If you’re a resident or fellow, colleagues may tell you to start applying for jobs in your final year of training. That’s when most postings appear and organizations get serious about hiring. But if you ask a recent physician hire or a program director, you might be surprised to hear them recommend how early in that final year you should start.
"I remember being told six to twelve months [ahead of graduation] was the time to explore what’s out there," says Alexandra Ristow, M.D., a primary care physician in Tampa. "But given the constraints of residency, earlier is better."
"I always say earlier is better, but with the pandemic, even more so," agrees Vivian Hernandez-Trujillo, M.D., program director of the allergy and immunology fellowship at Nicklaus Children’s Hospital in Miami. "Normally, I’d say six to nine months would be OK, but now I say at least nine to twelve months out. Everything is just very fluid."
The earlier you start, the more prepared you’ll be to make an informed decision and do the research and preparation you need to choose your first job wisely.
Med school and residency are demanding. You might feel like you don’t have the extra bandwidth to think about your first job ahead of time. But if you take certain steps early on, it’ll make the active job search at the end of your training easier and help you build skills you’ll use throughout your career.
One important early consideration is where you want to live. Many physicians naturally locate near their residencies. "There’s good and bad about [this tendency]," says Gus Geraci, M.D., a family practice physician and health care consultant. "The good news is that you’ll know the area and you’ll know many physicians."
But he says the bad news is that, depending on your specialty, there might not be many opportunities to change employers later. This can be frustrating if your first job isn’t a good fit or you don’t like the area well enough to stay long-term.
If you land a residency in your preferred location, the job hunt is a little easier. But often, this isn’t possible. "It’s the match system. You open the envelope, and that’s where you’re going," says Ristow, acknowledging that residents often compromise on location to pursue a particular training program. But even if you can’t secure a residency in your ideal location, you should still think about your geographic preferences early on so you can start building the right connections to help you land a job down the road.
Expanding your network can be daunting for many professionals, not just physicians. It can also take a lot of time. But the sooner you start developing this skill, the easier it will be. Try to start in a low-key setting. For instance, you can meet likeminded people through social activities and learning opportunities. This makes it more comfortable to ask for help during your job hunt.
One great first step is getting involved with causes and organizations you care about. "I used to do a lot of interfaith work and held a lot of leadership positions in college," says Atena Asiaii, M.D., MPH, an OB/GYN with El Camino Medical Associates in Mountain View, California. She says exploring personal interests can also help physicians focus "on the diseases and patients you feel the most passionate about treating."
Specialty societies also help you make connections easily. Many offer free conference tracks as well as job fairs. These are all great opportunities to network and learn about practice options. You may also find opportunities to take on leadership roles, represent students or give a presentation.
"With the help of the AMSA [American Medical Student Association], I did my first poster as a med student," says Hernandez-Trujillo. "It’s never too early to start giving back," she adds. In fact, helping others is one of the most powerful ways to network, especially for physicians who are uncomfortable asking for help or putting their career goals first. Hernandez-Trujillo also points out that physicians who go on to specialty training may have the opportunity to join multiple societies and make new connections in each.
You can also get a head start on your CV. Once you’ve drafted the basic document, it’s a simpler matter to update it with new credentials and publications. If you don’t have a template, Hernandez-Trujillo suggests checking in with your program director, who probably has a good example for your specialty. PhysicianCV.com is another good place to start.
In addition to maintaining your CV, you can start tracking your procedures during residency. Future employers will need this documentation for hospital privileges, and it’s much easier to track as you go than to compile the information later.
Your specialty society may have an app you can use to track your procedures, according to Poonam Velagapudi, M.D., MS, FACC, an interventional cardiologist and associate program director of the cardiovascular medicine fellowship at University of Nebraska Medical Center. "But you can do it in a Google Doc if necessary," she adds.
Tracking your work accomplishments and productivity has another advantage. It can help you understand the economics of medicine. If billing and coding training is offered during residency, pursue it early on. It might be hard to add this to the demands of a busy residency, but trying to do it while juggling interviews and evaluating offers will be even harder.
