If you could go back in time and talk to your younger self, chances are you’d have advice and encouragement to share. Perhaps you’d set your mind at ease about med school applications, share tips on financing or reassure yourself about your fortitude to weather residency. Similarly, it can be helpful to imagine your future self may also have some encouraging thoughts to share with the current you. Maybe you’d tell yourself how to handle job applications or identify your priorities—or maybe you’d just thank yourself for all the work you’re putting in now. Below is information about what every resident should know before signing their first physician contract.

For better or worse, we still don’t have a way to consult our future selves on life decisions, but we do have the next best thing: advice and wisdom from those who have gone before us. 

Lesson 1: Recognize your value

A common experience among physicians navigating their first job searches is the mental shift from being the chosen to being the chooser. When you’re applying for med school, hoping to match into residency or even competing for fellowships, you must largely depend on the decision making of others whose opportunities are valuable to you. When you’re applying for practice opportunities, however, you’re the one offering value to employers, so a mindset shift is in order. 

“I wasn’t necessarily prepared for the shift from interviewing for residency, medical school, fellowship to interviewing for a job. … It was a shift in mentality that took a little bit of time to adjust to,” says Adina Schwartz, MD, a reproductive endocrinologist with Reproductive Medicine Associates (RMA) in Somerset, New Jersey. “All along that path of training, part of you feels like you have to fit the mold of what they’re looking for, that you have to sell yourself. …But when you’re interviewing for a job, the shift is now that you are the one offering something of value. You have a lot more power in terms of advocating for exactly what you’re looking for.” 

If you don’t know your own value, it’s hard to accurately assess how much you can expect from a position and employer. Online tools like the Resolve compensation data on PracticeLink.com can help you understand your market value, which will be based on your specialty, location and experience level.

There’s also your value as a person, which is surprisingly easy to lose sight of during training. Bringing it back to the forefront of your mind during the job search can help you assert your needs and expectations, thereby protecting your health and work/life balance and also keeping burnout at bay.

“I, during residency, actually had a large brain tumor that had to be removed, and that experience really was what woke me up to taking care of myself, wanting to prioritize work/life balance,” says Utah-based anesthesiologist Dawn Baker, MD, author of Lean Out: A Professional Woman’s Guide to Finding Authentic Work-Life Balance.

“…I got what I call ‘stuck on the treadmill of achievement,’ which is very easy for residents to do,” says Baker. “Once they are finished with residency, they stay in that mode very often. …But [my] health scare woke me up to realizing that I need to reprioritize myself and go back to my original vision. And so I took this generalist position straight out of the anesthesia residency.” 

Remaining stuck on that treadmill of achievement—especially after residency—can lead you toward a career that’s not actually in line with your original vision for your life. Recognizing your value as a provider and as a person will help you prioritize yourself and identify the role truly a fit for you. 

Lesson 2: Identify what you’re looking for

Another universal lesson from the job search is the importance of knowing what you’re looking for. What matters to you in a practice? It could be the type of organization, location, schedule, opportunity for partnership or leadership, compensation, culture or a combination of factors. Not everything can be your highest priority, but identifying your non-negotiables will provide guidance and clarity during every step of your search. 

“The main things I was looking for in a practice were patient care—so making sure that I was going to be able to provide my patients with the best care possible—and support,” says Schwartz. “What is the support staff? Are there nurses? Are there nurse practitioners? Is there admin? Is there a financial coordinator? Those are all things that not only make your life easier on a day-to-day basis but also make a really big difference in terms of patient experience.” 

One key consideration to help guide your search is to envision your ideal practice setting, whether it be a private practice, an employed position within a health system, an academic role or a hybrid. Each of these options have additional factors to weigh and prioritize. 

“The considerations are somewhat different” for different types of practices, says Stanford, California-based pediatric anesthesiologist Greg Hammer, MD, author of GAIN Without Pain: The Happiness Handbook for Health Care Professionals. 

