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7 Career Tips for Residents & Trainees

This is the hard part, but it does get better. Completing residency training and becoming board-certified in any specialty gives physicians the most options to live a flexible, high-earning, and autonomous life both within full-time clinical medicine and beyond.
 

So how can you set yourself up to Doctor Differently after training?
 

Here are my 7 Career Tips for residents

1. Eye masks, earplugs, blackout curtains, sneakers >>>> clogs (in my personal opinion).

2. Every trainee should have a copy of their malpractice Certificate of Liability (COI).

I’m sorry if this is the first time you hear it, but you can be sued on your very first day of residency. It’s not something we like to think about, but you deserve to be educated about the details of your malpractice insurance policies and learn how you are protected and exposed to malpractice lawsuits. You’ve worked hard for this career and our society’s litigious nature can take that all away. As a trainee, you must have malpractice insurance in order to treat patients and those policy details should be explained to you during resident orientation. On a personal note, malpractice insurance was never mentioned once at any time during my training.

Request a copy of your individual COI and ask that your residency administration use a noon lecture to explain the details to your class. If your administration seems to stall or balk at your request, go to human resources who will have a copy of your COI on file and keep it for your own records. 

3. You are allowed to unionize.

Your residency administration may say that you’re not “allowed” to unionize, that it’s “not worth it”, or that “you don’t understand the downsides”. Always remember that we physicians are stronger working together across specialties than we’ll ever be as individuals. Approaching administration and politely requesting fair pay and humane working hours as individuals has not been successful for us in the past. It takes all of us coming together and leveraging our invaluable collective labor to ensure that our minds and bodies are protected from the stakeholders who earn profits from our labor.

These are examples of things residency unions can successfully demand from institutions:

• Relocation costs from medical school

• Housing & food stipends

• Hospital parking fees

• Board registration fees

• Humane working conditions

• Higher salaries that reflect your worth and value (yes, even as trainees).

Visit: Committee of Interns and Residents for more information about resident unionization efforts across the U.S.

4. A(nother) fellowship or degree will not make you happier.

As residents, you are surrounded on all sides by a system that encourages and rewards arduous academic ventures. It’s easy to feel like you must continue on a learning/training tract, but you do not. The only reason to do a fellowship is a near-obsession with the science, medicine, patients in a certain field. If you wake up thinking of nephrons and go to sleep thinking about glomeruli, please do a nephrology fellowship. But if you are considering a fellowship solely on the basis that it will make you more valuable and important in this profession, I urge you to reassess. 2-3 years of additional training (and trainee salary) may not be worth the sacrifice. I almost did a fellowship for 3 bad reasons:

• Many of my co-residents were doing fellowships. It just felt like I had to keep up intellectually. People seemed impressed when I said that I was continuing my training for a another few years. Is that not the purest definition of secondary gain?

• I didn’t know how to find my first attending job. After decades of schooling and sacrifice, physicians are not necessarily provided with the tools or guidance to find jobs and we are certainly not taught how to negotiate or advocate for ourselves in the process. Applying to fellowship felt like a respectable way to delay the inevitable. I assumed that more training would eventually guarantee that the perfect, high-paying job would fall into my lap as a reward for my additional academic service. PSA: There is absolutely no guarantee that you will earn more money after doing a fellowship. Sometimes the exact opposite is true. You could actually earn less (peds heme-onc, peds ID…).

• I wanted to feel “special and elevated” above general practice. Yes, I’m admitting it. I didn’t think being “just” a pediatrician was good enough. I imagined that being fellowship trained would give me an additional distinction. I assumed that as a “generalist”, my only real career option was busy, outpatient clinic and I was NOT a fan of that career prospect. Spoiler: I eventually discovered that there is a wide, open world of flexible, lucrative, and innovative clinical and non-clinical career options for all physicians, fellowship-trained or not. © 2024 Doctoring Differently. All Rights Reserved

5. Apply to jobs outside of your training institution.

Cast a wide net in different geographical locations when applying for your first attending job. It would be nice to assume that a home institution would reward a trainees’ loyalty if they were to decide to stay, but too often the exact opposite is true. Home institutions often offer lower salaries to trainees because they recognize that we don’t feel comfortable applying to number of jobs or exploring different health care systems. I know it would be much more convenient to stay in a familiar system, but that may come at a cost.

6. Share your job offers with your co-residents.

There is almost no salary transparency in medicine, so let’s start now as trainees. According to a New York Times article, the beginning of a physician’s career is when the gender disparities in salary begin. As senior residents, you have relatively equal credentials and experience, but employers may use the lack of salary transparency to offer widely differing starting salaries to candidates even within the same specialty within a residency class.

Create a class wide shared Google doc or spreadsheet and encourage your entire class to enter their offers. Then everyone go back and counteroffer (negotiate) 30% higher. A starting offer is just that. There is always room to go up. My assistant residency director told me “Don’t ever try to negotiate your salary. It doesn’t work for physicians.” That is not true. Negotiate every term every time.

7. Full-time, clinical medicine is not your only career option.

As a resident, I thought that my only career options were full-time inpatient pediatrics and full-time outpatient pediatrics practice because that is all I was exposed to as a trainee. My mentors and professors had only worked in academia so they did not understand the plethora of career options available to all doctors beyond the walls of academia. As a result, we were actively discouraged from pursing any venture beyond full-time clinical medicine as they were deemed invalid, illegitimate, and unsustainable ways to practice medicine.

My first few years as an attendant in full-time academic practice were grueling and low-paying. After nearly 3 years, I chose to quit that job for survival and began to explore any opportunity my degree and medical license would allow. Rather than doing a fellowship or getting another degree, I was determined to discover ways I could utilize the education and experience I already had.

I am grateful for those 2-3 years in full-time, clinical practice that solidified my medical knowledge and forced me to make grown-up doctor decisions in intense circumstances. If you decide to take a full-time clinical job, be prepared to reassess in 2-3 years. Your first job will probably not be your forever job and that is ok. We have permission to explore different facets of medicine and pursue whatever interests us at any point in time. There are no rules to this career and we can make it whatever we want it to be.

The Doctoring Differently® Academy is an online platform designed to help physicians explore non-traditional career options outside of conventional clinical practice. The academy offers digital courses and access to a community that guides doctors of all specialties in finding flexible and fulfilling careers. It focuses on non-clinical and alternative roles in medicine, aiming to reduce burnout and help physicians reclaim their time while maintaining financial stability.

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