The Job Hunt

 The ultimate goal that so many of us have worked so hard for for so many years next to our husbands. It can work out exactly as you had planned or hoped or it can go all kinds of crazy directions with so many unknowns. I think the latter is more likely these days.

Every specialty is different, private practice is different then academics, etc but this is our story. 

My husband was a resident in a very small, competitive, surgical sub-specialty in one of the top programs in the country. Two years of research were built into his program and he loved to teach so all along he was pretty sure he wanted to do academics. He is not a PhD so a lab of his own was not his goal but he did want to keep a hand in the research he had started during his research years. He wrote a few papers (probably not enough) and presented a few posters, he went to a conference every year or so and we both thought he had networked well. With the help of his mentor and chairman at his residency he landed a great fellowship and we moved for fellowship knowing that the job hunt needed to start soon. 

His fellowship mentor was great, very well connected and interested in the fact that his fellows got good jobs where they wanted doing what they wanted. This was key because his residency chairman and mentor were not any help in looking for “the job.” We were both very discouraged by this as well as the fact that there seemed to be so few jobs in his sub-specialty for the year he was finishing. Because there are so few in his area we learned that graduates tend to stay at their residency or fellowship institution and that was not an option for him at either location.

A few months into fellowship he got a call from a practice in his hometown. We had lived out of state ever since the beginning of medical school and because the one academic program in his hometown had been through a lot of turmoil we had been very honest with our family and friends that we didn’t think we would ever be back. When my husband got this call he was pessimistic that a private practice job is what he wanted, he has very little business sense and was not interested in the politics of a practice. His mentor told him, “don’t close a door until you know what is behind it” and I agreed so he agreed to at least go on the interview and see what they had to offer. In the mean time he was applying for every academic job he heard of but most were filled internally or the job was pulled because they decided they needed a different sub-specialty instead of his, of course we would find this all out later not at the time of application.

At this time he also started working with a well known and well respected recruiter in his specialty. Working with a recruiter was not of interest to either one of us because so many do not understand his specialty and his sub-specialty within it. However this recruiter is married to a physician in the field and is well respected by both the candidates and the hospitals/practices because of her knowledge. I watched their site religiously and when a job popped up that I thought was interesting I’d bring it to my husband’s attention, like many other things he just didn’t have time to monitor it. His hometown has a very unique identifier that recruiters tend to use, someone who isn’t from there wouldn’t know where it was but we always laughed when we saw a post with that description because we knew which city it was. 

A month or so after the first call from his hometown a job popped up on the recruiter site that was also in his hometown, I sent it to him and he inquired about it. They were looking for an experienced surgeon, someone to lead a new group, not someone straight out of training so we wrote it off and moved on. A few weeks later another posting showed up that looked to be from the same hospital but it was not looking for a leader role and this time they called my husband the day it was posted, I didn’t even have a chance to send it to him. This job was more interesting to him because the hospital had decided to employ their surgeons directly instead of contracting with a practice. There was a tie to a medical school though they didn’t have residents in his specialty and there were ties to a private research company that could offer opportunities in the future. 

So at the end of October he had two solid leads, neither of which he was crazy about, several academic jobs in the pipeline (or so we thought) and then the shoe dropped that his fellowship mentor was leaving to take the chairmanship at another program. In his specialty fellowships are a one-on-one mentorship, they are not required or accredited so they are truly for the experience only. We didn’t know what we were going to do, what was going to happen to his fellowship and if we were even going to have a job to go to in July.

Thanksgiving weekend we lied to our families to rearrange our travel plans so that he could interview in his home town without anyone knowing he was there because we had decided after being told where to go to med school (he got in last minute off of a waitlist) and then residency and fellowship we wanted this to be our decision for our family of 4. The interview at job #2 went great, he was dumbfounded and at the end of the 2nd day they handed him an offer and a contract draft. We were both shocked to say the least, he still had an interview with the other group in town and he wasn’t even sure this was the direction he wanted to go. Luckily there was no pressure for a quick answer and we discussed things over and over and over while he went ahead with the other interview a week later. He knew very quickly the first job in his hometown was not where he wanted to be and we kept going back to the pending contract, the pros and cons, the lack of academics and the proximity to family (was moving back after 13 years going to be hard? yes!).

