Navigating Your First Attending Job: Tips from an Entrepreneurial Physician

I had a resident reach out to me recently and ask for help as they prepared to launch their first job as an attending. Their question was simple, “Give me some tips.”

My number one recommendation for any resident in this position is this: incorporate yourself during residency and enter the marketplace as a micro-business, requesting a PSA (Professional Services Agreement), rather than solely signing on as a W-2 employee in a traditional employment contract. To learn more read my post 20 Reasons Every Resident Should Form A Micro-Corporation

At a minimum, you should consider job stacking by combining 1099 work with less than full-time (1.0 FTE) W-2 employment. This approach will give you flexibility, autonomy, and increased earning potential right from the start.

Embrace the Entrepreneurial Mindset Early

The transition from residency to becoming an attending physician is monumental. After years of hard work, you're finally nearing the goal you’ve been chasing since medical school. You didn't go through all of that just to settle for a one-size-fits-all job. But how do you navigate this next chapter with purpose and control over your professional destiny?

Incorporating yourself before you start practicing as an attending puts you in the driver’s seat of your career. As a micro-business, you have the flexibility to work as a contractor under a PSA, which allows you to negotiate on your own terms, keep a portion of your earnings within your business, and create multiple revenue streams through job stacking or side hustles. This shift in thinking—from being an employee to being a business owner—will empower you to make choices that align with your values, lifestyle, and financial goals.

Resident Question: Leveraging Networks for Relocation

A resident posed an intriguing question:

I'm pondering how best to approach this upcoming phase as a new attending, particularly with regional preferences and plans for relocation in mind. Before medical school, my experience with my work made job hunting quite simple—just submit a resume. However, now I'm contemplating how to best search for a job as a doctor?"

First of all, congratulations! Reaching the end of your training is a huge accomplishment. You’ve been working for years to get to this point, and you're about to start your attending career. This next chapter is all about identifying what’s most important to you—and there’s a lot to consider beyond location, salary, or scope of practice.

Start by defining your priorities. Location is an obvious one, but other factors include the practice setting (academic versus private), job structure, and what kind of support and mentorship you’ll receive.

It’s also important to accept that your first attending job might not be where you’ll stay long-term—and that’s okay. The average physician only stays in their first attending job for 3-5 years. Think of it as an extension of your training where you’ll hone your professional skills, especially as an independent practitioner. Use this time to gain experience, refine what you enjoy doing, and develop the skills you need for your long-term career.

Building Your Career with Flexibility and Options

During your first few years out of residency, try to keep your skillset broad. Even though you likely trained to practice across a range of specialties, many physicians begin to narrow their scope of practice early on. Keeping up a wide array of skills means you have more options as your career evolves.

For example, when I started my career, I routinely performed lumbar punctures—something I didn’t particularly enjoy due to the stress involved. Over time, I decided to drop that procedure from my practice and now have IR perform the procedure. The point is, in the early years, keep your options open. That way, when you’re ready to make a change, you won’t be limited by a narrow skillset.

Finding Your First Attending Job

Once you know your criteria, it’s time to start the job hunt. Here’s where networking plays a crucial role. Medicine is a small world, and your network can be the most powerful tool for finding opportunities. Put the word out that you're looking for a position and be specific about what you want. Reach out to colleagues, mentors, and contacts from your training program. Many physicians have landed dream jobs simply through word of mouth.

This is exactly how I landed my job in rural Indiana nearly 30 years ago. I reached out to a medical school friend who had started working near where I wanted to be. I asked if he knew of any jobs, and he said, "We're looking for someone." The rest is history.

Don’t forget to check your specialty’s job boards and hospital websites. Sometimes the best jobs aren’t widely advertised, so it pays to be proactive and dig a little deeper. I’ve even found great opportunities just by regularly checking a hospital’s website.

Headhunters: Proceed with Caution

While engaging with headhunters can be a perfectly viable strategy in your job search, it's crucial to keep in mind that these professionals primarily serve the interests of employers rather than job seekers like yourself. As intermediaries, their primary goal is to fill positions for their clients, and they often earn a commission based on successful placements. This dynamic can sometimes lead them to promote opportunities that may not align perfectly with your career aspirations or personal needs. Be mindful of the allure presented by enticing offers such as complimentary flights, luxurious hotel stays, or other appealing perks during the interview process. Though these benefits may seem tempting, they should not cloud your judgment about whether a role truly suits you.

Instead, consider these experiences as valuable opportunities for practice and information gathering. Approach each interview with an analytical mindset, using it as a chance to learn more about the industry and potential employers while honing your interviewing skills. Above all else, exercise caution when it comes to accepting sign-on bonuses prematurely. During periods like residency or early career stages when long-term goals are still being shaped, committing to such bonuses can inadvertently tether you to a position that might not fulfill your future ambitions or fit into your evolving life circumstances. By avoiding these binding agreements initially, you'll maintain greater flexibility and freedom to pivot toward roles better aligned with your growth and satisfaction down the road. In essence, preserving this mobility allows you to remain adaptable in an ever-changing job market landscape where opportunities arise frequently but require careful consideration before making any lasting commitments.

Even if you’re eager to secure your first job, don’t rush the contract negotiations. Hire someone to review you contract, it will be worth every dollar. A poorly structured contract can turn an otherwise good job into a nightmare. Here are some key clauses to watch out for:

Non-Compete Clauses

While the Federal Trade Commission recently ruled against non-compete clauses, ongoing litigation may challenge that decision. You should assume that non-competes still apply to you. Make sure the duration and geographic scope are reasonable. For example, one year may be acceptable, but five years is not. Similarly, in a densely populated area, a two-block radius may make sense, but in a rural setting, a 50-mile radius is likely unreasonable.

Why You Should Incorporate During Residency

So why is it so important to incorporate yourself during residency? As a micro-business, you have more control over your income and work conditions. You can negotiate contracts like a PSA, where you’re paid directly by the hospital or practice for your services, keeping you independent of many restrictions placed on W-2 employees. You can read more at my blog 3 Reasons You Should Create A Professional Micro-Corporation

Additionally, you have the potential to job stack, combining a part-time W-2 position with lucrative 1099 work, such as locums or telemedicine. This strategy not only diversifies your income but also helps you build multiple streams of revenue, giving you financial stability and professional flexibility.

Take Control of Your Career with SimpliMD

If you're feeling overwhelmed by the complexities of contracts, job stacking, or starting your own micro-corporation, SimpliMD is here to help. I offer personalized micro-business consultations for only $99. This includes a one-year membership to SimpliMD, valued at $2,500, giving you access to exclusive business tools, resources, and guidance to help you succeed as an independent physician.

If you know you want to venture out into a solo micro-practice (like DPC) when you launch your career, you will really benefit from a business plan. I offer a micro-business plan for your purchase right here at SimpliMD for only $99. Don’t miss out on this resource!

Learn How to Create a Practice Without Walls

Interested in going deeper into the world of self-employment and micro-business ownership? I highly recommend enrolling in my course, “Creating a Practice Without Walls.” You’ll learn how to form a micro-corporation that gives you agency in the marketplace, allowing you to build a career that’s both financially rewarding and professionally fulfilling.