First, congratulations on graduating from medical school and getting matched! Residency may seem like a huge hurdle but becoming a resident is a major accomplishment. All your hard work and studying puts you one step closer to the long-awaited outcome – your first day as a practicing physician.
When to Start Looking
Since residency programs can last anywhere between three and seven years, we recommend you start your search based on your program completion date, not when you start. Reject the assumption that it’ll be a breeze to find your first job. Yes, physicians of all kinds are in demand across the country but, every opportunity out there may not be what you are looking for. It would be a shame to go through so much to be a physician and be stuck in a practice that leaves you struggling to make ends meet, is too stressful, or isn’t what you wanted to focus on.
Start your job search 12-18 months before your residency ends. There are three main reasons to start that early. The first, the hiring process can take as long as 10 months, or longer. Second, it can take three to five months to go through the licensing and credentialing process. Lastly, you might find a position that really excites you only to discover that you need extra training. Give yourself the best odds of finding and landing the perfect opportunity by starting your search early.
What to Look Out For
Surveys have shown that residents and fellows in their first positions have the highest turnover rate.1 This is most likely due to accepting a position that isn’t a great fit. That happens when you don’t spend enough time on your job search and accept a position out of necessity rather than choice. It can also happen if you don’t do the research on market conditions or on the practice. Another common reason for leaving a position is inequitable compensation due to failing to negotiate your compensation package or not fully understanding what is in your compensation package. An additional pitfall that catches residents is a feeling of being locked into a certain city or town. It is important to remember that there are opportunities across the country and that you can find the lifestyle you want in many cities, big or small.
Create a Priorities List
Sit down with your family or significant other to decide what is a must have and what is a nice to have. Start with a list of needs that have to be met personally and professionally. Your financial needs should be on this list. Do you want to work for a big organization or for a small one? Are you looking for the highest income straight out of residency or are you more focused on experience or contributing to the community? Is loan repayment required or optional? Once everything is listed, go through and prioritize the list. This will help you know where to start your search and how to choose one opportunity over another.
Location Makes a Difference
Don’t focus your job search on a particular location, focus on finding a practice setting that offers the best fit for your lifestyle. Casting a wide net opens up more opportunities and leads to a better work/life balance. Location can impact your compensation. Explore your options using our salary calculator. Location also affects what bonuses and benefits are available and your income potential. In addition to the impact on your salary, your location also has an effect on your cost of living. Don’t be misled by a slightly higher salary in a city with a vastly higher cost of living.
Patient Diversity and Experience
Do you want to become highly specialized or not? Your first practice can change your career path. If you choose to practice in a rural location, where access to advanced healthcare facilities is limited, you will likely see a more diverse mix of patients and needs.2 You might end up doing inpatient, outpatient, and emergency medicine. The type of practice setting you choose impacts the amount and quality of experience you get while treating patients. If you practice at a large facility with more experienced physicians, there is a chance you’ll be able to learn from your colleagues as you practice. If you choose a busy facility, you’ll have the potential to see more patients. That can be a benefit or a drawback. More patients generate more paperwork adding time doing administrative tasks. Think about what you want to get from your first position.
Preparing for Interviews
It is important to remember that the interview process may take months. The better prepared you are, the smoother the process can be. Make sure your resume/CV is formatted to be readable with no misspelled words or grammatical errors. Ask for letters of recommendation and speak with your colleagues about being a reference before scheduling any interviews.
Your interview will be the first time you get to see the facility and explore the community firsthand. You are there to see how well you connect with the administration and staff of the organization. Their goal is to determine if you will be a good cultural fit, while you should focus on seeing if you like the culture and your potential new co-workers. You should show up to your interview having already done some research, and you should have a good idea of what to expect. While you’re at the facility, take some time to assess the attitudes of everyone you encounter. Were you greeted warmly in the reception area? Stop and chat with physicians or residents that are in the coffee shop or cafeteria. Once you leave the facility, do some reconnaissance on the surrounding area. How is traffic? How far away is the closest grocery store? Take some time to check out the neighborhood you want to live in. Are there good restaurants in between the facility and that neighborhood? Ask everyone you meet about the community and surrounding area including what brought them to the area. Make sure that the facility and community checks all the boxes on your priority list. Once the interview is over, stay in contact with your interviewers. Express your interest in joining their team and thank them for taking the time to speak with you.
Reviewing the Offer Letter
Carefully examine all offer letters and preliminary contracts you receive. Offers often have deadlines, and you don’t want to miss out on a great opportunity because you didn’t read the fine print. If you plan to have a lawyer review your offer, make arrangements for that beforehand and make sure your lawyer commits to a reasonable time frame. Negotiate any items in the offer you are dissatisfied with or unsure of. If something is missing, ask about it. Communication is key at this stage, so never shy away from asking a question or negotiating something you require.
There are many types of compensation models used in healthcare today. Compensation models impact your income potential and your tax burden. It is important for you to understand not only how much, but also how you will be paid. Salary is the simplest and can seem like the best option for new physicians. The downsides are that you may not be rewarded for outstanding performance or cost-saving practices. You are usually contracted to achieve a defined level of productivity and/or quality to earn your salary. We have detailed what you should know about physician compensation here.
Questions to Ask About Compensation
To gain an understanding of your compensation, we have compiled a list of questions that you can ask during the hiring process.
- What is my guaranteed base salary?
- How long is the guarantee?
- What type of production model is used in addition to my base salary?
- What is my earning potential based on worst- and best-case scenarios?
- What are other physicians at the practice earning?
- What is the wRVU threshold?
- What are the dollars paid per wRVU?
- What is the payor mix?
- What other incentives, bonuses, and benefits are there that contribute to my total compensation?
- Are there any quality incentives and how are they measured?
Before You Accept
Go over your priorities list again. Breaking a contract can be difficult, and you may be forced to continue working in a situation where you aren’t fulfilled. You might find that it’s too expensive to break your contract. Some malpractice insurances have an expensive “tail,” plus there may be moving expenses, signing bonuses, or other monetary advances that require payback. If you have family considerations, think about the challenges of finding new schools and new extra-curricular activities, etc. The bottom line is you want to be comfortable with all aspects of your contract before you accept, to avoid dealing with an early exit.
Licensing and Credentialing
You did it! You accepted your first job as a physician. The licensing and credentialing process is the last step that you must complete before you start practicing. Don’t let your start date slip due to delays in acquiring your license. The licensing process varies from state to state and can take months. Ask questions to be clear about what is expectations. Stay on top of any paperwork or correspondence from the licensing board. Pay attention to all deadlines and be proactive, so you don’t miss anything.
Resident to Physician
The transition from resident to physician is time-consuming and without proper attention, may result in an unsatisfactory first practice experience. By following this guide, you can have a great first experience and a long and fulfilling career. In summary:
- Start looking 12 to 18 months before your residency program ends.
- Create a priorities list to make sure your first position is a good fit for you, your career, and for your family.
- Don’t be locked into a specific location, explore where the best opportunity is.
- Prepare for your interview and use your on-site interview to evaluate the facility and community.
- Review your offer letter carefully to make sure you understand your compensation. If you have any questions, be sure to ask.
- Allow ample time to get your licensing and credentialing.
- If you need help with any step of the process, a recruitment firm can be a great asset.
1 “First Practice Survey” Jackson & Coker, 2012. http://www.jacksoncoker.com/physician-career-resources/newsletters/articles-surveys/images/FirstPractice.pdf
2 “Rural Practice, Keeping Physicians In” AAFP. https://www.aafp.org/about/policies/all/rural-practice-paper.html