We finally took the plunge and sent the contract to an attorney a few weeks into December. It was obvious that an academic job was not going to become an option. The job had become more and more intriguing, he would be the 3rd of 5 they were going to hire and because they would like for him to start the day after his contract was signed we could leave fellowship early and start early. We got the contract reviewed and signed just before Christmas and were very happy to tell our families at Christmas that we were coming home after 13 years. What had been a very stressful six months was finally over. It may not sound very stressful here but it was a daily stress, discussion and sometimes argument about whether we were doing enough, whether 13 years of hard work was for naught if he couldn’t find the job he wanted and whether we were making the right decisions for our family.

Because of the location of the new job and where we would live my husband had to have two state medical licenses plus his credentialing for the hospital. He and I spent an entire weekend filling out paperwork, requesting more paperwork and reading instructions until our eyes popped out. I have this great picture of he and I sitting at a table with piles of paper and our two laptops open, it looks like someone’s office had exploded. But the licenses came through, the credentialing went through without issue and on April 10th our moving truck pulled up in front of our fellowship rental. We enjoyed his three weeks off getting settled in our new home and then he started the “real” job.

We are now 14 1/2 months out of training and I won’t tell you the transition was easy, it wasn’t. Moving in mid-April when you have to take your kids out of their school and activities isn’t easy, being new to an area and neighborhood (the kids and I have never lived here) while everyone else is engrossed in year end activities, etc. was hard but just over a year later we are glad we have made the right decision for our family.

Now I wouldn’t say all of our decisions were the right ones, we love our house now but looking at 20+ houses in a long weekend and deciding when you’re spending what we spent was probably not the best idea. We didn’t want to move twice because of all of the moving we had done in the past and in hind sight that was stupid, we should have rented until we found the perfect house. But its growing on us, our kids are happy here and I finally feel like I’m hitting a groove with friends, groups, etc. My husband couldn’t be happier with his job, he’s very happy with the case mix he’s getting and is very happy with his partners. It hasn’t been all champagne and roses as they’ve already lost one partner who they are now trying to replace and his NP left for a better job for her family but those are bumps that anyone is going to have and we have discussed that we could see ourselves staying here forever. Who knows what is going to happen with healthcare going forward but for now we’re growing where we’re planted and hoping for the best.

Everyone’s hunt is different, everyone’s story is different, every specialty is different but hopefully this will help you go into it with your eyes open and know there are jobs, and sometimes where you least expect them.

Perspective from one year out:

Perspective from one year out:


Thinking back to residency a few of the things that seem to be universally dreamed about for the ‘it gets better’ phase is money, schedule, and stress. I certainly dreamed about the day when I no longer had to worry over paying the bills, more time together as a family, and being rid of the stress that comes with residency. Dreams of that final job, where DrH would be happy, content, respected, and well paid for working the ideal schedule for our family. Looking back, I realize now how little we knew navigating that murky water of starting the first job, what life would be like after training was complete, and how brutally similar that final job can be to residency. Life does get better after residency…in some ways.

Money and paying the bills every month is probably one of the biggest stressors in a resident’s family’s life. This is likely especially true of those families with only the resident income. We were a two-income family for 99.9% of residency, as I stayed in my job until a month before DrH finished residency. Even with two incomes and $100k+ joint income we still had hard months. We were working on paying off his student loans and providing for our son who was born during residency. Money after residency is definitely good. Thus far, at one year out, we have chosen to keep our large expenses very similar to what they were during residency. We have bought items for our home that have made life nicer but have not bought new cars or a new house, yet. We save heavily for retirement, our son’s education, pay heavily on student debt, and give ourselves a very generous monthly allowance for buying whatever suits our fancy at the time. We pay people to mow and weed treat our lawn. Our son is in a private, well regarded preschool just for the socialization. We have season passes to three theme parks, two out of state, and the local aquarium. We do almost monthly date nights, complete with a couples massage at our favorite spa and a fancy dinner, which the bill, many times, will run in excess of my monthly payment on my Mercedes.