If you’re evaluating private practice opportunities, for instance, he advises considering buy-in, case distribution, compensation, equity, predictability of the schedule, supervisory responsibilities, support and the potential for add-on cases. If you’re leaning toward academics, he also suggests you pay special attention to transparency around pay and predictability of hours.

Of course, don’t forget to consider what you’re looking for outside work hours, too. Maybe you’re interested in strong school districts, a specific climate, proximity to family or a recreational pickleball league. 

“You really need to be honest about what your values are and what you want because it’s going to be different for everyone,” says Baker. “Where do you want to be living? What kind of things do you want to be doing when you’re not working? All that stuff matters, and people forget it in residency.”  

Lesson 3: Learn about the business of medical practice

Your job search may also reveal things you never learned about the industry of healthcare, but wish you had. 

“There’s no Business 101 in medical school. We go through extensive medical training, and then we’re expected to leave training and join a business and all of a sudden understand how business works,” says Schwartz.

Doing what you can to learn about the business side of medicine before your interviews will help the “business speak” seem less foreign.

Schwartz found colleagues’ expertise to be the best resource for getting up to speed on the business of medicine, especially as it pertained to the approaches of different types of organizations.

“A big part of [learning] was talking with colleagues, residents or fellows who graduated a few years before I did and had just gone through the process. They were really an incredible wealth of knowledge and were up-to-date on what the different kind of business approaches may be for the different practices,” she says. 

Don’t expect yourself to understand everything, however. It’s OK to ask questions in your interviews and site visits to get further clarification, and you should fully anticipate continuing business ed will happen on the job.

The logistics of running a medical practice may also have been largely unaddressed in your training, but how smoothly the practice runs will undoubtedly contribute to your day-to-day job satisfaction and should therefore be considered when you’re evaluating options. In fact, as a former member of Stanford’s WellMD initiative, which studied burnout, Hammer found practice inefficiency to be one of the main burnout contributors. 

“This is something that I would ask if I were interviewing for a job,” says Hammer. “‘Do you have trouble keeping enough people to clean the rooms in between cases?’ Because if you’re doing four or five cases in a day, and the turnover time in between cases is 15 minutes longer than it should be because you don’t have enough staff or your stocking practices are inefficient…that adds up to an hour to an hour and a half later each day that you’re staying. You miss dinner with your family and your kids, piano recitals and so on.” 

Lesson 4: Require clarity—and be suspicious in its absence 

Another lesson not to learn the hard way: If you hear anything questionable or vague in your interactions with an employer, don’t just assume you’ll understand later. Inquire further to see whether a practice will sufficiently explain all key aspects of their compensation model, team structure, productivity expectations and beyond. As it turns out, vagueness itself can be a major red flag. 

“My first group that I interviewed with, I thought it went well. Everything on paper sounded great,” says Schwartz. “But then I started asking some questions, and I wasn’t getting clear answers. [At] what location was I going to be working? What would the schedule look like? Who would be in the office with me? What support staff would I get? It became kind of a gray zone. It was clear that they were kind of hedging questions.” 

The reasons for the lack of transparency are myriad. Maybe the left hand isn’t talking to the right hand within the organization. Maybe the need is so great that there are unrealistic expectations about what one provider can cover. Maybe the compensation model is just plain confusing—or unfair. 

“I think the recipe for unhappiness is when the person next door is working not as hard and getting paid more, and nobody really knows because there’s a lot of special deals,” says Hammer. 

“When I looked at other jobs, they were less highly evolved. …For example, transparency: how you get paid for your time, how the schedule is distributed, who stays late. Do you have a clinical commitment? And what happens if you work over your clinical commitment?” says Hammer. “These things were not really well worked out. At least I didn’t get a lot of straight answers. [Whereas] at Stanford, everyone’s on the same salary grid; people get the same reduction in clinical commitment for salary support from grants. It’s very transparent. And I just think that’s extremely important.” 