Beyond the essentials of billing and coding, learn how benchmarks and productivity measurements work. This will help you compare compensation plans more accurately when you’re evaluating offers, according to Asiaii. She did several job searches in the few years after training, and she learned from each. One of those lessons? Ask about productivity expectations. A job that appears to pay more may actually pay less on an hourly basis.
Geraci points out there are books that can help you learn the basics of physician compensation. So can organizations like the MGMA. Plus, the practice management wings of specialty societies and medical associations often offer surveys, webinars and other tools.
Learning about the business side of medicine can also help you evaluate practice settings. For example, Ristow began learning about alternatives to the fee-for-service model from a senior resident who told her about value-based care practice groups. Without understanding billing and productivity terminology, it’s harder to compare practice models. Studying these earlier will enable you to learn at a manageable pace, so you can understand your options and narrow your search.
Additionally, your fellow residents, especially those ahead of you, and your program director can help you explore your practice priorities and options. There’s no downside to building these relationships as early as possible. After all, developing trusted relationships takes time.
"I met some of my mentors through ACAAI and AAAAI," says Hernandez-Trujillo. "They were able to help me to progress not just into my first career positions but also into leadership roles." She adds that it’s important for your mentors to know you personally. "They can say, ’I can see you fitting in here,’ or, ’I have a friend who’s hiring, and I want to recommend you.’"
Velagapudi adds that residents and fellows who need visas to work in the U.S. should research what practice settings are open to working with them. "Reach out to someone ahead of you. A senior fellow or colleague who has dealt with that can help," she says. Lead times for visa paperwork can be long, too - just another reason to start your job search early.
A year before your training ends, it’s time to get into the thick of the job search. Get going by creating online profiles and signing up for alerts.
It may feel a bit early, but you’re likely to see some applicable postings. Hernandez-Trujillo points out some organizations do want to make hiring decisions that far in advance. Plus, you’ll be able to put your research and networking to good use as you refine your preferences and priorities.
In the meantime, you should prepare to ace your interviews. Get some practice in through mock interviews with fellow students, residents or other colleagues. Don’t just prepare for the interviewers’ questions; think up some of your own to ask. After all, employers aren’t just evaluating you. You’re also evaluating them.
"My biggest takeaway from the job-hunting experience - both right out of residency and again a few years later - is that you need to approach it with the mindset of creating a partnership," Ristow says. "You won’t get an offer from every single job. It’s most important to get the job that fits you."
Because medical training is so competitive, Ristow believes many physicians are conditioned to be people pleasers. She warns, "If you go into an interview and come out saying ’I nailed it, they loved me,’ but don’t have info you need to decide whether job is right for you, you’ve failed."
She adds that while physicians might hesitate to ask about organizational culture and clinical philosophy, these questions are a sign of engagement and preparation. More important: If you don’t ask these questions and wind up in a position that doesn’t fit you, it’s a lose-lose for both you and the employer. Asiaii agrees, saying, "If they’re going to reject you for your curiosity about the job, it’s probably not the right one for you."
However, it’s still important to ask the right questions at the right time. "You don’t want to lead off with questions about compensation," explains Velagapudi. It’s best to start off with more general inquiries, then work toward specifics if and when both sides seem to think it’s a good fit.
If you’re searching in a smaller subspecialty or region, you might find you’re not seeing as many job postings or getting as many interviews as your peers. This isn’t cause for alarm or discouragement. You just may need to do more legwork.
"Call the local medical society in the area you’re targeting and tell them you’re looking for a job. You’ll either get, ’No,’ or you’ll get, ’You should talk to so and so. They’re looking,’" says Geraci. He points out that not all jobs are advertised, especially opportunities with smaller practices. If you’re hoping to work in that type of practice, don’t be surprised or discouraged when fewer jobs are posted. There may be other opportunities you can dig up by networking.
Hernandez-Trujillo echoes this advice about reaching out. She adds, "Even if someone’s not hiring now, they might be a few months later."
Plus, even if an organization or employer doesn’t know of any openings, they may be able to refer you to someone else who does. Be polite and thank everyone you speak with. That way, you can be sure you’re remembered positively if an opening arises.