Saying that the money is perfect would be an overstatement. DrH was 31 years old when he started working in his first job. He is young compared to many. We worry about the future and we worry about making a normal retirement age goal. The income level is almost necessary to catch up on just saving for the future. We feel incredibly behind already. However, we do not worry about how we are going to pay our electricity bill or buy groceries anymore. The money post residency is probably one of the biggest things that really does get better.


Not all things are as fun as the money post residency. DrH is an IM hospitalist so his schedule, admittedly, is better than many. He works an average of 16 days per month and most of his stints are in 6-9 day blocks. He is now facing working up to 4 nights per month. This is a recent change as the nocturnist in his group had a car accident that has put her out of working. It is not a welcome change, as he hates night shifts but we roll with it, as it is what it is, and there is nothing that we can really do about it except adjust. His schedule is only published some times a couple of weeks before the next month starts. It fuels the feeling that we are living month to month, just like in residency, moving from one rotation to another.


Working post residency can be frustratingly similar to in residency. Even though he does not have a residency program director he now has a medical director and assistant medical director. Time off, for my husband, has become his most valuable commodity post residency. One of the major perks of working as a hospitalist is longer stints of time off. This time off feels necessary, due to the long hours of working, simply to recover and to have some amount of family time. Calling in sick as a hospitalist places a burden immediately upon the others in your group who are off that day to come in and cover for you. It is not a job where your patients can be canceled for the day because you are unable to work. Post residency, in a position like this, there are still people who will call in sick. DrH has had to go in on his week off to cover for others. He is compensated financially for these days but the time off is lost. Weeks off have recently become a source of stress due to how frequently he had been contacted regarding work. He struggles to disconnect from work during his time off due to this possibility. This is an area that has been hard to adjust to and something that even a year out is an area of continued struggle. His time off is his time…unless something happens to prevent someone else from coming into work.


There are other stresses after residency as well. Residency had plenty of stresses associated with it. He was expected to complete a long list of procedures, attend journal club, do some minimal research, prep for and exceed expectations on in-service exams, read for a prepare for all of his rotations, know everything about his patients and his intern’s patients, maintain a consistent clinic schedule, teach interns, and endure morning report and M&M, to name a few. This list of demands on any medical resident is never ending. There is always more that each resident can do, even if not specifically required. Demands and stressors like this do not really cease post residency, however, they just take new forms. As a practicing attending he is now expected to bill as “effectively” as possible for each and every patient. This is a practice that is measured and reviewed monthly, pointing out to each physician publicly the amount they lost the group due to how they wrote their note. There is also a new and very real stress of practicing on your own medical license and malpractice insurance. The burden of practicing good medicine all while trying to not piss your patients off is a very thin line to walk sometimes. The reality of patient satisfaction surveys and threatened legal action bring a new level of stress to a new physician. Even though it may have been said in the heat of the moment, legal action has been threatened over something as stupid as him removing unnecessary narcotics from a patient’s med list, even though it was for valid reasons. When you stand in a room and have a patient or patient’s family say “if you do X, we are going to sue you” it jars the core of confidence which that physician practices. It is an unnerving statement and it has a profound impact, yet it is very much the society we now live in and the entitled attitude that the vast majority of patients have. This makes the REAL practice of medicine very different than the expectation that was there before medical school or even while in residency.


Just know that going from residency or fellowship to that grown up doctor job is in many ways great. It will offer more flexibility financially and allow your family room to breathe and ability to do things that you have been sacrificing during all of this training. In other ways, it can be worse. It can be painfully stressful, the schedule is almost neveras good as it sounds like it will be when you sign that contract, and the first job, statistically, will likely not be the last job, and that’s okay. Some things may be better and some may be worse. Nothing about finishing residency means that life will be easy from here out. Life is hard sometimes and it is up to you what you do with those lemons when they are handed to you.

