Things I Wish I Would Have Known Graduating Residency

There is a lot of growth and change required from when a doctor is in training to being an attending. Often there is a lot of stress that goes along with this change. The feeling of being out on your own, no safety net of your program anymore is a weird feeling when you first make that transition.

I wanted to look back at the things that I wish I would have known upon graduating residency about the practice of medicine or my life post-graduation. Some of these will also be things that I’m very glad that I did after graduation.

Academics Is A Bubble

I am not referring to academics being an investment bubble.

Academics is its own culture that can differ quite a bit from how medicine is practiced outside of the walls of the institution.

I trained in a wonderful university-based program, with three hospitals we rotated through. However, almost none of these rotations were with groups outside of academia. Don’t get me wrong. I loved my training as much as you can love training. The long shifts were brutal, and unnecessary, but that is a different debate.

All my advisors in academic medicine before I graduated were wonderful doctors. However, none of my advisors had any experience of practicing medicine outside academics. These types of doctors were what we called “lifers”

They spent their entire life or career inside of academics. They graduated college, went straight to medical school, then residency, possibly fellowship, then immediately were hired by the academic center to work as a physician.

I felt like there were not a lot of ways for me to learn about life outside of medicine in academics. I had no idea how sheltered training can be from private practice.

For any resident or fellow, I would encourage you to reach out and join Facebook groups or forums for your specialty. Private practice is a huge world out there and you need to know what your options are. You need to get to know what is going on in your specialty outside of academics.

You Will Pay A Price For A Good Name

When I graduated residency, I was between being a hospitalist or outpatient internist. I had my first job interview with an outpatient primary care clinic. They kept bragging about their name recognition, how great the medical facilities were, how big they were as a group. They also named dropped about how they sponsored a local sports team.

I could not help but get the feeling that they were selling me on how great they are and how grateful I should be to work at such a wonderful place. Then they hit me with the starting offer.

The starting salary that they offered me… $145,000 a year.

While I am sure this is a wonderful group of doctors to work with, the salary was a bit of a slap in the face. As I have grown as a physician and businessperson, I now realize that all that big fancy stuff means big overhead.

My paycheck was going to those marble floors, that ridiculously big check-in area with nice fountains and sculptures everywhere. My salary was also contributing to the CEOs multimillion dollar salary for running the organization. It also contributed to sponsoring the local sports team.

My brother and his business are current sponsors for the same local sports team. Did you know that they give you box tickets to sporting events with your own chef? He also gets to do a meet and greet with the players where he gets a signed ball from the team. Funny how I was never offered that perk for working for the organization.

If you see flashy things, your salary is going to pay for those things. Think about overhead anywhere you take a job.

The More Desirable The City And Less Specialized You Are, The Less You Can Negotiate

This may seem like commonsense. I am in internal medicine. There are a lot of us graduating residency every year. Even though there is a doctor shortage, a lot of these doctors flock to major desirable cities. I happen to live in one of those more desirable cities. When I interviewed for my first job, I tried to negotiate a contract with the group. The CEO for the group was very blunt. My contract was a take it or leave it contract. If I did not take it, there are overall twenty doctors who would be willing to take the job that I interviewed for.

You don’t have much leverage in this type of situation. I hired a lawyer to review my contract and, in the end, it didn’t change anything for me. My lawyer also just basically read the contract back to me in regular terms. I walked away from it feeling like it was a huge waste of $600.

I have gotten to know the owner of Contract Diagnostics, and I will say that I wish I would have used his service. He talks to a lot of doctors who were in my shoes. He gave me a lot of life advice about what to expect with a group like this if I took the job. ***Note, they are a sponsor of this blog****

Pay Down Debt

Working my butt off, picking up extra shifts and spending that money paying off my student loans was probably one of the best things that I did upon graduation.

Whenever things went south with my previous group, I had the financial ability to not have those loans hanging over my head to start my own practice.

That has ballooned to possibly the best investment I’ve ever had. Starting my own private practice.

If I had kept my debt obligations high, I most likely would not have taken the risk to start my own practice. I would have taken the sure job making significantly less money working for someone else.

Not all debt is bad. However, keep debt to a minimum until you find your path to how you want to practice medicine. It keeps many more doors open.

Don’t Buy A House Right Away

I did not buy a house right away after graduating residency. However, I am still listing this one because I thought when I joined my group, I was in a city I love with a group I love and thought it would be there forever. That job lasted about 2 years and then I moved to the completely other side of town.

If I had bought right upon taking my first job, I would have had more debt, more roots holding me down. I don’t think I would have started my practice up.

Build Assets

The more assets you can build that bring in some level of income, the more freedom you will eventually have.

I have been accumulating assets such as commercial real estate that I practice out of, and now a new rental house.

You need to diversify and have other assets beyond relying on medicine for every dollar you earn in the future.

Keep A Pulse On Burnout

I worked my butt off to pay off my student debt. However, I went too far. I was starting to burn out, I was starting to get angry and snappy with my wife. I was even starting to have palpitations (probably PVCs) from lack of sleep and working 28 days a month, often 12-hour shifts.

Life is a marathon, and I went overboard. Looking back, I could have done this much smarter and not exhausted myself. Keep a pulse on burnout and if you are not having a good balance in your life. If you start finding yourself being snappy with your significant other, complaining too much at work. You most likely need to rebalance your life.

Spend Some Cash

If you were like me, you probably lived like a resident for many years. Life is short, we diagnosed people with sad and unfortunate conditions every day. Do not be afraid to spend a little bit of money for your personal enjoyment. If that means living in a downtown apartment, we can walk to live music every night you are off, do it.

If that means joining a boat club where you can hop in and go to the lake every weekend, do it.

Money is a means to enjoy your hard work. Don’t feel like you cannot enjoy yourself a bit. You don’t need to be a martyr.

Even Physician Owned Groups Can Screw You Over

If you think that venture capital groups are the only groups that might screw you over after graduating residency, you are going to be wrong.

While I would not advise thinking every job is going to screw you over. I would not go into a job thinking just because they are “physician owned and operated” that they will not financially hurt you.

There are tons of stories about doctors holding partnerships out there those other doctors can never obtain. There are also lots of stories about older doctors selling practices to larger venture capital groups before other doctors can join partnership.

Don’t count your investments until the ink is dry. This includes buying into partnerships with a physician owned group.


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3 thoughts on “Things I Wish I Would Have Known Graduating Residency

  • April 23, 2022 at 10:08 AM

    Great Article! Very helpful as I start my first attending job soon.

    • April 24, 2022 at 5:32 AM

      Thanks for following along, happy to help in any way that I can!

  • April 25, 2022 at 11:16 AM

    Sage advice! You echoed so many of my own trials after graduation. They really don’t teach you private practice in training.


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