Lessons From My First Year as an OB/GYN Attending (And Passing Oral Boards)

Welcome back to the OB/GYN Resident Survival Guide. It has been six months since the last episode, and there’s a very good reason for that. I needed to take time off to prepare my case list, study for, and take the ABOG Specialty Certifying Exam—also known as oral boards. And I’m happy to share that I passed, which means I’m now officially a Fellow of the American College of Obstetricians and Gynecologists.

Unless I decide to move to a new country, I will never have to take another board exam again, and that is an incredible feeling! I truly cannot wait for you to get here too—and I hope that through this podcast, I can help you reach this milestone one day.

Because this felt like such a big moment, I wanted to use this episode to share some takeaways from my first year out as an attending. For context, I graduated residency in June of 2024, and I’ve been practicing independently for almost a year and a half now. And let me tell you—this first year out has been a whirlwind.

Lesson 1: Clinic as a new attending is challenging—and sometimes the answer is “I don’t know.”

The first thing I learned is that clinic as a new attending is genuinely hard. And sometimes, the most honest answer you can give a patient is: “I don’t know yet—but I’m going to work with you to figure it out.”

I did plenty of clinic in residency, but I truly don’t think residency training fully prepares you to feel confident with every possible OB/GYN problem out there—and that makes sense. Think about it: you need 200 vaginal deliveries and 145 Cesareans to be deemed competent. By the time you hit those numbers, you really do feel capable, because repetition builds confidence.

But the problem is… you’re never going to see 100 to 200 cases of every gynecologic condition in residency. Some conditions you might not even see 10 times, let alone enough to feel truly fluent in managing them. And this year, clinic was the main area where I felt like I had catching up to do.

So I had to get comfortable with being uncomfortable. I had to get comfortable being honest. Telling a patient, “I’m not completely sure yet what’s going on, but here’s what I’m thinking, here’s what we’re going to start with, and I’m also going to consult with colleagues or do additional research and follow up with you.”

That takes time. It makes clinic more draining. But it’s also a reminder that the learning never stops in this field. The more you practice, the easier it gets—and the less time you spend week after week trying to fill in gaps.

Lesson 2: You can find yourself again after residency.

This one sounds cheesy, but it’s true: it is possible to “find yourself” again.

Halfway through residency, I had a bit of a quarter-life crisis. I would cry from time to time because I felt like I didn’t know who I was anymore outside of work. I had no hobbies. I wasn’t interested in hobbies because I was too exhausted. I felt culturally out of the loop because I didn’t have the time or energy to keep up with anything outside of medicine.

And I spent so much time in residency building up post-graduation life in my mind as this magical era of freedom—like everything was going to feel light, and joyful, and exciting.

And don’t get me wrong: graduation was amazing. Nothing compares to walking out of residency for the last time, going on vacation, and realizing you’re no longer a resident.

But after that trip that summer, I felt… deflated. I thought I’d be riding a high, but all I could feel was tired. So tired. And it honestly freaked me out, because I kept thinking: Is this it? Am I going to feel exhausted forever?

I thought I’d feel vibrant, and vivacious, and like my old pre-residency self again—but instead I was just depleted. I wanted hobbies and interests… but I didn’t have them. I didn’t want them. I just wanted to do nothing.

But here’s the good news. About three months after graduation, something shifted. I finally started catching up on years of sleep debt. I started reconnecting with neglected friends and family. I remembered old interests and developed new goals. I started feeling excited about life again.

And I realized: it is unreasonable to expect your nervous system to bounce back after four years of chronic exhaustion in a few short weeks. Healing takes time.

So if any of you listening—especially the PGY4s—feel that sad, anticlimactic, “wait why don’t I feel amazing?” feeling after graduation… that’s okay. It’s normal. It won’t last forever. You will feel like yourself again.

Lesson 3: Preparing for oral boards takes longer than you think.

Another big lesson: oral boards prep takes a lot longer than you expect.

As a reminder, ABOG certification has two parts: the written exam (taken shortly after residency), and the oral exam (which you have up to eight years after residency to take). The exam I’m talking about here is part two: the oral boards.

I didn’t have to take it as early as I did, but I’m really glad that I did. That being said—I massively underestimated how long it would take to prepare my case list.

Part of this exam involves creating three case lists: one for obstetrics, one for gynecology, and one for office. This is essentially a master list of every delivery, every surgery, every admission, and every patient where you had significant involvement in their care over a 12-month period. The office list is smaller—40 patients—but those cases must be categorized based on the problems addressed.

I started working on my list in October 2024. Then… I stopped. And I left it until the end of June. The submission deadline is in August, so I truly thought I had plenty of time.

I did not.

When I say I was cramming, I mean I was spending hours every day for weeks trying to get my list completed, reviewed, revised, and submitted. It was painful.

But I will say this: the preparation was way worse than the exam itself. So if you’re a PGY4 thinking about taking oral boards your first year out—no regrets, I recommend it. It might be the smartest you’ll ever be! Just don’t do what I did. Don’t leave your case list until the last minute.

Lesson 4: Having money helps.

This last one sounds silly and obvious, but I want to say it anyway because it’s something you can look forward to.

Wanting to be rich isn’t why most of us go into this field—at least I hope not. But having financial stability makes an enormous difference. It’s motivating. It’s exciting.

There’s no real stress around money anymore. I can pay for basic needs easily, and it’s honestly fun to decide where I want to spend money, how, and on who.

That being said… nothing prepares you for the shock of jumping tax brackets. I truly believed that tax season meant everyone gets a return. Like, “Yay, free money!” No. You become a doctor and somehow—even though taxes have been deducted all year—you still owe more money.

I’m not angry about paying them, and trust me, I BELIEVE in paying them. It just caught me off guard, so this is your heads up!

Final thoughts

There’s obviously so much more I learned this year, but these were some of the biggest themes during this transition.

I’m still learning every day. But overall, this has been such a fantastic season of life. I love what I do, and I love who I get to work with—especially the residents. And I really do feel like everything it took to get here was worth it.

I’m able to have a lifestyle with flexibility. I can choose how I want to practice. And once the fog of sleep deprivation and the constant stress of residency finally cleared, I remembered why I went into this in the first place—and why I actually love it.

This podcast is called a “Survival Guide” for a reason. I know many of you are trying to survive medical school and residency, hoping it’ll all be worth it. And at least in my experience… it really is.

So keep going. Keep chugging along. And keep hanging in there.

If you have requests for future podcast topics, feel free to email me at info@drkcmiller.com (the link is in the show notes). And I’ll see you next week.