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After the Match: The Agony of Treading Water

Cook, Thomas MD

doi: 10.1097/01.EEM.0000511114.72473.f7
After the Match

Dr. Cookis the program director of the emergency medicine residency at Palmetto Health Richland in Columbia, SC. He is also the founder of 3rd Rock Ultrasound (http://emergencyultrasound.com). Friend him atwww.facebook.com/3rdRockUltrasound, follow him on Twitter @3rdRockUS, and read his past columns athttp://bit.ly/EMNMatch.

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One of my residents accepted her first job offer last year and was planning to move 1,500 miles away. She had completed her undergraduate and medical degrees at our university and stayed for her residency. She decided to move away from the home she had known for 11 years.

Like a lot of residents in their last year of training, she thought it was time for a change. A good friend and classmate of hers was heading back to Dallas, and we already had several great alumni who were happy there. Her initial geographic interests for jobs did not pan out, so this seemed like the next best thing. I had sensed for a while that she was having second thoughts, so I advised her not to force the decision. She thought it over, and elected to stay in South Carolina a little longer.

Most senior residents will have committed to their first job by December of their last year. It's one of the most exciting decisions, but there is also a lot of stress that goes with it. It's fun to have potential employers pay so much attention to you. Your education and talents generate offers that include annual salaries that exceed the combined income of every job you have had in your entire life.

What if you cannot find a job that you really want? This can create a lot of anxiety. Most of your classmates are excited to tell you about the new job they have accepted, and after years of school and training, you just want to get on with your life.

I think it's important to compare your situation with others of your generation, especially those who are not in medicine. The difference is astonishing. Millennials will average four job changes by the time they are 32 and up to a dozen during their career. This can involve multiple relocations. It is very unlikely, however, that a physician will do this. Physicians are risk averse by nature; we tend to be conservative in our behavior and lead stable lifestyles. Program directors are in a unique position to witness this firsthand.

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The Immobile Physician

Anytime a residency grad gets a new job or moves to another state and requires a new medical license, a number of forms pass through the desk of his program director. They all ask the same questions: dates of training, past disciplinary actions, and medical or mental health issues that could prevent the physician from adequately performing his duties. These forms also give the program director a snapshot of how often physicians change jobs or move: It does not happen often.

More than two or three job changes in a career is uncommon. By the time a resident graduates, he is older, suddenly has a large income, and tends to buy a larger home. Like all adults in their 20s, he is much more likely to get married and start a family. All this makes it that much harder to pick up and move again.

Nearly all residents are lulled into thinking they will have more free time when they are done with residency, but that is often not the case. The expression that “time is money” really applies when you start your first job. You will be paying down a large student loan and have a more expensive lifestyle, so you will work a lot more hours early in your career to compensate for that. The last thing you want is to look for a new job shortly after you start your first one.

I have had several residents struggle with this decision. A few will delay until just before graduation to commit half-heartedly to a job that might not work out. Many more take a different approach. They tread water. As the expression implies, they are moving without going anywhere. This is agony for a lot of residents. They want to get going, and sticking around the mother ship is not what they had in mind.

But why push the decision when you may not need to? Many residents are already moonlighting in other EDs near their training hospital, and the faculty of many programs belong to groups that cover nonteaching hospitals as well. These EDs need to be staffed with great people they trust (like you). Why rush into the next 30 years of your life? Stick around for a while, work a little less while living in your current place, pay down some debt, and study for the boards without having to worry so much about fixing up a new home, finding work for your significant other, or getting your kids set up at a good daycare or new school.

We've had several grads work for two or three years at the other hospitals we cover, affording them the luxury to refine their clinical skills while developing a better understanding of what they really want from their careers and their lives.

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