Five mistakes I made choosing my first job

We all have either experienced the fears of starting our first job or will eventually do so at some point in our careers.  It only happens once for everyone.  Those of us who are in the market for a job change will end up reliving some of the challenges in job hunting—hopefully we all have learned from our past mistakes. As I am advising upcoming graduates during their job hunt, I have decided to collate some of the mistakes I experienced when I was seeking out my first job:

Not understanding the options for academic medicine

Not all academic doctor jobs are created equally.  Medical graduates really only experience one or two academic scenarios from their training.  What you might not like about your own experience of academic medicine may not necessarily be reality in all cases.  Not all academic doctors conduct research.  Not all academic doctors actually teach, believe it or not! How one’s compensation in the academic world also isn’t necessarily tied to academic productivity or clinical productivity. In fact, there are plenty of academic jobs that essentially function identical to that of private practice. 

If your attending always seems to be jet setting across the world giving lectures and attending meetings in nice places, it doesn’t mean that your life in the same setting would pan out similarly.  You might not necessarily realize the sacrifices that they make to have that sort of lifestyle.  

Not knowing what I could ask for

Nearly everything is negotiable. Period.  The caveat is that you have to realize what authority your potential employer actually has in negotiations.  If you are negotiating with a small medical practice, it is likely that anything and everything is negotiable, even a stipend for a nanny! If you are in talks with a large HMO company, it is possible that the department head may have less leverage than you realize no matter how much they want to recruit you.  Having a relative sense of what a potential employer can control will give you a better sense of what can be discussed on the table.

At some point, you have to raise the price on your worth…

Underestimating the time it took to get up to speed

One of the problems with finishing your residency or fellowship is feeling that you’ve mastered your trade.  It gives you a false sense of security. This rings so true especially if your training spanned an inordinate length of time. Why wouldn’t you feel confident about your skills if you spent the last six, seven, or more years doing the same thing?

In reality you really only are fluent if you remained at the same institution, and even then there with be hiccups with independent decision making.  There is a difference between practicing medicine knowing that there is someone responsible for you and calling the final shots.  When you take on a new job, you have to learn how the EHR works, who the hospital protocols are, where the parking garage is, and how to get from one wing of the hospital to the emergency room without getting lost. 

Frankly, all of the hiccups involved with a new job can be overcome with time. It takes more time than what you’d realize to become comfortable with a new gig.  A rough estimate of the timeline to fluency is as follows: 

  • Learn where the doctor’s lounge is: 1 week
  • Learn hallways of the hospital system: 3 weeks
  • Learn electronic health system: 4 months
  • Feel like work is second nature: 2 years

Expecting to make a whole lot of money

I must be getting old, but I get the sense that all of the new graduates want to work four days a week and make half a million dollars.  Sure, medicine still does provide a relatively stable lifestyle but there’s really no free lunch.  Some doctors find ways to carve out additional green in creative ways, but I tell every new graduate (or anyone else whose asked for my opinion), DON’T GET GREEDY. If you do, you will ruin it for the rest of us

Some specialties will have a better lifestyle or remuneration than others, but no specialty will be perfect.  Some of us are okay moving out to the boonies to practice medicine in exchange for a better lifestyle or compensation.  Only you (and your family) will be able to decide for yourself what is important.  Don’t chase the buck. It’ll get old pretty quickly.

Not everyone is your friend

This speaks from my cynical side, but realize that there is still business in medicine.  It doesn’t matter if you are negotiating with a single doctor, medical group, hospital, or venture capital firm—the negotiations have to be profitable for both sides.  While not every employer will be out to squeeze every penny and second of work out of a new doctor, there is always that possibility.  

The world is full of sharks.  Sometimes you have to deal with them.  If you are unlucky enough to be suckered by one of them you still have a chance to learn from your mistakes.  Sometimes the issues arise from negotiating pitfalls, where the junior associate ends up taking the bulk of the overnight calls, or simply limitations with growing her practice.  Maybe the new doctor gets shipped out to satellite offices where there is limited volume initially. Some of the dealings I’ve seen are so devious that it boils my blood to realize how much the world can take advantage of naive doctors. 


That’s it for now.  Make a checklist when you are in your job hunt. Figure out your priorities, and good luck! If you have any comments or questions, sound out in the comments section!

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