As you approach the end of your fellowship training, you’re likely experiencing a wide assortment of emotions: jubilation to finally be a practicing gastroenterologist, trepidation at no longer having an attending over your shoulder, excitement to earn a substantially larger income, and stress with navigating a move and the horror that is credentialing. While our mentors give us invaluable guidance to navigate these next steps in our journey, you step into so much unknown your first year in practice. I entered mine at a turbulent time -- COVID had ravaged the world and healthcare system during my advanced endoscopy fellowship. Several institutions remained on hiring freezes or rescinded previous job offers to early-career gastroenterologists. I was grateful to circumnavigate such rough seas and land a well-compensated position with high volume advanced cases, and at an institution that was excited to bring in new endoscopic technologies.
Unfortunately, several aspects of my role became challenging and, ultimately, unsustainable. My body took a physical toll from a heavy call burden and lack of breaks between long procedure days. My earning potential became capped as I did not have the option for group buy-in and my hospital denied inflationary salary increase requests. The culture of the institution remained fixed on a previous group’s practice, limiting the ability for me and my partners to perform our roles with full autonomy. Within my first year in practice, it became evident this position was not aligning with my goals, and I resigned.
As physicians, we are inherently resilient by way of our grueling training. It can feel demoralizing to realize an attending position no longer serves us, but multiple studies found approximately half of new physicians leave their first job within 3 years. As such, we need to ask the questions, especially the uncomfortable ones, that will truly determine if a role is a good fit. It is imperative to understand not only what your compensation will be upon signing, but how it changes in the future. If you are not receiving incremental increases or the ability to promote to another level, you are accepting a pay decrease due to inflation. You must ask not only how frequent the call expectation is, but where emergent/weekend cases are performed, what support staff you have, and contingency plans for illness or reduced physician staffing. If you are joining a private practice, inquire about buy-in, and, the group’s financials to avoid pitfalls. When considering a position, be sure to understand and negotiate the provisions related to leaving, including the notice period, bonus payback policies, and noncompete covenants, since they may limit your flexibility later on.
Most important of all, know that leaving a position does not mean you have failed. It means you have identified your values and given yourself the opportunity to find a role that better aligns with you. We are all deserving of clinical roles that allow for maximal fulfillment.
Author
Dr. Anjuli Luthra is a therapeutic endoscopist and physician entrepreneur based in Tampa, Florida. She has recently transitioned from employed gastroenterology practice to locums in order to facilitate her roles as a small business owner providing financial education for healthcare professionals and young women, medical device consulting, and creative writing.