The one thing I wish I knew when I took my first job

If only we could move backwards in time.  We could right all of our wrongs, and never make a mistake in life.  

It would be nice to relive certain time points in our lives to make a better choice.  Perhaps in the end none of this makes a difference, but many doctors do wish that they made different decisions when taking their first jobs.  That is typically a point in our lives where our choices can impact everything else in our lives.  At this point doctors have the least amount of money they will ever have but are the youngest that they will ever be in their working careers.  Many will have young families to support and are making decisions to move their family across the entire country.  
To this end, I wanted to recap some of the salient points I give to new graduates when they are choosing their first jobs, and hopefully stop them from making the mistakes that I made.  

Assess availability of colleagues
Some people in the world are built to tackle challenges alone.  Most of us perform better if there is backup.  This is where mentorship and colleagues come into play.  Medicine is an interesting career path where it is unusual that physicians have peak knowledge, experience, and stamina altogether straight out of training.  Every specialty is unique and will vary on how much experience and age come into play.

Don’t you just hate it when someone eats your food?

Young doctors will have to prioritize what is important to them when taking a new job.  For some of us, taking a lower paying job within a multi-doctor department may be a better option than to take a much higher paying job inheriting a practice from a solo physician.  Having the ability to grow along with your colleagues or mentors is an intangible perk that we have to weigh against everything else. 

Assess peak earning potential
Most physicians advise new graduates to assess the peak earning potential of a job as a key factor rather than starting salary.  There are two sides of this coin.  Logically, the bulk of a physician’s career will be spent in the peak earning timeframe so being able to earn a high amount for a long period of time will maximize the chance of greater overall earnings.  The calculation falls apart in two scenarios:

  1. Part of the compensation package is tied to a pension — This is commonly seen in the Kaiser Permanente (KP) system, where physicians are paid a highly competitive starting salary but have little room to grow their incomes.  The compensation package at KP is tied to a generous pension that takes into affect after a certain length of employment.  The purpose of any pension is to relieve the burden of the employee to save for retirement by having a guaranteed lifetime income.  For some people, it’s a huge benefit. For others, the pension is a set of golden handcuffs.  You can leave the system “early” but will not be able to maximally reap the benefits of being in the system longer.
  2. Physicians wanting to FIRE — It’s always better to front load your earnings if you want to maximize the amount of time that it will grow.  If your working career is only going to be ten years, then it doesn’t make financial sense to take a job where you are compensated pennies for the first five years and start making big bucks for the next five years. FIRE tends to be in the minority but it is important to consider the consequences of your income trajectory.  Anecdotally, front loading earnings is exactly how engineers and other early retirees have been able to hang up their hats at age 30.  Compound interest and time in the market pays off no matter what.

The coin could even land on its side! Life still happens, and I have certainly known doctors who made what is seemingly the best decision to maximize their salaries only to find out that their spouses hate the city that they moved to.  

Location, location, location
Every single one of us has a must-have whether or not we are aware.  It could be a Saks 5th Ave, a Costco, or a simply good hair salon.  For most people, location matters.  If you choose to move your family out to the Yukon for a seven-figure job, you’d better have a game plan to get them out if curling or ice fishing isn’t your family’s favorite sport. Don’t get blindsided by other enticements.  You are in it for the long haul, so you need to make sure your choice makes sense.  You can still make mistakes even if you make the best choice possible given what you know.

The ultimate dealbreaker
The biggest regret that I had when choosing my first job was that I didn’t negotiate enough.  Remember that everything is negotiable, even if you are told otherwise.  Sometimes larger institutions have boilerplate contracts, so they may not be inclined make modifications to the contracts simply because it would require work from their contract attorneys.  Whether or not you can convince the other party to modify their contract to your liking will ultimately depend on how badly the potential employer needs you. 
There is a fine line with asking for what you feel you deserve and also asking for something that is unreasonable for the other party too.  I’ve seen new graduates both shortchanging themselves and also overestimating their own abilities.  If there are other doctors vying for the same job, then your potential employer has the upper hand.    However if you are the only candidate on the docket, you might have more leverage than you realize. 
The moral of the story? Don’t be afraid to ask, and make sure you have a good justification on why you deserve what you are asking for. 

What other questions should you have asked during your first job? 

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