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.