Podcast Summary: The OB/GYN Resident Survival Guide

Episode #15: Lessons From My First Year as an OB/GYN Attending (and passing oral boards)
Host: Dr. KC Miller
Date: January 12, 2026

Episode Overview

In this reflective solo episode, Dr. KC Miller shares candid insights from her first year as an attending OB/GYN, fresh off passing the challenging ABOG Oral Boards. Her mission: to demystify the transition from residency to attending life, normalize common struggles, and encourage OB/GYN residents and new attendings during this phase of their journey. She covers the unexpected learning curve of new independence, finding one’s personal identity after residency, the exhaustive process of board certification, and the highly relatable new realities around physician income.

Key Discussion Points & Insights

1. The Challenge of Clinic as a New Attending

Realizations about Training & Competency
- Dr. Miller admits the transition is “a total whirlwind, mostly in a good way,” but the learning curve remains steep.
- Despite extensive residency exposure (“200 vaginal deliveries and 145 C-sections”), new attendings won’t have encountered the full spectrum of gynecologic issues ([02:00]).
Getting Comfortable With “I Don’t Know”
- Residency is insufficient to prepare for every problem.
- She describes regularly needing to say to patients, “I don’t know, but I’m going to work with you to figure out what’s going on.” ([02:53])
- Dr. Miller underscores the importance of collaborating with colleagues and ongoing research:
  
  “The learning never stops in this field and the more you do it, the easier it gets…” ([05:30])

2. Rediscovering Identity After Residency

Residency’s Toll on Personal Identity
- Dr. Miller shares her vulnerability:
  
  “Halfway through residency I had a bit of a quarter life crisis ... I didn’t know who I was anymore outside of work.” ([06:12])
- She describes emotional exhaustion and the surprising “anticlimax” after graduation.
Time and Patience Are Key
- “About three months after graduating, that mostly changed.”
- Emphasizes recovery from “sleep debt” and reconnecting with family and friends.
- Urges residents:
  
  “If you feel the way I did the summer after graduation, that’s OK. It’s not going to last forever. You can find yourself again. You just have to be patient with yourself.” ([10:18])

3. Preparing for Oral Boards: “Worse than the Exam Itself”

Procrastination and Unexpected Time Commitment
- The oral exam (Part 2 of ABOG) requires case lists for Obstetrics, Gynecology, and Office patients—an intensive process she underestimated.
- “I thought this would be plenty of time. But when I say I was cramming … I am not lying, this took me a couple of weeks spending hours a day…” ([13:02])
Advice for Residents
- Strongly recommends taking boards early:
  
  “This might be the smartest you’ll ever be.” ([15:48])
- Her regret: leaving the case list until the last minute—“Don’t make the same mistake I did.”
- Notes the case list prep was “way worse than the exam itself.”

4. The Financial Reality of Being an Attending

Positive Change: Financial Freedom
- Dr. Miller concedes,
  
  “Having money makes a big difference ... It is very motivating and exciting to look forward to when you’re stuck in the dredges of residency.” ([17:32])
- Enjoys being able to choose how and where to spend, though still mindful about financial decisions.
Surprise at Physician Taxation
- Unexpected downside:
  
  “Nothing can prepare you for the shock that comes when you jump tax brackets ... you still end up owing the government money.” ([18:26])
- Jokes about the misconception of always receiving a tax refund as a doctor.

5. Final Reflections and Encouragement

Reaffirmation of Career Choice
- “I love what I do and who I get to work with every day … I am able to have an amazing lifestyle ... I can choose how I practice.”
- Credits the flexibility and reward of OB/GYN practice.
Words of Hope for Residents and New Attendings
- Emphasizes that residency is called “Survival Guide” for a reason.
- “At least in my experience, I really think it is [worth it]. So keep chugging along, keep hanging in there.” ([21:20])

Notable Quotes & Memorable Moments

On Uncertainty:

“Sometimes the answer just has to be, ‘I don’t know, but I’m going to work with you to figure out what’s going on.’” – Dr. KC Miller ([02:53])
On Post-Residency Blues:

“All I could feel was tired. I was just so, so tired ... I thought I’d feel vibrant and vivacious and like my old pre-residency self. But all I could think about is how I should have hobbies and interests—but I just don’t.” ([08:24])
On Clinical Independence:

“You’re never going to see 100 to 200 of every different gynecologic disorder in residency.” ([03:15])
On Oral Board Preparation:

