The Resident’s Guide to Landing that First Job

28 Aug 2015

By Sareh Parangi

A few months ago we had the pleasure of having Julie Freischlag (Vice Chancellor of Human Health Sciences and Dean at UC Davis School of Medicine and an AWS member) come and speak at MGH about her thoughts on the future of vascular surgery. I thought it would be nice for her to chat with the residents and fellows rather informally about how to successfully find their first job and negotiate a package that will work for them. I realize that residents work very hard and as faculty most of our efforts go into teaching them all kinds of clinical pearls so they can be competent and caring surgeons. However, one thing we neglect to teach them well is the transition to the next phase of their life-a real job! Keeping in mind that many residents are doing fellowships, it is not clear to me that fellowship directors are including job search information in their fellowship either (to be clear, I am the fellowship director of the Endocrine Surgery fellowship at MGH and I feel that we also do not provide clear directions/help on job search or negotiation). For adults whose path has been fairly straightforward and clear: college >medical school> residency> fellowship, how to choose a job can be a daunting task, especially considering additional forces that come into play: marriages, partners, loans…etc….

I sat in the back and listened to Dr. Freischlag expertly provide her advice, having been a division chief, a chairman and a dean, she managed to keep the information current and simple. The residents and fellows were very engaged and asked tons of questions so it was clearly a topic that connected with them. She focused her thoughts on searching for academic jobs but I think some of the points could be applied more generally too. What did I get out of her talk and the answers she provided our residents/fellows?

  1. Residents and fellows should look around for jobs, and write chairs and division chiefs. They should not necessarily wait only for posted jobs. Letters should be simple and grammatically perfect.
  2. You should not just include a standard letter but also include details about why you like this particular department or division, what makes them special in your eyes and how you would fit into the department. Include what you “can do for them” in clear and simple language. Have a vision of what your contributions to their specific department would be. Do your research about that specific department, strengths and weaknesses… standard boiler plate letters just go in the garbage.
  3. If you do get an interview, show that you can be flexible and open to wearing different hats early in your career: Is your dream to have a practice taking care of only melanoma patients but the chairman needs you to be flexible and take care of the medical student curriculum too? Remember that the chair/dean who is doing the hiring knows their own departments and therefore can see the forest not just the trees. In fact they may see how your career will/should develop at their institution better than you might yourself. By being dedicated and flexible and trusting the hiring chair you can work together to create a realistic package that works for everyone.
  4. There may not be as much room for actual monetary negotiations as you think. Many academic practices have fairly standard boiler plate contracts and a certain salary in mind when looking for candidates. While there might be some wiggle room in negotiating a dollar amount, there might be more room in negotiating things like: administrative help, research start up dollars, office location, call schedule, OR block time, amount and definition of protected time. Try to set your own priorities, personally I have found being able to choose my own administrative assistant was so important to building my practice…staff that answers your phone, interacts with your patients, referring physicians and colleagues is very important; a good one can help build your practice, a bad one can add at least an hour or two of extra stress to the work day.
  5. Be open about your alternatives with the Chair….if another institution is offering you a much better package financially or in other aspects, being open and honest about it is easier than beating around the bush. It will help everyone decide whether they can make the same “magic” happen at other institutions.
  6. While you do want to cross all the “t”s and dot all the “i”s, you do not want to let the negotiations carry on too long…there will be a loss of interest in your good faith in the negotiating process eventually. Many of the chairs do not have the legal authority to change the hospital or physician organization boiler plate type contracts so do not get to bogged down with details that are not changeable, instead focus on the parts that might be changeable.
  7. Many faculty move after a few years…your first job is not likely to be your only job anymore- so keep that in mind when negotiating for your first job! It’s not the end all be all of jobs! However, the tone you set (especially as a woman) during your first meetings/negotiations will often set you up for future promotions in the department so be careful to not come across as someone who does not care about the details and will take any job.
  8. This next piece of advice by Dr Freischlag had me surprised for sure….as someone in academics my entire career, I had always been taught that without “protected time” in the first couple of years of your job- there would be no academic career. Dr Freischlag pointed out that protected time early in your new job may be a double edged sword, while you might be able to negotiate a lot of protected time to do your research and get preliminary data that will be critical in developing your research program… sometimes this will backfire. How you ask? Dr Freischlag gave many good examples of young surgeons that became increasingly less confident about their own clinical skills during the first 3-5 years of their clinical practice, did not get to interact with more senior faculty and further develop their skills, did not interact with primary care or referring physicians, and ultimately after 5 years found themselves, viewed as “poor clinical surgeons” that no one knew at the institution by year 5 making selling them as the “go to surgeon” quite challenging for the chair. While research is very important, remember that most chairs are hiring “surgeons” first and foremost and you do need to become a good surgeon who increases confidence and continues to learn the first few years of practice. In the first few years of your practice, it is expected that you will continue to be on the learning curve, most referring physicians will give you a “break” and your fellow colleagues are more than willing to jump in and help you anytime….do not lose this “window of opportunity”. So I guess the takeaway message is while you should negotiate for protected time, try to keep a balance so you do not lose your clinical skills and in case your research career does not exactly materialize as you thought it might…you can be confidently “sold” to colleagues as a phenomenal surgeon.


Well, hopefully I have not misrepresented Dr. Freischlag’s important bits of wisdom. It was great having her here and interacting with the residents; they still corner me to tell me how grateful they are that I had arranged this special session with Dr. Freischlag.



Dr. Parangi is a busy endocrine surgeon at Massachusetts General Hospital, Harvard Medical School in Boston, with a particular interest and expertise in thyroid and parathyroid tumors. She focuses her clinical efforts on endocrine surgery and applies her basic science knowledge and expertise to tumor progression in thyroid cancer. She has been one of the Boston surgeons named in Best Doctor and her excellent in both research and her clinical expertise have earned her a national reputation. She has been a council member for The Association of Women Surgeons and the most prestigious organization of endocrine surgeons in the US, The American Association of Endocrine Surgeons, and a member of the American Thyroid Association. She has won numerous awards nationally and at Harvard Medical School for her NIH funded research in the role of BRAF oncoprotein in thyroid cancer invasion.

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