Finding a First Job: Lessons Learned

By Damien J. LaPar, MD, MSc

November 8, 2018

The scenario is all too familiar. You’re in the homestretch of your surgical training, you’re tired, your character and constitution are hardened, and your loved ones can’t wait for you to take the next step. The importance and reality of finding your first job hits you like a ton of bricks, leaving you with several questions.

Don’t worry—you’re not alone. Below, I’ve outlined common questions that trainees ask themselves while job hunting and provided guidance on how to successfully navigate the process.

What is my first job supposed to look like? There isn’t a template for what your first job should look like; junior surgeons often are hired to fill a practice gap (and sometimes an academic research gap) within a given department. This may manifest as a program looking to expand a transplant service or a specific clinical program. Your first job should provide appropriate surgical volume to accommodate your continued growth with a plan for moving toward complete surgical independence, as well as appropriate senior-level support for complex cases and surgical mentorship. If you want an academic surgical career, your first job should provide an appropriate commitment (i.e., “protected time”) to fostering your academic and research agenda.

Your first job should provide appropriate surgical volume to accommodate your continued growth with a plan for moving toward complete surgical independence.

How do I find available jobs? While the CTSNet job board is a good starting point, most early career surgeons learn of employment opportunities through direct surgeon contacts or mentors. In addition, new surgeons may inquire about job openings by forwarding a letter of inquiry and curriculum vitae to a given center. Perhaps the most important aspect is keeping an open mind. Narrowing your focus or scope of practice too much will undoubtedly limit your potential opportunities.

Who can I ask for advice on whether a job is a good job? First, engage any and all senior mentors you may have to help you analyze a given job. Remember, your mentors have been through this process before, so they know what the upsides and downsides of most first jobs look like. They also can provide useful counsel regarding the landmines that exist in early careers. When evaluating academic opportunities, utilize mentors to help you analyze whether the “academic package” is realistic.

Second, trust your instincts. Only you know how important certain details are for you and/or your family (e.g., location, cost of living, schools for kids, call schedules, and availability of senior partners/mentors). You also likely have a proven track record to yourself on successfully evaluating situations and making important decisions at this stage of your life. Do not discount the visceral feelings you have when evaluating different job opportunities. They are usually the best measure of your ultimate happiness and success. 

Do not discount the visceral feelings you have when evaluating different job opportunities.

How do I navigate the negotiation and contract process? If you ask 10 surgeons how to negotiate your first employment contract, you will likely get 12 different answers. This is because there really is no correct answer. Ensure that certain aspects of your contract, including employment role, academic title, salary, scope of practice, and health insurance coverage, are sound and clear. Much of the variation in contract negotiation is related to fringe benefits, including signing bonuses, retirement plan opportunities, private school and/or college tuition programs for children, and mortgage assistance programs, so inquire about everything. (If you do receive a signing bonus prior to starting your job, you may be responsible for paying taxes on it, so negotiate accordingly.) 

I also recommend hiring an employment attorney—preferably one who works with physicians on employment contracts—to review your contract before signing. He or she can evaluate the contract for anything that may be missing or deficient and which would be of great interest to you. Finally, be very realistic with what your needs are when negotiating research and academic resources. If you don’t get what you need to succeed, you will likely fail early in this area of your career.

How do I evaluate academic versus non-academic jobs? The answer to this is actually quite simple. Ask yourself whether you want to spend each day of your career in an academic setting or in one focused principally on patient care. Academic jobs may exist in both university-based and non-university-based programs. Strong academic jobs provide not only the philosophical support for academic progress, but demonstrate an appropriate financial and physical infrastructure that is accessible to you. Once again, seek the advice of academic mentors to help you evaluate the infrastructure that may or may not exist. Also, ask yourself how committed you are to surgical trainee (resident and fellow) education. One of the most important aspects of an academic career is mentoring and training the next generation of cardiothoracic surgeons. If this isn’t your bag, that is fine – just be honest with yourself so that you can ensure happiness and success early in your career.

Good luck, and enjoy this exciting transition in your life. You’ve certainly earned and deserve the fruits of your labor!

The opinions expressed in this article are those of the author and do not necessarily reflect the views of The Society of Thoracic Surgeons.

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