As in Hammer’s experience, the lack of transparency within one organization may make the transparency of another more apparent—and appealing. This was also the case for Schwartz, who gained confidence about the RMA opportunity thanks to the clear answers they consistently provided. 

“RMA was very upfront [about] any question I asked. ‘This is what your salary will be. This is how the bonus pays. This is what your schedule will look like. Here are some example schedules of some other providers,’” says Schwartz. “They clearly did not want to hide anything. They wanted me to have a very clear understanding of what they were offering. And that, to me, made a very big difference.” 

Lesson 5: Don’t just sign the first contract you see

By the time you receive your first offer, you may feel like signing a contract immediately and calling it a day. Resist the temptation and give yourself time to determine whether the situation is the right fit for you.

“It is very, very easy to get swept up in having multiple practices and people approach you and flatter you and offer you huge contracts with salaries that seem astronomical compared to what you’re being paid as someone in training,” says Schwartz. “And it’s very tempting to just sign, [to] be like, ‘This is 10 times better than what I’m making right now. It has to be better than the lifestyle I’m living.’” 

Signing right away closes the door on all other opportunities, one of which might actually be better. “You don’t have to commit to them right away,” says Schwartz. “They know you may be interviewing at more than one place. It’s OK to say, ‘I’m interested. Let’s touch base in X amount of time.’ And in the meantime, you’ve now interviewed at two or three other places, and now you have a better feel for what the different options are and what you feel like is the best fit.” 

Even when you’ve evaluated multiple options and are ready to commit, enlist an experienced health care or contract lawyer to vet the document first.

“There may be some underlying things thrown into the contract that you may not catch,” says Schwartz, who worked with a lawyer specifically focused on reproductive endocrinology contracts. 

“The first time I was sent a contract, I sent it to him. He helped me pinpoint things that maybe I could try to negotiate. So he didn’t speak on my behalf to the company, but he helped me make bullet points of things that I could try to negotiate,” she says. “And we kind of went back and forth that way, and only once he and I agreed that the contract included everything or didn’t include things that I didn’t want, then I actually went ahead and signed.” 

And, of course, if the contract never gets to an acceptable point or the role simply isn’t the right fit, say no and keep looking. 

“After you’re done with residency, no one’s grading you,” says Baker. “But people are still in that mode of, ‘What are they going to think if I say no to this role, or if I just don’t want to have that extra shift, or I don’t want to do that extra responsibility?” 

Taking on a responsibility or even a whole job simply because others want you to is a fast track to burnout and resentment. For this reason, only sign a contract you—and your lawyer—actually feel good about.  

Lesson 6: Take care of yourself in the process

Last but not least, remember to take care of yourself throughout the job-search process. It’s likely your medical training has required you to put your own needs on the back burner, and adding a job search to the mix can contribute to burnout if it’s creating unmanaged anxiety.

“Having a mindfulness practice really becomes essential,” says Hammer. “Most of the time, anxiety is worry about what’s coming next. …So having a practice where you can bring your attention to the present moment—that’s really the definition of mindfulness—is so vital. It’s vital to our health, it’s vital to our happiness, it’s vital to diminish the incidence of burnout.” 

For time-strapped residents, he advises simply setting your alarm three minutes early for a brief bout of deep breathing and a self-guided tour of the GAIN elements: gratitude, acceptance, intention and non-judgment. 

Baker, too, advises prioritizing time for solitude and mindfulness, even while acknowledging just how hard it is to make time. 

“Even if it’s like the one day a week that they have off and they spend an hour by themselves, just doing nothing,” Baker says. “It sounds like it wouldn’t matter, but it does matter. …It clears things up in your head.”

As she points out, mindful time may eventually end up providing the clarity you need to make a confident decision at the end of your job search—and to step out onto your unique career path.  

“You have permission now to do things however you want,” Baker says. “You can design your career path the way that you want it to look. You are in charge now.” 

By prioritizing your value and your needs, requiring clarity from employers and committing only to signing a strong contract, you’re setting yourself up for a successful search and a promising career ahead. •