall Street Journal and others, including your local newspaper, everything you say and do is fair game. Meaning that if you respond to a friendly question after a couple of beers, your candor could end up in print.

Getting your name in the paper can be valuable but plan to do it strategically. Start by reaching out to healthcare industry publications, such as the AMA Journal, PracticeLink Magazine and Becker’s, that focus on supporting healthcare providers. Even so, remember to always be on your guard. If you’re having a conversation, be sure to say everything is off the record. If you’re being interviewed, ask that a copy of the interview be sent in advance. If the reporter says it’s against policy, either refuse the interview or have them email their questions. If you find yourself at a party with a reporter, and you think your behavior might come into question, designate someone to watch your back, in much the same way you have a designated driver.

Who you are now may soon not be enough

Now that you’re out of training, it’s reasonable if all you want to do is be the best doctor you can be, and perhaps get back to your home life as a parent, spouse or social butterfly. In a year or perhaps later down the line, however, your ambitions might shift, and you will start to want more. Maybe publish, volunteer, present at conferences, join a research project or teach. Of course, you can be a success at whatever you do, but how long it takes to do it and the impact you can make will come down to how well you start laying the groundwork now.

Start putting out feelers and building contacts. For instance, join a registry for speakers and podcast guests, take notes on how TedTalks and other presentations are structured and keep in touch with the dean at your former university. Also, reach out to reporters that have covered topics you’re interested in, and offer to be interviewed in the future. Reach out to publications like PracticeLink Magazine, that are within the healthcare industry, to write guest essays. Minimal-stress initiatives like these will help put your name out there, give you a track record to build expertise and help make it easier to branch off into more things when your ambitions take you there.

Your inner critic will have to be silenced

Introspection is good when it comes from a place of confidence. Harsh criticism, however, is very different from personal feedback. Thinking about how you could have handled a certain situation better is useful for improved patient care. Beating yourself up because you weren’t invited to lunch with the chief resident is unreasonably harsh. Listening to your inner critic can be distracting, provide undue stress and give you the wrong idea about yourself.

If you have a strong inner critic, shut it up. Take time for a bit of non-judgmental self-discovery. Claim your strengths, work on your weaknesses and take ownership of your personal power. When we know what we want, we are challenged to take it.

Your professional network will need to be nurtured

Your professional network from medical training, built of professors and doctors from your residency and fellowship are a great start, and it’s certainly important to stay in touch with them. But, your future will require a broader professional network across multiple channels and platforms. First is to bookmark anyone of note. It could be someone quoted in an article, or who wrote an essay, or whose name appeared as a guest speaker at a conference. 

Next, leverage your memberships to medical societies, fraternal organizations, alumnae groups and social media networks to make first contact: “Hi. I saw your quote,” “I liked your essay,” “I was impressed by your speech,” along with a very brief explanation of who you are and what you want. If you don’t want anything, all the better. Sometimes it’s enough to just say hello and to have their contact information.

When you are ready, they’ll be in your database. “Hi. I reached out to you last year. I’ve been asked to speak at the local university, and I wonder if you could offer some advice.”  Or “I will be at this summer’s medical conference and if you’re going to be there, I’d love to buy you a cup of coffee.”

The goal of professional networking is to foster relationships with others that are mutually beneficial to the careers of you and those in your network. As someone just out of training, you might think there’s not much you can offer. That’s ok. As you grow in your practice and excel in more things, people will start to reach out to you. The amount of goodwill you received from your seniors should be the amount of karma you extend to your juniors as they try to build their professional networks.