Thinking About That Second Job - Some Thoughts for Senior Residents About to Graduate (and Junior Attendings)

You’ve probably focused mostly on finding your first job, but what a lot of docs don’t talk about is finding that second job.

Two important concepts to remember:

1. It’s ok to move on.

2. Think the decision through when you consider moving on.

You may get some people asking, “Why would you work somewhere else?”. People that stay with one job their entire career are more and more rare. Moving from one employer to another is the norm in other fields. However, in some pockets of medicine, people still ask why you want to move on like you are the anomaly.

The reality is that things change: you, your family, your department, your hospital, the economy, etc. Everything changes. What was a good fit at one time may not be a good fit even just a year later. So don’t feel guilty of moving on from your first job.

Most people move on from their first job into a second job. It’s a natural part of your career.

The change may be obvious, may be a hard-to-pinpoint, or something in the middle. Most likely it will be something in the middle.

How do you figure out what changed? Address the issue in a systemic, logical manner, the same as you would a patient with a combination of symptoms. Collect your initial data, make your differential diagnosis, collect more data as necessary, narrow down your differential diagnosis, and formulate your specific plan.

What’s your differential diagnosis? What changed can be you, your family’s needs, your coworkers, your hospital leadership, your local economy, etc. Maybe the job was a bad fit, as we’ll discuss below. Your data can include your own observations, opinions of your co-workers, opinions of your family, etc. Your plan is what you will do about.

Sometimes it’s not that things changed, but a case of you not knowing what would fit you. That’s fine. The only previous experience you have is residency. Your first attending job is a chance to test the proverbial waters. It’s fine to enter your first job not knowing what kind of job will fit you. But if you’re feeling dissatisfied, break down your situation as above, reflect on what you’ve learned from this first job, and move onward.

Let’s look at a couple examples that can illustrate a some of these concepts. I loosely based both of these examples on real life situations.

Let’s say you’ve landed your community hospital job and worked a couple years there. Early on you’ve reluctantly gotten roped into doing a couple lectures for the PA and NP students that occasionally rotate with you. You had a good time doing those lectures. This surprises you. You find you enjoy working with the students. Your occasional teaching shifts become your favorite shifts despite the students slowing you down. At some point in the second year, you start to feel dissatisfied. Your department has been pretty stable, as has your life outside work. Maybe this job was not a good fit. Maybe you should think about looking for a job in academics.

Let’s say you’ve landed your academic job as full time faculty at an EM residency program and you’ve worked there for a couple years. You get yourself on a couple residency committees or projects. You’re teaching residents every shift and really enjoy it. After a few months you find that the committees and projects start to take up almost three times as much time as your protected time. Around that same time, personal commitments start to take up more of your free time. From the beginning the way the residents subtly question your judgement made you a little uncomfortable, but it was no big deal. Now you’re already emotionally worn out from the outside commitments and you start to see your residents’ behavior as disrespectful. In the second year, you realize that you’re dissatisfied. Maybe things have changed so much that this job is no longer a good fit. Maybe you should think about a job with less nonclinical responsibilities, like a job in a nonteaching community hospital.

If you find yourself dissatisfied with your first job, it might be time to move on… and that’s ok. When you’re considering what to move onto next, break down the situation systematically as you would a patient with a medical complaint, take into account the lessons you learned from this first job, and move on accordingly.

About me: I’m an emergency physician currently practicing in New York City. I’m the inspiration for one of the examples above. I’m also the author of The Handbook of Medical Charting and A Guide to Clinical Decision Making.

How Should I Save My Money? – Some Thoughts for Senior Residents About to Graduate

 

If you’re like most docs graduating from residency, you’re a little overwhelmed with amount of income you’re suddenly making. You don’t know how to deal with this income. Unfortunately, most medical schools and residencies do not give you any significant guidance on the subject. I intend this brief post to get you started on that journey. It’s a start, not the end, but I think it will get a lot of people started in the right direction.