If your efforts to drum up interest aren’t yielding many (or any) interviews, your target might be too narrow. "Make a list of your priorities," says Velagapudi. "There may be one or two that are really important for you. They are your soul. The others, you should be willing to compromise on."
Before you get too far into the interview process, be sure you’ve lined up reference letters. "You don’t want to have to give people a one-week deadline," Velagapudi adds. You should also be preparing to negotiate. Read up on the language of negotiating, and ask mentors and colleagues for advice.
As you get closer to follow-up interviews and offers, it’s time to make sure that all your questions are answered and that you’re armed to negotiate and evaluate offers. It’s a good idea to line up professionals who can help you review contracts.
"Have your contract reviewed by a health care attorney experienced with physician contracts - not a general business attorney," Geraci suggests. Some organizations may ask physician candidates to sign a preliminary document, such as a letter of intent, before moving ahead with a contract. Your health care attorney should review that, too.
Fellow and former residents who’ve already landed their first jobs may be able to refer you to a good lawyer. And since you can work remotely with most lawyers, Geraci says you should be able to find qualified advice, even if you’re searching in a remote area.
Spadework done earlier in residency to understand about compensation and productivity will serve you well now. But if you haven’t yet got a handle on these things, it’s time to dive in - or look for help from a consultant who specializes in physician contracts.
You can also start asking would-be employers more granular questions: How much of your compensation is based on productivity? How is productivity calculated? What factors might help or hinder you in meeting your productivity goals? What kind of support staff will you be working with? Will you have help with marketing to build your practice? Is there an existing panel of patients you’ll be seeing?
Asiaii recalls that one of her early jobs paid very well, but the productivity expectations were difficult to meet. When she was searching for her current job, she made sure to ask questions and clarify her employer’s expectations more clearly.
"I didn’t know what questions to ask at first. This time around, I wasn’t shy about it," she says. "I asked specific questions like, ’What if I can’t get my OR time?’ ’How many patients will I be expected to see in a day?’ and ’What happens if I don’t meet my benchmarks?’"
Don’t just ask about compensation though. Try to learn about the organizational culture of any prospective employer. For example, Asiaii says that as an OB/GYN, it was important for her to ask if any procedures were off-limits. And no matter what your specialty, you’ll want to understand scheduling and call duties.
Getting a clear picture of the practice culture also means talking to people working there, not just the ones in charge of hiring. Brooke Grant Jeffy, M.D., a dermatologist in the Phoenix area, wasn’t able to do this during the interview process for one of her first positions. "They flew me out to visit, but I was very sheltered from other physicians," she says. She now considers this a red flag and encourages younger physicians to speak to potential colleagues before accepting an offer.
Velagapudi adds, "Ideally you’ll be able to visit in person to talk with many people - not just physicians." She points out that staff members have a valuable perspective and can help you get a feel for the work environment.
Even if you do all your homework and ask all the right questions, it’s possible - perhaps even likely - that you’ll be looking for a new position a few years after your first. "Most of the people I trained with stayed in their initial practice about two years. You’re just lacking in preparation for how to look for a long-term position," says Jeffy. She adds that physicians looking for their second position are much better equipped to know what they want.
If you’re job-searching for the second time, remember what you’ve learned about knowing your preferences and asking specific questions. The good news is: You’re now much more knowledgeable about practice settings and fit.
Plus, your network will likely be larger the second time around, so it will be a more valuable asset in your search. For example, people you meet through work, such as drug and device reps, may have the inside scoop on practices that are hiring and what their atmospheres are like.
Social media can also be useful for physician job-seekers. "There are all these Facebook groups for physicians only now," Jeffy says. "I moved across the country and looked for another job without any contacts [with the help of people in these groups]. In smaller specialties, everyone kind of knows everyone."
She says private messages on Facebook and LinkedIn are invaluable, since you can reach out to ask colleagues questions without posting them publicly. Jeffy adds that, if possible, it’s helpful to track down physicians who’ve left the practice and ask them about their experiences.
Geraci says expert legal contract review during your first job hunt will make your second job hunt much easier. Some contracts include noncompete covenants that can restrict your ability to switch jobs in the same community or start a practice of your own. An attorney can help you amend these terms to make them less restrictive - or negotiate them out of your contract altogether.