The (Temporary) First Job #illumedati 3

Hey everyone, it’s Medicine Mondays again… and this is kind of a followup to my previous post, Choosing Your First Job. This post will go into a little more depth about The First Job, more specifically, about choosing a first job with a “temporary” mindset.

Stock Photo from: Pexels

What do you mean by “Temporary First Job”?

Well, I think a few things go through your mind when it’s your last year of residency/fellowship. After the long training, you need to start looking for a job. For some of you that means dusting off your interview attire again and trying to put together some semblance of a Curriculum Vitae. Weighing on the back of your mind are your significant student loans, but all you really want to do is go start your “real life”.

I understand.

There are a few different scenarios that play out in the “temporary first job”:

The Forever Fellow

Some of you will try to go the path of least resistance, such as staying on at your program to “get more experience”. It’s kind of scary to leave “the nest” and it is comfortable to stay at your program where you know how everything works.

Here’s the problem… if you’re a fellow and you stay on, you’ll always be a fellow.

June 30th was your last day of Fellowship, and then July 1 comes and *BOOM* you’re an attending. However, you don’t just stand toe to toe with all the other attendings that just taught you yesterday. They have more experience than you, you were their fellow… you’ll always be their fellow.


Well not really… but this can take some time to go away… or it may not go away until the next “forever fellow” comes through. Either way, unless your plan was to stay at that program forever, this is likely a temporary arrangement. If that is the case, you are just delaying the inevitable time when you will leave and go out into the real world by yourself. Perhaps those few extra years you stayed on and worked at your program will help you gain confidence in your skills and ease the transition a little.

I can’t deny this possibility.

However, those years you stayed at your program in this limbo as a “Junior Attending / Used to Be Our Fellow” you could have been somewhere else gaining more experience. For some specialties, the difference in a few years could be the difference between partner salary and associate salary. This could be substantial. 

Additionally, since you stayed at your program, I’m not really sure it counts as a real “first job”. If you recall my “Choosing Your First Job” post, you may recall most physicians don’t stay at their first job (or even their second). So, if you spend 3 years at your program to gain more experience, and then spend another 3 years at your “real first job” before you decide to move on… then you’ve kind of wasted 6 years.

6 years of seniority you could have had might be substantial.

For example, let’s say an attending physician makes $200,000 as an associate, but $300,000 as a partner. In the example above, by delaying a possible partnership track, you will have given up $600,000. That’s not small chunk of change.

The Frugal Wanderer

For some, you will be finishing up your last year and then realize that the $250,000 in medical school loans you took out is now $400,000. After the initial shock, you start thinking to yourself, I can make this go away, I’ll just go work somewhere and pay it all off in like 5 years and just make it gone.

For example, let’s say you are originally from New York, but decided to work in somewhere like North Dakota which pays its physicians pretty well (relative to other states) and also has pretty low cost of living.

Trust me, I thought about doing this too. 

However, after giving it some real thought, it would almost certainly have been a temporary arrangement. I don’t have any friends or family in North Dakota and neither does my wife. Is it possible that we would have moved to North Dakota and really liked it? Yes, it’s possible… but risky… and probably unlikely.

So…? Who cares if it’s temporary… You always say live like a resident and pay off your student loans.

You’re right, I do say that. However, there are a few disadvantages that may not be readily evident.

Opportunity cost – Just like the “Forever Fellow”, you are giving up 5+ years in an area that you will probably not stay. Then you will most likely move somewhere else and start as an associate and be the “low man on the totem pole” again, with no seniority. Or, in the 5 years, you may have made partner already, which may make it more difficult to leave.

Low Cost of Living – You may grow accustomed to the low cost of living as your dollar goes farther. Rent and household goods are cheaper. Houses are cheaper. Maybe you even bought a nice house in your 5 years there. It may be hard to adjust to a more “normal” cost of living and “normal” housing prices when you move. It may also make it difficult to sell your house when you leave. This is significantly worse if your plan was to move to an area with a high cost of living (NYC, SF, Honolulu, etc.)

