When You Finally Get to Pick — Choosing Your First Job out of Training

Career Resources articles posted on NEJM CareerCenter are produced by freelance health care writers as an advertising service of the publishing division of the Massachusetts Medical Society and should not be construed as coming from the New England Journal of Medicine, nor do they represent the views of the New England Journal of Medicine or the Massachusetts Medical Society.

By Nisha Mehta, MD, a physician leader whose work focuses on physician empowerment, community building, and career longevity in medicine  

Do you remember checking off the “pre-med” box in college? For many of us, that decision set us on a trajectory for the next decade or more — what classes to take, exams to study for, and rotations to do. Sure, we had some decisions along the way, such as choice of specialty, fellowship, and medical school and training programs, but for the most part, somebody told us where and when to show up, and what to do, and we did so.

As you approach the end of training, there’s a different decision that in many ways is much more complicated. Now you’ve got to figure out what that life you’ve been working so hard for actually looks like. Do you want to be an academic physician, a physician employed by an organization, in private practice, or go out on your own? Do you want to practice full time or part time, and if part time, what does that look like? Do you want to take call or not? What complexity of patients do you want to see? Who do you want your colleagues to be?

For the first time in your adult life, you get to decide what everyday looks like, and for many early career physicians, on any given day, depending on who you speak to, you could be persuaded into a lot of decisions.

This is where it’s really important to take a step back, and ask yourself what it is that you really want. It’s also time to brush away all the answers that you “should” give, which you’ve carefully honed over the years to reflect preconceived notions about what being a doctor looks like. You really don’t have to fit a stereotype anymore. If you want to work two days a week from 9–2, chances are, if you try hard enough and are flexible enough, you can make that happen.

Here’s my advice. First, take some time to list all of your dealbreakers. This goes in both directions in terms of things that you need to be happy and things that will actively make you unhappy. If you know that any job that requires you to take your vacation in one week blocks instead of having the ability to take individual days will detract from your overall happiness, put it on there. Then start listing qualities in the ideal situation. Be brutally honest with yourself about things: how much money you want to earn, where you want to live, and what kind of hours you want. If your ideal job has a true lunch hour where you can eat or exercise, put that down on the list. If your ideal job requires partners that regularly have journal club and go over cases together, put that down. This isn’t to say you will find a job that has every single thing you want, but it helps to have objective criteria to look at when evaluating options. This way, you don’t get swayed when a job offers you twice what you had listed as the amount of money you need, but is wrong for you in every other way.

Once you have your list ready, try and talk to people who have similar jobs. This can be hard for a lot of trainees, because you may not have a lot of exposure to physicians outside of your academic institution. Reach out to your alumni networks from medical school and residency, online physician communities, medical societies, or elsewhere to see what pros and cons they may point out that you hadn’t thought of. While you have their attention, ask them if they know of any jobs that meet those criteria or places to start looking, and ask them for input about jobs that you may have come across. Often times, someone will have inside information about a particular organization or group that may positively or negatively influence whether you want to take a job.

Of course, your final step is how you actually feel after you’ve interviewed at a job.

As straightforward as this may sound, most graduating trainees don’t take the time to go through this process, and it’s probably a big contributor to why job turnover is so high in the first few years into practice. Many people jump on job offers for the wrong reasons - the job is prestigious, recommended to them by a mentor, it’s in the town they’ve always pictured themselves living in but not the right practice setting, or simply because they’re afraid that they won’t find another job. Although some practicalities will always factor into your job search, don’t start from that point. Start with that list you put together above, and it’ll give you criteria to judge each opportunity that comes your way, and hopefully land that job that’s right for you. While no job is perfect, making sure that your major goals are fulfilled by it will go a long way towards both personal and professional happiness.

Back to listing