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What to Consider When Deciding On Your Post Residency Career Path: Advice From the Council of Early Career Physicians

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You’re a second-year resident and you’re starting to consider what professional path you’ll take after residency. Do you stay on as a chief resident, go into fellowship, start as an attending physician, or take time to build your CV? Our Council of Early Career Physicians gives advice on what to consider with each professional choice.

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Choice #1: Chief Resident

“I found my chief year to be one of the best years of my training for personal and professional growth.”

PROS CONS
  • Bolsters teaching experience if you want a teaching position after residency, especially if you aren’t planning to do fellowship
  • Great for personal and professional growth—gives insight into academic medicine including developing skills like leadership, coaching, teaching, and mentorship
  • Chief year is often very challenging and it’s not uncommon to work long hours and do more administrative work than expected
  • The role is often about managing expectations from residents, faculty, and program directors

Questions to Consider:

  • Do you enjoy or want to sharpen your people and management skills?
  • How much time is dedicated to administrative, clinical, and teaching duties?
  • What is the salary difference between faculty level and resident level?
  • Can you afford to take an additional year at a slightly higher-than-resident salary versus starting your fellowship or job as an attending?
  • What are the highs and lows of the role?

Preparation:

  • Seek out opportunities to be a teacher and mentor to your co-residents
  • Seek out leadership experience
  • Talk to current or former chiefs to get a better idea of the role

 

Choice #2: Fellow

“Find the specialty that brings you true joy and adds vitality to your life, not the one ‘you think you should do’ because it looks good on paper.”

Questions to Consider:

  • Do you want to have a subspecialty?
  • Have you done research in the area?
  • Does your program have opportunities to rotate in that area?
  • Will the additional training provide more professional opportunities?
  • Will the additional training generate a higher salary?

Preparation:

  • Ask your senior residents how to get involved in research in the field of your choice
  • Ask seniors who apply to that field if they can connect you to mentors in that field too  

 

Choice #3: Hospitalist/Primary Care Physician

Questions to Consider:

  • Do you want to be employed in a small, large, or academic practice?
  • How does the practice support new primary care physicians (PCPs) and what is the team structure? Are there medical assistants, registered nurses, and nurse care managers to support PCPs?
  • What is the call schedule and are you expected to work during extended hours?
  • Do you prefer a fixed salary, salary plus incentive bonuses, or production only?
  • What is the compensation package, and does it include continuing medical education (CME)?
  • How many vacation days will you have? Is there a lockout on when you can take vacation days?
  • How are you promoted or evaluated for a raise and what are the metrics?

 

Choice #4: Strengthen CV Through Experience

“Though there is pressure for many to go straight to fellowship from residency (and many are used to going one step after the other in succession along this journey to being a doctor) it REALLY is ok to take a year or two between residency and fellowship and it might even make you a better, more confident candidate.”

Pursue something that keeps you clinically active while also building your CV and experience portfolio:

  • If you’re applying to a highly competitive specialty that requires research experience, you can work as a researcher to strengthen your CV.
  • You can work clinically independent as a hospitalist or nocturnist.
  • Between residency and fellowship, you can volunteer or teach.
  • You can work in urgent care or primary care, although working as a primary care physician is more challenging given the time it takes to build a panel of primary care patients.