“When I say I was cramming to get all of my patients on the list … it was a huge pain. But the preparation was way worse than the exam itself.” ([13:07])
On Taxes:

“You become a doctor, and even though your taxes have been deducted from your paycheck all year, somehow you still end up owing the government money. It is crazy.” ([18:39])
On Hope for Residents:

“If you feel the way I did the summer after graduation, that’s okay ... You will heal.” ([10:19])

Timestamps for Key Segments

00:00 – Welcome, board certification update, and setting up the episode
02:00 – The learning curve in clinic as a new attending
06:12 – The loss of personal identity and adjusting to life post-residency
10:18 – Reassurance for those feeling burned out after graduation
13:02 – Oral Board exam logistics, case list crunch, and lessons learned
17:32 – Financial realities and unexpected tax challenges
21:20 – Final reflections, encouragement, and closing remarks

Episode Tone and Style

Throughout, Dr. Miller’s delivery is honest, reassuring, empathetic, and laced with relatable humor—a balance of vulnerability and practical advice. She validates listener anxieties, offers permission to be imperfect, and closes with an uplifting affirmation that the journey, though demanding, is ultimately rewarding.

For future episode suggestions, Dr. Miller invites emails at info@drkcmiller.com.

Transcript

A (0:00)

Welcome back to another episode of the OB GYN Resident Survival Guide. It has been six months since the last episode, and the reason it's been six months is because I needed to take some time off to prepare my case list, study for and then take the ABOG Specialty Certifying Exam, otherwise known as Oral Boards. And I'm happy to say that I passed the exam and am now considered a Fellow of the American College of Obstetricians and Gynecologists. So unless I move to a new country, I will never have to take another board exam in my life, which is an amazing feeling and I cannot wait for you guys to get here and to hopefully be able to help you reach this milestone one day. Given the momentous occasion, I thought that in this week's episode I would just share a few of the things that I've learned in my first year out as an Attending. So as a reminder, I graduated from residency in June of 2024. And. And so I've been practicing as an Attending for almost a year and a half. And let me tell you, the first year out as an Attending is a total whirlwind, mostly in a good way. The first thing I learned, honestly is that clinic as a new attending is challenging. And sometimes the answer just has to be, I don't know, but I'm going to work with you to figure out what's going on. I did a lot of clinic and residency, but I truly just don't think that the training you get in residency is enough to really get you to the point where you feel very, very comfortable with every possible obstetric and gynecologic problem out there. Which makes sense. I mean, when you think about it, you need 200 vaginal deliveries and 145C sections to be deemed competent enough to graduate. And by the time you reach those numbers, you do feel competent, because it takes that much exposure to truly feel confident managing those situations. The problem is, you're never going to see 100 to 200 of every different gynecologic disorder in residency. You might not even see a hundred cases of some of the most common problems. So as far as medical knowledge and experience goes, I feel like that was the one place where I felt like I had to catch up on this year, and I just had to get comfortable with being uncomfortable and being honest with my patients when I didn't know the answers to some of their questions and being okay with saying, you know, I'm not sure right now what is going on. This is what I'm going to start with, and I'm also going to consult with one of my colleagues or a few of my colleagues or do some research and then get back to you. And that part just takes extra time, which can make clinic more draining. But it's just, I think, an example of how the learning never stops in this field and the more you do it, the easier it gets and the less time you're spending doing that week after week. The second thing I learned this year sounds kind of cheesy, but it's that it is possible to, quote, unquote, find yourself again. About halfway through residency I had a bit of a quarter life crisis. Like I would cry from time to time about how I felt like I didn't know who I was anymore outside of work and how I had no hobbies and I wasn't interested in hobbies because I was too tired to have them. And I was so out of the loop culturally because I didn't have the time or energy to keep up with the news or social media trends, which I have to laugh at because of all the things to feel bad about, that last one is definitely not the one. And I spent all this time in residency building up the post graduation life in my mind as this time of freedom. And it was going to be the best time in my life. And it was an amazing time. Don't get me wrong, I was very, very excited. There is nothing that compares to the feeling of walking out of residency for the last time and going on vacation and just not having to be a resident anymore. But after my trip that summer, I just felt so deflated when I thought I was going to be riding on a high. All I could feel was tired. I was just so, so tired because residency was so exhausting and, and then that was really stressful because I just kept thinking, is this it? Am I just going to be tired and exhausted for the rest of my life? I thought I was going to feel vibrant and vivacious and like my old pre residency self. But all I could