While you’re still approaching it, the end of residency feels like the culmination of years of hard work, sacrifice, and dedication. It feels like finally, you’re at the end of the tunnel and you can relax. The reality, though, is that the end of residency marks a transition, just like several transitions we’ve already gone through as seasoned medical professionals – from high school student to undergraduate, undergraduate to medical student, medical student to resident, and then resident to attending. Just like the transitions that have preceded it, it’s important to be an informed participant in this next stage of your career, finding your first position as an attending. Several previous articles have addressed the need to carefully examine contracts, know your worth to the health system, and approach the process with eyes wide open. Because of this, I’ll focus on what aspects of positions I, as a neurosurgery resident, will be looking at when it comes time to find my first attending position.
A Position as a Hospital Employee
The norm when most of my mentors were training was for surgeons, and especially subspecialty surgeons to own their own private practices. This was purported to allow not only more autonomy for the surgeons who ran these practices free from hospital administrator oversight, but also the chance for a more lucrative income which was based solely on one’s individual productivity. In contrast to this setup, hospital employment of subspecialty surgeons, such as cardiothoracic surgeons and neurosurgeons is on the rise. I will personally be looking for a position with this type of employment set-up, because I believe it will allow me to focus more on delivering healthcare to my patients rather than the nuts and bolts of running a private practice. While the compensation may be less than I could earn independently, I and a number of my peers, place a premium on being able to focus on operating and taking care of patients rather than the small business aspects of managing a practice.
An Environment that Promotes Mentorship
At every step in the way of my medical education, it was hammered into me that medicine is a team sport. This is true in almost every aspect of patient care and in the development of a young surgeon. One of the most important factors in my choosing neurosurgery and in my progression as a surgeon has been the encouragement and teaching of mentors. Mentors help to guide your progress and support your career from an early stage. No matter what type of practice you choose, finding an environment where the more senior surgeons embrace their role as mentor is key. The culmination of residency does not mark the creation of an expert physician, but rather a safe physician. Finding mentors as a junior attending is an important part of continuing your development towards becoming an excellent physician or surgeon.
This aspect is even more crucial for someone seeking employment over private practice. In private practice, the more senior physicians have a vested interest in your success and increased productivity – it improves their income as well. In an employment environment, there may be no external motivator for a senior physician to mentor you, and there may even be disincentive – they’re not able to complete as many cases or see as many patients if they’re spending a significant amount of time on teaching or double-scrubbing cases to help teach. Because of these factors, finding an environment that promotes mentorship and continued learning is probably the single most important factor I will be considering when evaluating positions.
Evidence of the Hospital’s Investment in My Success
This aspect is trickier than the others, as there’s no one metric I will be assessing. Some of the commonly cited aspects new neurosurgeons should consider are the hospital’s commitment to buying new technologies, provisions for block operating time, and dedicated time and support for continuing medical education. These, in and of themselves, seem relatively small, but numerous more senior attendings have reiterated to me the importance of the details when it comes to quality of life. Evidence of your future employer’s investment in you may be different depending on your specialty and may be more focused on frequency of call or willingness to provide advanced practice practitioners or medical scribes. Whatever the evidence, it’s important to consider what details matter to you and bring them up when assessing each potential job prospect.
Ultimately, the factors that you’ll consider as your look for your first job are personal and largely depend on what you value. For me, as a neurosurgery resident, I value continued mentorship as well as being able to focus on operating as much as possible. In addition, I want to join a healthcare system that values my contributions and is willing to work with me to make investments that I consider important in my work environment. You should discuss the process with junior attendings you may know or recent residency graduates to find out what their experiences were and what you should be considering when it’s your turn to find a position. In the final analysis, the most important thing to consider is your happiness, because as an early career attending, you will likely be working long hours, and you want to ensure that you enjoy the environment and the people with whom you’ve chosen to surround yourself.