January 20, 2019

3 Things to Consider Before Residency Ends and Full-Time Work Begins

With a projected physician shortage of ~100,000 by 2025, you’re a hot commodity coming out of residency. But you don’t want to be thrown to the recruiter wolves unprepared. Think about what you’re looking for in a job and educate yourself now on how to navigate your career fresh out of residency.

Two big factors in selecting a group after your residency ends are location and size. Do you want to live in the suburbs, an urban area or a rural area? Do you prefer a large or small group? Consider the tips below to keep your career on track and avoid mistakes made by me and other EM colleagues.

1) Location, location, location… of Practice

Choosing where you (and possibly your family) are going to live and work for the next several years is a difficult and complicated decision. You’ll have to think about family and friend considerations, avocations, the weather, among other factors. As mentioned previously, you’re a hot commodity and will have your pick of locations whether it’s in the same state as your residency or the other side of the country.

I divide location into three categories: urban, suburban, and rural each broken down by pros and cons.



More diverse facility and job options. Depending on the city there can be a range of facilities from Urgent Cares, Freestanding Emergency Departments, Hospitals, Surgery Centers, etc.
Larger patient populations generally attract a larger specialty base. Greater access to specialists for referrals and consultation (ie. more neurosurgeons, pediatric specialists, ENTs, etc).
Greater access to urban amenities like restaurants and entertainment.


There’s usually more physicians in the area resulting in greater competition and lower salaries overall.
Practices can be affiliated with more than one facility with higher on-call responsibilities



Lower density of physicians and less competition resulting in higher salaries.
More sophisticated medical facilities since these areas are by and large newer, master planned communities.
You’ll generally find better schools, community organizations, local government oversight, and local college influence


More specialization in practices, which makes it difficult for new physicians and surgeons to practice in a field without a fellowship and board certification.
Less entertainment value than the big city. If you don’t have family, consider moving closer to the urban core.



Lower cost of living overall.

Higher demand for physicians and low competition equals higher salary.
You practice as more of a generalist since there are fewer speciality practices and available specialists.


Smaller population size and less sophisticated facilities.
Lack of subspecialty support.
On-call responsibilities tend to be more demanding due to the lack of support. Rather than being limited to your specialty, you may be required to provide whatever care is needed in an emergency.

2) Type of Group

Your next big decision is what size of group do you want to work for. Contract management groups such as EmCare and TeamHealth are what we consider large groups. They bid for multiple contracts with hospitals and are constantly hiring physicians to keep shifts filled. Small, democratic or local groups on the other hand are often physician owned with a more limited contract base.

Big Groups

Money, money, money: big groups can pay. With more opportunities and contracts around the country, there’s more work for physicians at these groups. Since groups are always at risk of losing a contract if a shift isn’t filled, they’ll pay physicians virtually anything to fill a shift.

These are large, public companies with thousands of physicians. The result? A less personal experience where you might feel like a cog in a big system. Administrative support is often located in another state and hugely inefficient in processing requests and providing support to physicians. Physicians are more likely to be non-board certified as quality takes a backseat to the necessity of filling the shifts at all cost – especially in emergency medicine where physicians filling ED (Emergency Department) shifts can be non-board certified and non-residency trained.

Small Groups

Smaller groups are more personal with an administrative staff who knows you and tend to be more service oriented than a larger corporation. These groups attract and recruit residency trained, board certified physicians to create a more collaborative work environment.

On the downside, you probably won’t make as much money. Trust me, you’ll still be doing well for yourself, but the smaller groups lack the deep pockets of a public corporation. Small groups have fewer ED contracts and have more of a local footprint. If EmCare loses a contract they have hundreds of other facilities you can work in, but if a small group loses a contract you may have to dust off your CV and start the 6-8 months credentialing process for your next job.

Bottom line, if you’re looking for a more personal and collegial environment then a small group may be the place for you. On the other hand if you’re looking to make a little more money and have more opportunities of places to work at, a big group may be the fit for you.

3) Practice Management Support

What’s one headache most physicians face regardless of the size of their group or location of practice? Paperwork and credentialing. Also known as practice management, the administrative tasks associated with running a group can be a nightmare and include: scheduling, billing, recruiting and credentialing.

Credentialing in particular is a grueling process rife with miscommunication that on average takes 6-8 months. When you first sign on with a group or hospital, after your residency ends, there’s a huge mountain of paperwork and administrative processes to collate and verify your credentials. An average credentialing packet can take a physician 4 to 8 hours from start to finish to complete. Problem is you don’t get paid for the time it takes to fill out the packet. Trust me, if they did pay you for the hours you spend on forms and paperwork, there would be a renewed focus on streamlining this most onerous and inefficient of tasks. Plus every facility you work in has a reappointment process every 2 years that’s challenging to keep up with, let alone all the credentials that expire asynchronously (aka your medical license, DEA, driver’s license, references, PALS, ACLS, ATLS, etc).

Rather than trying to gather and organize all your information manually, use a service that can organize and track all that information for you to minimize turnaround time and the overall headache of the process.

Most physicians just want to practice medicine and not have to deal with the administrative BS. Keep your information in one place and up to date so you can practice medicine rather than refilling the same paperwork over and over again. Regardless of your practice size or location as a physician, find an online tool or service that eliminates time spent on paperwork so physicians can get back to life and patients.

There’s a Lot to Consider After Residency Ends

Ultimately when choosing where to start your career, it all comes down to what works best for your individual needs and where you want your medical career to take you. Think hard about the next 5, 10, or 20 years, and where you want to be in life. Don’t wait any longer or you may fall prey to recruiters who just want to fill job openings and don’t care about your long-term career goals. Chose the right location and group for you where you can get back to simply practicing medicine… Ciao!

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