think about is how I should have hobbies and interests, but I just don't. I just want to be doing nothing all the time. There is a positive end to this, I promise. About three months after graduating that mostly changed and I realized that yes, I can feel like my true self again. I finally caught up on the sleep debt. I was catching up with neglected friends and family regularly. I remembered some of my old interests and developed new interests and goals and had things that excited me and it just took some time and I had to realize that of course it's going to take more than a few weeks to bounce back after four years of residency and working 80 hour plus weeks. And I just want anyone listening now, especially the PGY4s, to know that if you feel the way that I did the summer after graduation, that is okay. It's not going to last forever. You can find yourself again. You just have to be patient with yourself and make all the plans that you want to make, go on your vacations. It's still going to be amazing. But if you do have kind of that almost anticlimactic or almost sad feeling that I did, that's okay. You will heal. Okay. The third thing that I learned this year is that preparing for oral Boards takes a lot longer than one would expect. As a reminder, the ABOG OB GYN certification process has two parts. The written exam, which you take a few weeks after completing residency, and the oral exam, which you actually have up to eight years to take after completing residency. So the exam that I'm talking about is part two, the oral exam. And I did not have to take it as early as I did, but I'm really glad that I did. However, I just underestimated how long it was going to take me to get my case list done. So part of this exam involves creating three different case lists. One for obstetrics, one for gynecology, and one for office. And it's essentially a master list of every patient that you've delivered, every patient that you operated on, every patient you admitted to the hospital or even had significant involvement with in their care over the course of a 12 month period. The office list only has to have 40 patients, but they're subdivided into various categories depending on the problems addressed at the visit. So I started working on my list in October of 2024 and then I kind of stopped and left it to the end of June. Mind you, the submission date is August, so I thought this would be plenty of time. But when I say I was cramming to get all of my patients on the list in time for someone to review it and then make the edits for from the review in time to submit it, I am not lying like this took me a couple of weeks spending hours a day, so it was a huge pain. However, I will say that the preparation for that exam was way worse than the exam itself. So if you are a PGY4 and you're thinking about taking your boards the first year out as an Attending, no regrets, I recommend it. This might be the smartest you'll ever be. But don't make the same mistake that I did and leave it to the last minute. The last thing I learned sounds kind of silly and obvious, but I just want to bring it up to give you something to look forward to. Having money makes a big difference. Wanting to be rich, I would say, is not why most of us go into this field, at least I would hope. However, it is very motivating and exciting to look forward to when you're stuck in the dredges of residency. And while I still think frequently about money, and I try to be careful and intentional about how I spend my money, there's still no real stress around money anymore. I have enough to pay for my basic needs and then some. And it's really fun to be able to get to choose where I want to spend it and how and on who. I will say, though, that nothing can prepare you for the shock that comes when you jump tax brackets. Like, I just thought that everyone annually gets a tax return. Tax tax season is an exciting time. I'm going to get a thousand bucks or two thousand bucks in the mail in May or June. No, you become a doctor, and even though your taxes have been deducted from your paycheck all year, somehow you still end up owing the government money. It is crazy. And this is coming from someone who believes in taxes. Don't get me wrong, I think they're important. I am not angry about paying them. It just was more than I expected. All right, there's obviously a lot more that I learned throughout this year. However, those were some of the dominating ideas as I went through this transition. I'm still learning every day, but overall, it has been a fantastic time in my life. I love what I do and who I get to work with every day, especially the residents. I do feel like everything it took to get here was worth it because I am able to have an amazing lifestyle. There's a lot of flexibility in the way that I can choose to practice. And once the fog of sleep deprivation and stress of residency cleared, I was able to remember really why I went into this and why I like it so much. And that's what I want to leave you with today. This podcast is called the Residency Survival Guide for a Reason. I know a lot of you are really just trying to survive medical school and residency and are hoping that it'll all be worth it. And at least in my experience, I really think it is. So keep chugging along, keep hanging in there. And if there's any new attendings out there, listening to this as well. Maybe this will normalize some of your feelings that could be similar to mine. That is it for today. If you have any requests for episodes or topics for the podcast, please email me at info Dr. Casey miller.com the link is in the show notes and I will see you next week.