Moving – Having to move eventually may eat into the “extra money” you made, unless your new job covers moving costs.

I’m not saying this is impossible. However, it’s easier said than done to just go live somewhere for a higher salary and lower cost of living. If you can do it, that’s great, but just remember that it’s not “free”, there is still an opportunity cost.

The Yolo Wanderer

This one is for the person who is just wants to go somewhere different. Maybe they want to go do a few years in New York City and live the “Sex in the City” life, or just live in San Francisco for a few years because they’ve always wanted to live in the Bay Area. Or maybe they just want to be somewhere warm for a few years, and want to move to Hawaii for a few years or something.

Just remember that those student loans are still accumulating interest. Also, all of the places I mention above have a ridiculously high cost of living while their physician pay is not all that competitive. The above Opportunity Cost and Moving disadvantages I described above still hold true, just with the additional burden of student loans weighing you down.

With the higher cost of living, the ability to pay off your loans in a reasonable time frame decreased pretty significantly.

I’m not saying this is a horrible idea. I’m just saying make sure you have a plan to deal with your loans. Make sure the increased cost of living and opportunity cost are really worth it to you.

The Rushed First Job

Let’s say your significant other finds their dream job somewhere. So you rush to find a job in the same area as the job they just found, and you don’t want too much of a gap between finishing residency/fellowship in June and starting the new job… so you rush.

You may go on 2 or 3 interviews and then just quickly accept a job that seems “ok”. It’s not “horrible” and you tell yourself it’s just a temporary arrangement.

Then you start the job and it’s kind of what you expected. It’s “not bad”. Then things that you don’t like start to bother you. However, it’s not enough to make you start looking for another job. So maybe a few years go by and you still don’t really like the job that much and then it starts to annoy you. Finally, you start to look at other job opportunities.

Here’s the deal though, you already have this job. The “next job” has to be definitively better than your current job. The reason for this is because you aren’t leaving this job for location reasons, or because your significant other is moving, or for family or whatever. You are leaving because the next job has to be better.

That’s a difficult decision to make prospectively, without having worked at both jobs.

The unknown is scary.

For that reason, you may put off looking for a new job for awhile… much longer than you ever thought. You may even go on a few interviews and get a few job offers. However, in the end, changing jobs is difficult. The fear of the unknown… the possibility that this new job, while sounding great on paper, may be worse. The job you know versus the job you want.

Sometimes you don’t have any choice but to take a suboptimal job. However, if you can help it, do your best to research as much as possible. Talk to colleagues you trust and go on a lot of interviews.

Also, remember that no matter what your first, second, or 10th job is… make sure you understand your physician contract, more specifically your termination clauses and restrictive covenants (non-competes). Also, remember to understand your malpractice insurance.

Read the Physician Contract Series  – 1 2 3

Just remember that no matter how much you know, you will never know as much as a lawyer who deals with physician contracts all the time, day in and day out.

You don’t know what you don’t know.


Choosing Your First Job is difficult.

Leaving a Temporary First Job is harder than you think.

Maybe you want to stay in your comfort zone, like the Forever Fellow. However, if you don’t plan to stay forever, you are probably just wasting your time.

Even if your intentions are good, like the Frugal Wanderer, trying to pay off your loans as soon as possible. Every decision has ramifications, and the opportunity cost may be difficult to see.

Sometimes, you just want to get away, like the Yolo Wanderer. However, your student loans don’t care, they will continue to accrue interest.

Unfortunately, sometimes outside circumstances force you into a Rushed First Job. Be honest with yourself about the job. Don’t stay if you don’t like it.

Whatever job you get, make sure you look at your contract carefully, with a professional. Read the Physician Contract Series  – 1 2 3



Agree? Disagree? Questions, Comments and Suggestions are welcome.

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