You did the coursework, finished the rotations, and passed the exams. Then somebody handed you a schedule full of actual patients, and things got real pretty quickly. Ivy clinicians share what they wish they had known when they were starting out.
There’s a funny thing about your first day as a clinician: you can spend years preparing for it and still feel completely unprepared once it arrives. You know the anatomy, the assessments, and the treatment approaches. You’ve completed clinical rotations, passed your boards, and probably spent a lot of time imagining what it would feel like to finally start practicing on your own.
Then the workday begins. There are schedules to manage, documentation to finish, insurance questions you may not have heard before, and patients who, very reasonably, don’t behave like case studies.
That was the focus of an episode of Clinically Speaking, where Ivy social media manager Bismarie Plasencia sat down with Alexis Del Palazzo, Brenna Munson, Krista Heffner, and Heather Ianuale to talk about what surprised them most early in their careers and what they wish someone had told them before Day 1.
The First Few Weeks Are Supposed to Feel New
For Brenna, one of those early lessons came when a child simply wasn’t interested in the activity she had planned. A transition that seemed straightforward on paper turned into a lesson in flexibility and figuring out what the child needed in the moment.
Krista remembers overthinking nearly everything at first. Alexis was surprised by something school couldn’t fully re-create: the emotional weight of caring for real people with real concerns, frustrations, and expectations.
That’s one of the biggest shifts from school to practice. Education gives you a strong clinical foundation, but experience teaches you how to use it when the person in front of you doesn’t fit neatly into the plan.
Sometimes that means changing course in the middle of a session. Sometimes it means asking someone else to talk through a case. Sometimes it simply means accepting that a difficult appointment was a difficult appointment, not proof that you picked the wrong profession.
Then There’s Everything Nobody Put on the Exam
School prepares clinicians to evaluate, treat, and think critically. The first job introduces the rest of the system around care: documentation, scheduling, billing, coding, insurance requirements, and all the practical details that make a clinic run.
Brenna joked that she came out of school knowing how to write a very good SOAP note, but the billing and insurance side of practice took more time to learn. Alexis remembered feeling similarly unprepared for coding and for documenting care in a way that clearly showed what changed and why it mattered. Krista pointed out that requirements can vary by payer, which adds another layer when you’re still learning the rhythm of the job.
Those skills come with practice. New clinicians get faster at documentation, more confident navigating the systems around patient care, and better at knowing what needs attention now versus what can wait. Good onboarding helps, but so does having experienced people nearby who are willing to answer questions without making you feel like you should already know everything.
That kind of support matters more than most people realize on Day 1.
Confidence Usually Grows with Other People Around You
Feeling uncertain doesn’t disappear the moment you stop being a new grad. Brenna said some of those doubts returned when she moved to another Ivy clinic, even though she was still doing work she knew well. Alexis described a similar feeling as she moved into new roles and leadership responsibilities. Krista remembered feeling like a beginner again when she treated her first patient after completing dry needling training.
That’s part of why mentorship matters at every stage of a career. The most reassuring thing isn’t always having the answer immediately. Sometimes it’s knowing there’s someone nearby who will talk through what you’re seeing, offer another perspective, or tell you they’ve been there too.
Brenna summed that up simply: “These are my teammates, and I can learn from them.”
That mindset is useful well beyond the first year. Clinical growth doesn’t happen in isolation. It happens through mentorship, feedback, continuing education, and the everyday conversations that take place between people who care about getting better at the work.
Documentation Gets Easier with Experience
Documentation is another area where the transition from school to practice can feel bigger than expected. In training, being thorough can sometimes mean writing more. In practice, clinicians learn that a good note is less about length and more about clarity.
The goal is to capture what happened, what changed, and what comes next in a way that is useful to the people who may need that information later.
The group also talked about tools like AI scribes and how technology can help reduce some of the administrative burden around documentation. Krista shared that she didn’t start using it right away, but once she became comfortable with it, she found it genuinely helpful.
The bigger point wasn’t that technology replaces clinical judgment. It was that the right tools can make some of the work around care easier, giving clinicians more room to focus on the part that requires them most.
Good Communication Takes Practice, Too
One of the quieter adjustments from school to practice is learning how to explain what you know in a way that makes sense to someone who hasn’t spent years studying it.
Krista remembered realizing that the language she used with other clinicians didn’t always land with patients. Alexis talked about wanting patients to understand why they were doing something, not just what came next in the treatment plan.
That gets easier with time. You learn when someone wants more detail, when they need the simple version, and when they need a little reassurance before anything else. You also learn that being clinically correct is only part of the job. If the person in front of you doesn’t understand what you’re saying, the explanation still needs work.
Relationships Are Part of the Care
Another theme that came through clearly was the importance of rapport.
Krista talked about getting to know patients beyond the diagnosis on the chart. Brenna described the same thing in pediatric care, where understanding what a child enjoys, what makes them comfortable, and what helps them engage can change the entire experience. Alexis framed it as meeting people where they are.
That sounds simple, but it’s easy to lose sight of when you’re new and focused on doing everything correctly. Sometimes the most useful thing a clinician can do is adjust the plan because the person in front of them needs something different that day.
Brenna put it well: “Rapport is part of your intervention.”
That idea fits the way we think about care across Ivy Health. Clinical expertise matters, but so does the connection that helps people feel understood, comfortable, and willing to keep showing up.
What We’d Tell Someone Heading Into Day 1
By the end of the conversation, the advice was practical: give yourself some grace, ask questions, trust the foundation you already have, and use the people around you.
Krista reminded new grads, “You know more than you think you do.” Heather added another point that’s easy to forget when you’re the newest person in the room: “Everyone has had a day one.”
That may be the most useful thing to remember. Nobody starts out knowing how every part of the job works. The confidence comes gradually, through experience, good mentors, mistakes you learn from, and enough time in the work to realize you’ve become the person someone else now comes to with a question.
That’s how clinicians grow, and it’s one of the ways strong teams get stronger.
Watch the full episode: Clinically Speaking: Day 1 in the Clinic: What We Wish We Knew as New Grads – https://youtu.be/o7gfA2wtcQM