The Money Meets Medicine Podcast

Starting Your First Job as a Physician

By Jimmy Turner, MD
Host of Money Meets Medicine

You’ve survived med school, conquered your residency, and now you’re ready to embark on your first real job as a physician. It’s an exciting time, but let’s be real – it can also be pretty overwhelming. I remember my first day as a newly minted doctor, walking into the hospital with a mixture of excitement and sheer terror. But here’s the thing: you’ve got this. With a little preparation and a lot of deep breathing, you can flourish in your new job.

Yet, there is something lurking around the corner that can add to your stress if you aren’t careful. In fact, the American Psychological Association consistently shows that financial stress is the #1 stressor in American households since they began the survey in 2007. With massive student loan burdens, a large jump in pay often leading to increases in spending, and not a lot of help you know you can trust (the reason Money Meets Medicine exists)… doctors aren’t immune to financial stress.

In this post, we’ll cover everything you need to know to start your medical career off on the right foot. From navigating the job search to nailing your contract negotiation, we’ve got you covered. And don’t worry, we’ll also talk about how to maintain some semblance of a life outside the hospital (yes, it’s possible!). So grab a coffee, put on your scrubs, and let’s dive in.

Table of Contents:

 

You’ve made it through the gauntlet of medical school and residency. Congratulations. But now, a new challenge awaits: finding your first job as a full-fledged physician. It’s a daunting task, I know.

When I was fresh out of training, I remember feeling overwhelmed by the sheer number of options and considerations.

First things first: you need to figure out what kind of practice setting and location aligns with your personal and professional goals. Are you drawn to the fast-paced environment and breadth of private practice or do you want a deeper dive into the world of academic medicine? Do you envision yourself in a bustling city or a tight-knit rural community?

These are big questions, and there’s no one-size-fits-all answer. Take the time to reflect on your priorities and values. Make a list of must-haves and deal-breakers. And don’t be afraid to seek guidance from mentors or physician career coaches who can offer an outside perspective.

Leveraging Alumni Networks and Career Fairs

Disability Insurance for Physicians

 

You know what they say: it’s not just what you know, it’s who you know. And when it comes to job hunting, your alumni network can be a goldmine of opportunities and insider info.

Reach out to former classmates and colleagues who are already working in your desired specialty or location. Ask about their experiences and if they know of any open positions. Attend alumni events and career fairs to expand your network and get face time with potential employers. And don’t underestimate the power of a personal connection. A glowing recommendation from a trusted source can go a long way in setting you apart from other candidates.

Utilizing Online Platforms and Staffing Agencies

Of course, networking isn’t the only way to find job openings. Online platforms like LinkedIn, Doximity, and specialty-specific job boards can be great resources for casting a wider net. Create a compelling profile that highlights your skills and experience. Engage with relevant content and join professional groups to increase your visibility. And don’t be shy about reaching out to recruiters or hiring managers directly.

Another option is working with staffing agencies that specialize in placing physicians. They often have access to exclusive job listings and can help negotiate contracts on your behalf. Just be sure to do your due diligence, choose a reputable agency, and recognize that they will be taking a cut of what you are being paid. That “negotiation” and “job finding” aren’t free.

Mastering Contract Negotiation and Understanding Employment Agreements

Before you sign on the dotted line, it’s crucial to understand the ins and outs of your employment agreement. This is where things can get a bit tricky, especially for new physicians who may not have much experience with physician contract negotiation.

First, let’s break down the key elements of a typical physician employment agreement. This includes: – Salary and compensation structure (base salary, bonuses, RVUs) – Benefits package (health insurance, retirement plans, CME allowance) – Work schedule and call requirements – Termination clauses and non-compete agreements – Malpractice insurance coverage.

It’s important to review each of these components carefully and ask questions if anything is unclear. Don’t be afraid to seek legal counsel to ensure you fully understand the terms of the agreement.

Here are a couple of important examples

  • Malpractice Insurance: Make sure you understand whether your “tail” is covered by the malpractice insurance provided by your job. If it isn’t, you will likely be stuck with a five-figure tail insurance purchase should you ever leave.
  • Intellectual Property: What does your employment agreement say about things you create while employed there? Do you own it? You might be surprised to find out you often don’t.  This might be worth negotiating.
  • Restrictive Covenants (non-competes): If you start to hate your job and want to make a change, how easy will it be? Can you work at the hospital next door, or do you have to drive a couple of hours to find your next job in medicine?  Make sure you know the rules and, if possible, negotiate this (or minimize it) out of your contact.

Negotiating Your Contract Like a Pro

Now, onto the negotiation process itself. This can be intimidating, especially if you’re not used to advocating for yourself. But remember: you are a highly skilled and valuable asset to any healthcare organization. Don’t sell yourself short.

Some tips for effective negotiation:

  • Do your research on market rates and industry standards for your specialty and location (MGMA compensation data is often a good source).
  • Identify your priorities and non-negotiables upfront.
  • Instead of saying “no” reframe non-negotiables as an obstacle that needs to be overcome. “I really love the job you are describing, the trouble is that my family is from the area and that non-compete really won’t work for me.” This makes them a team player who wants to solve your problem, as opposed to being on “opposite sides” of the debate.
  • Be willing to compromise on minor points, but stand firm on what matters most to you.
  • Get everything in writing and have a lawyer review the final contract.

Money Meets Medicine, Jimmy Turner, Justin Harvey

 

Remember, negotiation is a two-way street. The goal is to find a mutually beneficial arrangement that sets you up for long-term success and satisfaction in your career.

