From learner to leader: Navigating the transition from resident to attending

Moving from residency to your first job can feel extremely daunting. There is often little to no transition period from learner to attending physician. One day you’re a student, and the next you’re an attending with much greater responsibilities.

But before you get there, you are also tasked with finding a job that will work for you in terms of finances, professional fulfillment and work-life balance.

I recently wrote a piece for the AOA Bureau of Emerging Leaders newsletter discussing the realities that many people don’t consider regarding transitioning to their first post-training role. I am expanding upon that article here as I felt it would be beneficial to not just talk about trends but also share my own personal experiences and other advice that can be helpful. Below is the general advice I provided in my original article.

Strategic foundations

To offer some guidance on the transition from resident to attending, I want to share some information and explain how this transition can impact your life decisions.

• Around 50-70% of physicians switch jobs within the first five years of practice, with 40% of them switching within the first two years. I do not recommend signing contracts longer than three years right out of residency, nor do I recommend making any big purchases, such as a house. With numbers like this, it may be prudent to view your first job after residency as more of a “residency+,” in which you can define your practice and leadership style and figure out your work-life balance.

• Research what pay rates and benefits are standard in your region. Advocate for yourself and for adequate compensation. Sources like Medscape, Reddit and other AOA members can help provide information. It may be beneficial to take a more lucrative contract right after residency, knowing you won’t stay for more than three to five years, to pay off debt, establish financial security and set yourself up to be in a stronger negotiating position when it comes time to switch jobs.

• Plan for retirement and side gigs and explore different ways to be a doctor. Nearly 70% of doctors in their 40s want to retire by their 50s or early 60s. The top reasons include burnout at 74% and desire to pursue other passions at 61%. I encourage everyone to work hard to not burn themselves out on any one way of being a doctor, be that clinical, academic, research or whatever. Many schools and programs look for well-rounded applicants, and I encourage everyone to continue being well-rounded doctors to avoid burnout and seeking retirement or leaving medicine to pursue other passions. Groups such as Physician Side Gigs and the AOA are excellent networks to meet like-minded people and find new opportunities.

I hope this arms each and every one of you who reads this with helpful information. I hope it will set you up for success and that you can enter the world of being a doctor with confidence and security. Now, let’s talk about how I put this into practice. Let’s take it point by point.

The early years

At my first job I negotiated a two-year contract, then a one-year extension and left after completing three years. I had no intention of leaving my first job after just three years, but I did, like many other new attendings, as discussed earlier. I did, however, not buy a house and instead rented, which was an excellent decision, and I made no big purchases during my first few years, which helped me become more financially stable.

Another part of this transition is becoming board certified. I chose AOA Board Certification as I feel strongly that osteopathic board certification is the most relevant certification to me as a DO. I wanted to be certified by a body that is run by DOs and where DOs are in charge of managing assessments and criteria for certification. You can learn more about becoming certified through the AOA on the AOA Board Certification website.

From a medical practice standpoint, my practice changed drastically over time. At my first attending job, I went from practicing family medicine to making my practice almost 50% musculoskeletal treatments using osteopathic manipulative treatment (OMT) and acupuncture (I previously studied at the Beijing University of Chinese Medicine).

Now that I’m in my second job, where my practice is over 90% musculoskeletal treatment and lifestyle medicine, I also help coordinate shared medical appointments and group visits for community health outreach. My practice now looks drastically different than anything I could have expected from residency, and it is likely this will be the case for you too.

Knowing your market value

During my job search after my first role, I was much better equipped to negotiate pay rates. On one phone call I was given a rate for a travel (locum) position. I countered with something to the effect of “I can get that working an employed position with full benefits, there’s no reason for me to move out there with that rate.” They asked what I would take and I replied with a 50% increase in pay with housing for me and my family plus travel expenses. A few weeks later, the organization came back and said they would meet all my demands. This tells me one thing: I could have asked for more.

By this point I had signed a contract for a permanent position and, even though I didn’t take the locum position, the point still stands. We are in an employee market; the projected physician shortage over the next 10 years is well in excess of 100,000 but I believe it will be over 200,000 due to the shortage projections worsening year to year.

Finding my balance

I started teaching in my last year of residency and was able to become adjunct faculty one week after I graduated to teach a course online. I also help publish articles. I have authored guideline articles for a family medicine essentials guide in Saudi Arabia, I am a member of the AOA’s Bureau for Emerging Leaders and I am chief program officer for the nonprofit organization Medicine Forward.

I still play music, and I recently earned a bachelor’s degree in history, as history is one of my passions. Being a doctor is a life calling and an expression of passion and self; it’s not just a job. Anyone who can be a doctor is smart enough to pursue another field that has less stress. But as a doctor, you have the opportunity to positively impact people’s lives in a very fulfilling way.

In addition to my career in medicine, my other ventures feel just as natural and just as much a part of who I am. I tell people: “It’s not that I want to be a doctor, but being a doctor allows me to do everything I want in a way that feels like I’m doing the most good in the world.”

Uncertainty, discovery and growth

Moving from residency into your first attending role is one of the most transformative periods in a physician’s career. It’s a time filled with uncertainty, discovery and, ultimately, growth, both personal and professional. While no guide can fully prepare you for every challenge ahead, understanding the trends, setting boundaries and learning to advocate for yourself can make all the difference.

Remember: This stage isn’t the finish line; it’s the beginning of your lifelong practice of learning, adapting and leading with compassion. Trust yourself, value your worth and create a life and career that reflects who you are, not just what you do.

Related reading:

First-generation medical student: Listening matters in uncharted waters

5 DOs share how they matched into their top-choice programs