I recommend the following steps when considering what to do with your money:

Make your (or your family’s) budget. Figure out how much your costs are. In these costs, include what you can reasonably predict in the foreseeable future. Compare this to what you will be earning. The money you have left after your costs are what you have to save, spend, or invest for the next steps.

Save for an Oh S&^t! fund. See my previous blog.

Plan for retirement. Clinical medicine can be a tough job. You won’t be able to work forever. Most people won’t want to work forever. So start saving for retirement as soon as you’ve got a reasonable Oh S&^t! fund.

Educate yourself on your options in personal finance. Some physicians are interested in personal finance and become pretty savvy very quickly. Some physicians have no interest or aptitude in personal finance and don’t want to be bothered. Others fall somewhere in the middle. Whichever group you fall into, you’re a quick study… you had to be to make it to this point in your career. Read a couple of books on personal finance, watch a few videos online, and read a few articles on the topic. Use more than one resource to educate yourself. There’s a lot of potential material to cover, but you’re used to learning quickly thanks to the process of medical education. Use the critical thinking skills you’ve developed in medicine and you will quickly be able to follow a professional’s advice.

Hire a professional if you do not want to manage your money yourself. This is a individual decision based on your time, comfort, and interest. However, if you’ve educated yourself on personal finance, you will at least be able to follow, make sense of what the professional advisor recommends, and question when something doesn’t make sense. This is analogous to informed consent in clinical medicine… the better-informed patient can better coordinate with their clinician in choosing the option that is best for that patient. Be that better-informed patient.

Follow through with your savings plan. There’s no use in having this plan if you don’t use it.

These are only steps to start getting you organized. You have a lot of details to fill in and quite a bit of work to do, but to make it this far you’re already used to learning and work.

Note: For the purposes of this post, I’m not endorsing any particular resource for physicians to educate themselves on personal finance.

About me: I’m an emergency physician currently practicing in New York City. I manage my own, personal finances. I’m also the author of The Handbook of Medical Charting and A Guide to Clinical Decision Making.

 

What Do You Mean I Have Work Options? - Some Thoughts for Senior Residents About to Graduate

(Initial caveats: 

The following advice speaks to physicians employed directly by a medical group or hospital. It may not apply to independent contractors or locums physicians.

Also, not all of the work situations I describe will be available in every market. For example, a town with only one hospital may have fewer work situations than a large city with multiple hospitals staffed by multiple groups.)

One of the beautiful things about emergency medicine is that you can adjust your work situation in many ways to suit your life.

What do I mean by work situation? I mean your employment situation.

Most doctors graduate residency and the first thing they will consider is a full-time job at one hospital or with one group that covers multiple hospitals. There’s nothing wrong with the full time job if that’s what suits your situation.

However, sometimes that arrangement doesn’t fit every situation. Here are some alternatives to think about:

Part time work. You can ask for ¾ or ½ time hours. This may be a good situation if you have other time commitments. In some cases, you might be able to get health and dental insurance while being part time. Ask respectfully and the worst thing that can happen is the prospective employer will say “no”.

Per diem work. This is when you are credentialed to work with a hospital or medical group, but do not have a minimum number of hours. The flip side is you will not have a guaranteed number of hours, so the work may not be steady. Depending on the hospital or medical group, you might have a lot of control over what days you can work with them. You might also be restricted to only certain days or shifts. This control over which days or shifts you can work varies from place to place.

You can mix and match these situations:

Two part time jobs or a part time and a per diem or multiple per diem. You can get full time hours or more this way. However, make sure that the schedules are compatible. You do not want to be scheduled for the same day at two different hospitals. Multiple jobs can work when well you can control which days you work.

Full time job with a per diem job. This works well if you need to make a little extra money on the side and you want a little bit of variety beyond what you are getting at your full time job.

We should know what our options are so that we can fit our career to suit our needs, most other fields do not have this luxury. To be stuck in a work situation that does not work for you while there may be other alternatives is an unfortunate situation.

About me: I’m an emergency physician currently practicing in New York City. I have worked some of the variations of work situations I’ve described above. I’m also the author of The Handbook of Medical Charting and A Guide to Clinical Decision Making.