Transitioning Smoothly into Your New Role

Let’s be honest. The transition from trainee to attending physician can be a bit bumpy. There’s a lot to learn beyond just the clinical work – like navigating hospital politics, building relationships with colleagues, and finding your place in the community.

Managing Work-Life Balance from the Start

As much as I hate the phrase “work-life balance,” you know what I mean when I say it whether you like to call it “life-life balance” or some other terminology. The idea is finding contentment, purpose, and fulfillment in life.

In this realm, setting boundaries and prioritizing self-care from the start is crucial for long-term sustainability. This means being proactive about managing your schedule and protecting your time off. You want to travel? Make sure your schedule can accommodate it. Communicate your needs and limits clearly with colleagues and supervisors. One way to do this is to create what the Money Meets Medicine audience has become well acquainted with… your Hell Yes Policy (HYP).

Determine what matters most to you. As in, your top 5 priorities. The things that make you say “Hell Yes!” After that, learn to say no to anything that doesn’t make you say Hell Yes. Why? Because people treat you how you teach them to through your boundaries. Build them early and often.

Inevitably, there will be detractors to the Hell Yes policy who say “early in your career, you need to say yes to everything!” The choice is yours. Maybe that makes it into your own HYP, if career advancement is one of your top priorities. Maybe it’s not. That’s up to you.

Above all, remember, taking care of yourself isn’t selfish. Just like they tell you on an airplane to put your oxygen on first before caring for others, you should do the same as a physician in medicine. Take care of yourself so that you can provide the best possible care to your patients.

Preparing for Financial Management as a New Physician

As a new attending physician, you’re likely facing a significant jump in income, but also new financial responsibilities and pressures. In fact, this is a moment where most doctors make a mistake? Why? Because of Dennis Diderot. Well, not because of him, but because of a phenomenon named after him called the “Diderot Effect.” The short version of the Diderot Effect is that when you come into a “sudden accumulation of wealth” you are very likely to increase your spending in pretty much every category.

In this physician world, the Diderot Effect looks like graduating residency and then immediately buying the doctor house, the doctor car, putting your kids in private school, traveling lavishly, and buying the clothes befitting of a doctor. Now, these things aren’t bad in and of themselves. However, they are financially catastrophic if you aren’t saving enough for retirement or paying down your student loan burdens (we are here to help with student loan guidance, if you need it).

So, starting out create a budget that prioritizes debt repayment and saving for retirement while still allowing for an increase in spending that allows you to enjoy the reward of the hard work you’ve put in during training. My suggestion? Take 10% of your increase in post-tax pay (the difference between your attending paycheck and your residency paycheck) and spend it on whatever your heart desires. Spend the other 90% on building wealth, including paying down student loans, investing for retirement, etc.

Planning for Retirement Early On

Disability Insurance for Physicians

 

Speaking of retirement… It may seem like retirement is a distant dream when you’re just starting your career. But the earlier you start saving and investing, the more time your money has to grow. It is also paramount to be intentional with your retirement savings. You will not serendipitously arrive at financial independence at the age you want. It takes figuring out the age, how much you’ll need, and saving accordingly the amount you need each year to get to that goal.

So, make sure you enroll in your employer’s retirement plan (401k, 403b) and contribute enough to not only get any matching funds but to be able to retire by the age you want. For many physicians, this will mean maxing out your retirement plans (current max contributions are $23,000 for the 2024 tax year) and opening additional accounts (e.g. 457, Backdoor Roth IRA, taxable brokerage account, etc) to put more money away as well.

Automate your contributions so you’re saving consistently each month. Educate yourself on basic investing principles through a good personal finance book for physicians and choose a diversified portfolio aligned with your risk tolerance. I recommend the Money Meets Medicine podcast to keep you up-to-date on personal finance education. And, if all else fails, don’t be afraid to seek out professional advice from a financial advisor or retirement specialist.

Remember, even small contributions can add up over time thanks to the power of compound interest. The key is to make saving for retirement a habit from day one.

Insurance Needs for Physicians

Beyond the malpractice coverage mentioned above, there are other types of insurance that are crucial for protecting your income and assets.

Arguably, the most important is disability insurance to replace your income if you’re unable to work due to illness or injury. Why? Because while we can teach you everything you want to know about investing or paying off debt, none of that matters if you lose your income. It is your most important asset. So, right off the bat out of training (and ideally before training ends) make sure you get own-occupation disability insurance from an insurance agent you can trust.

Life insurance to provide for your loved ones in the event of your death. We recommend getting term life insurance and skipping the complicated and expensive whole/universal/permanent life insurance often pitched at physicians. It is not the right product for the vast majority of physicians, particularly early in your career.

Health insurance to cover medical expenses for you and your family may include adding another “retirement” account to your repertoire called a Health Savings Account (HSA). As the only triple-tax-free account, it is technically the best account that exists. This is so long as you do not have anticipated high-cost medical expenses each year.

Remember, insurance is all about managing risk. By having the right policies in place, you can have peace of mind knowing that you and your family are protected no matter what life throws your way.

Conclusion

Starting your first job as a physician is a major milestone – one that comes with its fair share of challenges and triumphs. But by being strategic in your job search, advocating for yourself in contract negotiations, prioritizing self-care, and setting yourself on a path to financial freedom; you’ll be well on your way to a fulfilling and successful medical career.

Remember, you’ve worked incredibly hard to get to this point. Don’t be afraid to ask for what you deserve, whether that’s a competitive salary, a manageable schedule, or opportunities for growth. And most importantly, don’t forget to take care of yourself along the way.

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