CHESTThought Leader BlogThoughts for Your First Job Search

Thoughts for Your First Job Search

By: Pooja N. Pandit, MD

This post is part of our Life as a Fellow blog post series, which features “fellow life lessons” from current trainees in leadership with CHEST.

Finding an attending position may be one of the most stressful parts of your third year of fellowship—but it doesn’t have to be! It’s exciting and the first time you truly have control over what you do. Most people recommend starting to look for a job in fall of your third year. Read on for some tips from my experience.

When I grow up…
Pulmonary and critical care offer a wide variety of job possibilities, so it’s important to figure out what you want out of a job. That’s right: YOU! I started out with a notebook where I wrote down my ideal position. Think about your dream job—and dream big. It’s okay if this changes over the course of your job search, I know it certainly did for me. Initially, I was looking at all critical care jobs, but I ended up taking a job that was purely pulmonary!

Some questions to ask yourself: do you want to do all critical care? All pulmonary? If you want to do both, what kind of split do you want? Do you want to do research and stay in academia or do you prefer private practice? Do you want to do bronchoscopies? Does that include EBUS? Do you want inpatient or outpatient? The possibilities are truly endless in PCCM, so it’s important to start out with an idea of what you would like, and refine your ideal situation based on the job market.

Keep in mind location, location, location.
This is a really important one for most people, perhaps even more important than the type of job you really want. The majority of graduating fellows have a certain geographic location they want to stick to, whether that’s for family reasons, a spouse’s job, etc. But, if you are open to exploring different regions, you may find your job opportunities really open up.

The same goes for compensation: places that may be considered less “desirable” to live in typically have better compensation. Likewise, cities that have a surplus of physicians often offer salaries that are less than the national average. This is a very personal decision, so be sure to think long and hard and discuss with loved ones. Also, if you have a particular reason for wanting to be in a geographic area, be sure to put it in your cover letter when you send in a resume.

Utilize your connections.
If you already have institutions in mind, be sure to ask your attendings if they know anyone there. Often, that is the only way to get an interview or a response. Many department chairs are incredibly busy and get a lot of emails—they may miss yours. Also, it’s harder than you think to find the emails of department chairs online. Utilize those connections (including those you may know from social media). Job sites are also helpful: CHEST has an excellent career development webpage that has job postings, as does NEJM.

Prepare for the interview.
I found job interviews to be much more relaxed than those for residency and fellowship. Some may have a different experience, so be sure to ask around (your former co-fellows are a great resource here), and find out what others thought. Most of your future colleagues just want to make sure you are a normal person and that you genuinely care about patients and their well-being.

If you are applying for a job that involves research, be prepared to speak about your research experiences and any grants or funding you have. Also, have lots of questions ready: you are interviewing them just as much as they are interviewing you. This is your chance to make sure that this position would be a good fit. Does it match with your ideal job description? It probably won’t match perfectly, but there is almost always some flexibility involved.

Break out your negotiating skills.
Job contracts can be confusing and hard to navigate. It’s also the first time you have some control over this process—in residency and fellowship, we just had to accept the contract we got. I’ll be honest: most friends and colleagues I’ve spoken to say that the majority of places do not change contracts or negotiate much, but it never hurts to try.

The same goes for having a lawyer review your contract. Even if nothing changes, you need to know what you are signing up for. Find a lawyer who will go through the contract with you line by line and explain what things mean. For example, I had never heard of “tail” coverage before my lawyer explained it to me. Don’t forget to look at the noncompete (especially important if you are geographically limited. What if you start your job and realize it isn’t the right fit?).

With regards to negotiation, never accept the first offer. Most lawyers have access to MGMA data with the median salaries in your field and can tell you if the compensation is appropriate. Don’t be afraid to ask about sign-on bonuses either. And while you may not be able to negotiate for higher compensation, you can negotiate for more time, whether that’s admin time, CME time/money, number of call shifts or weekends, etc.

Lastly, don’t worry if you are not able to change anything in your contract. It can feel like a defeat, but many jobs are set in stone, and administrators or department chairs may not want to upset your future colleagues by giving you a “better” contract than them. Either way, it’s a learning process. After you start your job, you may realize other things you should have asked and negotiated. Your first job is almost never your last job, so you will be able to put this knowledge to use later.

Don’t forget about locums.
Locum tenens is not something most graduates think about, but it’s a great option if you are having difficulty finding a job in your desired area and don’t mind traveling or if credentialing is taking a long time (as it did in my case). Both critical care and pulmonary locums positions are available across the country and may not necessarily require a firm time commitment. I was able to do two 1-week critical care locums positions and did not have to offer up other days or weeks to work. It helped financially between fellowship and attending life and also allowed me to have more time off, which was much needed after many years of training.

Talking to friends and former co-fellows, as well as attendings who recently went through the job search, is one of the best ways to learn more. Finding a job is stressful, but it’s also thrilling. Being done with training is a huge accomplishment. Don’t be afraid to ask questions, and go for what you want.

Pooja N. Pandit, MD

Pooja N. Pandit, MD

Dr. Pandit is an associate at Northern Virginia Pulmonary & Critical Care Associates in Northern Virginia. She was chief fellow in pulmonary and critical care at Thomas Jefferson University Hospital and finished her training in June 2021. She completed her internal medicine residency at Rhode Island Hospital/Brown University. Her clinical interests include ARDS, bronchiectasis, women's health, and resource utilization, as well as medical education and teaching. Dr. Pandit is a fellow-in-training member of the CHEST Airways Disorders Network (Bronchiectasis Section) and a member of the CHEST Trainee Work Group. She served also as a fellow-in-training member of the CHEST Women's Lung Health Network Steering Committee.