Time to leave the (training) nest: Finding your first attending job

26 Jul 2022

By Kimberly B Hoang

The job search for the first attending position is likely the first time in over a decade where surgical trainees face real choices and autonomy regarding their future. Before this, we are told where to work by the MATCH, what to study in medical school, and how to spend almost every waking minute during residency. Our training programs dictate our rotations, the ACGME dictates our success, and even our relationships / personal lives are invariably somewhat dictated by external forces not in our control.

It is, therefore, little surprise that many struggle with a seemingly overwhelming number of choices when looking for their first attending job. This time there is no set “process”, no rank list, and no MATCH algorithm to guide you. In fact, there is little transparency about job availability, details, candidacy, and competitiveness, especially as we continue to increasingly subspecialize. Coupled with the reality that many are navigating the process during an extremely busy chief or fellowship year, the task can range from challenging to outright unsuccessful. In fact, 20-40% of physicians switch jobs within the first 2-5 years.

To avoid becoming a statistic, here are a few points to consider:

  1.   (Really) Know thyself. After years of carrying out others’ plans and orders, this is the most important point: what do you want? Start broad, then get very detailed. I encourage senior residents to prepare their letters of intent or cover letters at the beginning of the job search. It forces many people, for the first time, to really think about the specifics of where they want to be 5-10 years from now and how to get there. Things to consider:
  2. What kind of cases do you want to do? How much OR time fulfills you?
  3. What are your career interests outside of the OR (e.g. organized surgery, administration, research, education, entrepreneurship, other)?
  4. What does your ideal week look like (e.g. percent time clinical versus research versus admin, family and personal blocked off time)?
  5. What does “good compensation” mean to you? How do you define “work/life balance”?
  6. Where do you want to live?
  7. What are the true dealbreakers and priorities? In fact, no job will be perfect. Decide what truly matters on your list and what you cannot live without. You may have to do certain cases you don’t enjoy as much to live closer to your extended family.  You may have to take a pay cut to have the lab and start-up package you need for a successful research career.
  8.   Make yourself known.  The surgical attending job market often relies heavily on word of mouth for some of the more desirable jobs. We often hear about positions before they are publicly posted, and the more we know about our trainees’ wishes (see #1), the better we can send the right opportunity your way. Be vocal, open, and honest with your mentors and attendings.
  9.   Get your paperwork in order. Spruce up (or just create) your CV and cover letter before you start the search. Make sure your emails and cover letters are succinct and easy to read. Chairpersons, Department/Division/Section heads, and search committees are full of busy and tired doctors. Use bullets, provide good data, and make yourself standout.
  10.   Find the networks that matter. National surgery job boards, subspecialty physician recruiting firms, and of course, cold calling/emailing all are helpful options. The best networks though, are the personal ones comprised of your friends, colleagues, those who trained you, and those you trained with. Some mentors are frankly more active in assisting their trainees find jobs than others. Identifying which network will be the most fruitful for the specific job you are looking for is crucial. Often, national meetings a year or two before your graduation can be great times to meet department leadership from across the country who are looking to hire in the near future and do preliminary meet-and-greets.
  11.   Who will vouch for you? Once jobs are interested in you, they will often ask references and colleagues at your program about you and your work. These references can be extremely valuable in the small world of surgery, particularly academia. Know who will really advocate for you and promote your career. Nothing is worse than a reference who is powerful or influential, but lukewarm.
  12.   Broaden your search. Be aware that many trainees experience a highly insular surgical environment in most training programs – often with one culture, in one overarching institution, and likely in an academic environment. Between medical school, residency, and maybe fellowship, you’ve probably experienced about 2-3 academic centers. Be open to interviewing at practice organizations, models, or jobs that seem different from where you trained – you may surprise yourself.
  13.   Interview well and understand the culture. Interview smartly and keep your ear to the ground. Do your research about the leadership and departmental culture that may or may not be presented at the interview. Use the same networks you made to find interviews to figure out if a job offer and future department will actually be a good fit. Will your future partners be mentors, colleagues, or competitors?
  14.   Know your worth. Now that you have your offer, is it fair? Knowing your worth is crucial and can be difficult, given increasingly diverse situations with quite variable pay (i.e. academic versus private practice compensation, start-up packages, long term benefits). However, good subspecialty resources exist, and this knowledge will power your negotiations. More than one offer in hand or a prior offer can be a practical way to understand your worth if you are having a hard time discerning this.  
  15.   Be wise about your offer. Women are often counseled that we do not negotiate enough with significant long-term financial and professional implications. Negotiate if you feel the offer doesn’t reflect your worth. Have a physician-contracts focused lawyer review your term sheet or contract to make sure you have not missed anything. And lastly, circle back to the priorities I mentioned in #1, and ensure your contract adequately reflects them.

Like all things, finding the “right” job is usually hardest the first time around. Remember: there is no perfect job – but there are jobs that can fulfill a surgeon long term. A wise first choice is professionally, personally, emotionally, and fiscally beneficial. Whether or not your first job ends up being your last, make sure to relish that, finally, the choice is yours.

Kimberly Hoang, MD is an Assistant Professor in the Department of Neurosurgery at Emory University and Winship Cancer Institute in Atlanta, Georgia. She specializes in neurosurgical oncology, particularly the treatment of difficult-to-access brain tumors near eloquent regions. Her research lab focuses on microrobotics, microelectromechanical systems, device development, and clinical outcomes research for brain tumors and neurosurgical oncology.

Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.

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