Tasha

Survivor Stories: Your first post-training house

by Jennifer, Survivor in Pediatric Ophthalomology

You’ve pinched a penny within an inch of its life. You’ve clipped coupons. You’ve scrimped, sacrificed, and waited patiently. You’ve lived in cramped quarters, pinning ideas and filing away dreams for Someday. Finally your Dr. H has completed his training, and you’re ready to find your perfect house.

Whoa, Nelly. Don’t burst out of that starting gate quite yet. Let’s talk about your options.

Here’s our experience:

We completed training nine years ago and joined a private practice in an urban area. Armed with a file folder of ideas, we bought a custom house in a suburban master-planned community twenty minutes from his office. “Custom” in this instance means we chose a builder from a list of four that built homes in this neighborhood, then chose a house plan (which dozens of other homeowners also chose), then we went to a design center to select all the flooring, cabinetry, countertops, and upgrades—from a very short list. We ended up with a beautiful home in a great neighborhood with top-notch public schools.

During the next few years, we got to know the area, the neighborhoods, and the schools. We lived in our home and figured out what worked and what didn’t. We bought 2.5 acres and started paying it down. In the meantime, we went to an architect with a piece of scratch paper and a rough floorplan. He drew it out on his computer, made a few tweaks to optimize, and handed it back to us. Then we interviewed several custom builders, got their estimates, and picked one.

(Then the story gets really hairy...the city council wouldn’t approve our plans...economy tanked...builder went out of business...land developer took six months to build a freakin’ driveway...scrambled for a new builder...sold our house in one day...ended up in a poorly insulated rental home...I ran screaming for the hills…)

Finally (FINALLY), six years after starting his new job, we moved into our Forever Home. We like to say, “they’re going to wheel us out of this house.” The next time I move (according to my plans), it will be to the old folks’ home or the morgue. Either way, I don’t have to pack.

Your experience could be similar to mine or completely different, but whatever you decide, I would gently encourage you to NOT jump into your Forever House right away. I know it’s been a long time coming and you’re ready for more comfortable living space, but be patient. There are several reasons to wait.

1. Your Dr. H will very likely see a big increase in income after a few years. If you can hold on a little bit longer, you will be able to afford a little bit more.
2. If you are moving to a new area, you will want to live there for a little while before you commit to a neighborhood and a house. Getting involved in your community for a few years will teach you a lot about the people and the schools. There’s no way you can know everything you want to know by internet research alone.
3. You need a few years in an interim house to know what you really like and what you can do without. Our Forever House has many of the features of our first house—with improvements. For example, our first house had a great 9-foot island in the kitchen that was perfect for hosting big parties and gatherings. But there was only 3-4 feet between the island and the counters, which during big parties with lots of people made navigating the kitchen pretty difficult. So when we drew up plans for our Forever House, we kept the island and made sure we had 5 feet of space between the island and the counters. We made several adjustments like that when we were designing our home.
4. As much as we hate to think about it, the likelihood that your Dr. H will change practices after a few years is frighteningly high. It happens. You don’t want to invest in a really nice house and then have to sell it quickly.

If you can rent a home in an area you think you want to stay in—even better. Yes, you will have to move again, and if you’ve been married during medical school and training, the thought of packing and moving will curl your hair. But it will be worth the extra effort to be exactly where you want to be in the house that fits you best. (A good friend of ours even convinced his department to pay for their moving costs from their interim house to their big house. It’s possible!)

A doctor-in-training’s wife has delayed gratification down. We’ve made it an art form. We know how to wait, and we believe waiting will pay off. It seems grossly unfair to have to wait any longer, but trust me: it’s worth it.

What is your dream? And Survivors, please share your experiences, good and bad. What would you do the same? Differently?