What to Think About When Searching for Your First Attending Job

You are halfway through or about to be done with residency and looking for your first attending job but are wondering how to search for the right one. To get straight to what will be the key to identifying the best fit will depend on your priorities. 

Evaluating your priorities is essential when looking for your first attending job after completing residency. It may not be apparent initially what those priorities are for you, but keep reading to see the key factors to consider. As you read them, think about what matters most and write a list based on your top priorities.

This big decision will impact your professional growth, work-life balance, and overall job satisfaction, so let’s ensure you are happy with where you start your new chapter. Here are factors to consider when searching for the right family medicine attending position:

1. Job Role and Responsibilities

• Scope of Practice: Ensure the job includes a range of patient care that interests you, such as pediatrics, geriatrics, women’s health, or chronic disease management. For example, if you do not want to do pap smears, you want to ensure the ob/gyn is readily available and will not depend on you.
• Workload and Patient Volume: Understand the expected patient load per day and how it fits your work style and goals. Are you willing to have 15/30 minute patient encounters (15-minute short and 30-minute extended visits)? Or will you want to have 20/40-minute patient encounters? This might not seem like a major consideration, but if you are like me and like to spend time with patients and like the education process, you definitely want to ensure you have 20/40-minute patient encounters.

2. Work Environment

• Clinic Culture: Look for a positive, collaborative work environment where you feel valued and supported. This can be hard to scope. I would really lean on your instinct after visiting the job location and talking to the team on this one. 

3. Compensation and Benefits

• Salary and Bonuses: Compare salaries across similar positions and consider potential bonuses or incentives. Let’s be honest we aren’t going to become millionaires as family physicians, but make sure you are appropriately compensated to enjoy your life outside of work. Ask about the sign-on bonus and if they will help move you to the area (pay for moving truck, movers, etc). Ask whether they will pay for your travels to and from work (especially if you have established in your current home and they need you to drive to the office that is an hour away, ask for compensation). 
• Benefits Package: Review health insurance, retirement plans, malpractice insurance, and other benefits. These are the basics. I won’t pretend like I know what I am talking about with this one. I am still learning to navigate this one. You should review it, ask questions, and look into it. 
• Loan Repayment Programs: Check for loan repayment assistance, especially if you have significant student debt. This is MAJOR. Especially if you are planning on working for hospital systems. The hospital system gets a substantial chunk of in your cash flow through patient care. Get them to pay for your loan! Unfortunately, they will have some sort of catch with this when they offer you loan repayment. For example, you must stay for a certain number of years to get the promised amount. They generally will give a certain amount per year. For example, if you are told they will provide you with $100,000 towards your loans over five years, they will give you $20,000 yearly. 

4. Work-Life Balance

• Work Hours: Understand the expected working hours, including any evening or weekend shifts, on-call duties, and potential overtime. Are you expected to work weekends? Do you want to work weekends or be on call? What are the calls like? What is expected of you to do when you are on-call? Do you have a nurse who addresses the problem first before you, as the physician, is contacted? How many hours is considered full-time? My friend works for a smaller clinic, works 30 hours a day, and is considered full-time. I work 40 hours per week, which is regarded as full-time. Do you want four days on and three days off? If so, are you okay with 10-hour shifts if they are asking for a 40-hour work week? Going back to my friend, she works four days a week from 8 AM to 4 PM! Her practice is not very busy, but how awesome does that sounds!?
• Flexibility: Look for positions offering flexible scheduling, part-time options, or job-sharing arrangements if important to you. If you want to transition to part-time easily, tell them ahead of time so that when you need to, they can and will do it without hassle. Remember, you are their gold mine; you need to ask for things so that you can continue to be faithful to them as they are faithful to you. 
• Vacation and Time Off: Evaluate the amount of vacation, sick leave, and paid time off available. They will count per hour. When you do go on vacation, who will be covering for you? I like to be off when I am off; this helps me avoid burnout. So, when I am not there, can I rely on my team to handle my patient needs while I am gone? Or will I be working even on my vacation days? Is that something I am okay with? These are all things to consider. Some people are easygoing about it, but some (me) get drained quickly; therefore, inquiring about this is important as it will make a BIG difference. 

5. Location

• Geographic Preference: Consider your preferred geographic location, including climate, proximity to family, and urban vs. rural settings. How will your drive to and from work be during snowy days? Will that make you feel miserable, driving back and forth? Is the drive easy? Will you need to get a train? Are you okay with that? Will you need to move? Will you be living in the area where you will be working? Are you alright with that? 
• Cost of Living: Assess the cost of living in the area and how it aligns with the compensation package. Generally, they are good about adjusting this but double-check. 
• Lifestyle and Amenities: Think about local amenities, recreational opportunities, schools, and overall quality of life. If you establish long-term, does the schooling system align with your vision of where your kids will learn? What can you do to get away from medicine that aligns with your preference? For example, I love to travel, so having an airport with a decent direct drive is very useful to make it more enjoyable each time I travel.   

6. Professional Development

• Continuing Medical Education (CME): Ensure the job offers continuing education and professional development opportunities. You will always need to keep studying and learning to stay well-informed and do your best for your patients. 
• Mentorship and Support: Look for a supportive environment with opportunities for mentorship from experienced colleagues. I didn’t really learn that I had this until I started working. I always knew I had mentors that I could always reach out to by text, but being able to have someone you can walk over to ask their opinion or guidance makes it more valuable. 
• Career Advancement: Consider the potential for career growth, leadership roles, and involvement in teaching or research if desired. Are there things you want to do in the future, and do they have them available?

7. Practice Structure

• Type of Practice: Decide if you prefer working in a private practice, hospital-affiliated clinic, community health center, or academic setting. If you want to work with students, choose a place that is either working to build that in or already has it. 
• Electronic Health Records (EHR): Familiarize yourself with the clinic’s EHR system and assess if it’s user-friendly and efficient. This one was a major one for me. I personally really like the Epic system. I worked with it as a resident and got used to it, so I wanted that same system for my big girl job. We are CONSTANTLY documenting. It is crucial to have a system that makes it as efficient as possible. 
• Administrative Support: Ensure adequate administrative support to help manage non-clinical tasks. There is so much tedious work, and how much you are okay with it depends on your level of patience. 

It is important to identify what matters to you and how you envision yourself living your day-to-day life. You are finally at a place where you can enjoy your hard work. Don’t just run towards the position that gives you the highest pay, but really be selective based on what will have a combination of good pay, good living, and good memories! 

I hope this article was helpful.

Much love,