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Physician Transition to Practice: A Guide and Checklist for Graduating Residents and Fellows

You’re probably on this page because you’re (finally!) almost done with residency or fellowship training. If you’re anything like us, this day can not come soon enough, as it’s been a long road through college, med school, residency, and/or fellowship. Some of you likely have spouses and families that feel the same. And yet, this is also a time that can provoke anxiety, as you want to ensure that you make the most of this next step into your physician career into attending life. We feel strongly that while training does a great job in preparing you to be a physician (really, you’re more ready than you think), it doesn’t do as good of a job preparing you for your life outside of medicine. Because of this, we’ve put together a free transition to practice series that goes over all the important things to know during your last year of training - how to search for jobs as a doctor, how to negotiate contracts, how to approach housing during your first job, basic personal finance including what that first paycheck will look like, taxes, life and disability insurance, dealing with student loan repayment, retirement accounts and investing, health insurance while between jobs, and more. This page gives you a checklist to make sure you’re prepared for all of those aspects of the transition as well, along with dedicated links to articles about the most frequently asked questions by residents and fellows graduating from residency or graduating from fellowship. 

Note: This article is part of our resources for graduating residents and fellows, as well as physicians looking for a change. If you are not enrolled in our free transition to practice series with webinars on these topics, you can sign up here.

Disclaimer: Please do your own due diligence before making decisions based on this page. We are not formal financial, legal, or otherwise licensed professionals, and you should consult these as appropriate. To learn more, visit our disclaimers and disclosures.

Transition to practice focus areas for graduating residents and fellows

Transition to Practice: Resources for the Last Year of Residency and Fellowship

This resource list is meant to help you navigate many of the resources we have curated for graduating trainees from residency and fellowship. We’re constantly adding new resources to it, and if you’re in your last year of training, we suggest that you bookmark the page to help you in the various different stages of the year. Also make sure to sign up for our free transition to practice series to have a chance to ask questions live at our dedicated virtual events and get your questions answered by experts such as lawyers, financial advisors, insurance agents, and mortgage agents.

Finding a Job and Negotiating the Right Contract

You’ve worked really hard to get where you are now, and you want to make sure the next step is the one you’ve been working towards. This requires being intentional about the job search, instead of just applying and signing a contract for the first job offer that comes your way. We know that finding a physician job can be overwhelming with all the options available to you in terms of practice setting and practice type, differences in salary, bonus structures, and benefits, and more. For the first time in your life, it isn’t just going down a pre-prescribed pathway where the next step in your journey has discrete steps. You should take some time to figure out what your ideal job looks like, what your dealbreakers are, and what your needs are in terms of location, earning potential, and hours, as this will automatically help you start filtering your options. Here are some resources for finding the right job and negotiating the best physician employment contract for your needs.

Resources for Finding a Job

Resources for Contract Negotiations

Housing for the Year After Residency or Fellowship

Given how many doctors change jobs in the first five years after graduating from residency or fellowship, many of the physicians on our physician communities advocate for waiting to buy a house until after you’re sure that you like the job. However, we understand that for many physician families, this is not the right decision. If you are going to buy a house, these are some resources.

Personal Finance Basics for Those Graduating From Residency or Fellowship

As someone who’s statistically likely to never have had a job outside of your education and training, going from a resident or fellow paycheck to an attending paycheck is a big step. You have likely been in survival mode for years, and probably aren’t saving much. If anything, you’re likely to have a lot of student debt, and possibly even personal loans. Many of our questions from graduating trainees revolve around these issues, and we want to make sure you get off on the right foot here. Basic personal finance actually isn’t very hard (certainly not med school or residency hard), and getting started on the right foot is key to ensuring financial success, and eventually financial independence.

Checklist of Things to Do Before Graduating From Residency or Fellowship

We’ve compiled a list of things to make sure that you don’t forget to do in the midst of all the chaos of graduation season.

Transition to practice checklist for graduating residents and fellows

  • Apply for your medical license in whatever state you’re moving to. This can take a lot longer than you think, so the minute that you know where you’re going, you should start the process. Otherwise, it can hold up credentialing, which can delay the start date for your job.

  • Gather up all of your procedure logs and similar. You’ll want to make sure you have this information for future licensing and credentialing, and it’s much easier to get while you’re still at the institution.

  • Get a copy of your malpractice coverage certificate and claims history information from your training program. 

  • Get a contact for the university or hospital system risk management office, just in case you’re notified of claims related to something in training later, as this will be the first point of contact you’ll need.

  • Figure out what you’re going to do about health insurance between graduation and starting your first job. 

  • Buy your disability insurance if you haven’t already. It will come at a significant discount if purchased during training. This is also particularly important if you have a pre-existing condition, as you may not qualify for disability insurance outside of training otherwise.

  • Create a financial plan for the time between training and starting your job. This is a difficult time financially for many graduating residents and fellows, as many residents and fellows don’t have substantial savings yet. However, you can and SHOULD enjoy this time off, not only to celebrate your accomplishments, but because it may be a while before you get this kind of time off again. Some ways to plan for expenses:

    • Save up an emergency fund over the course of your last year that you can use for travel, housing, health insurance, and other necessary living expenses during that time. Put that money into a short term option such as a high yield savings account so that it’s earning some money in the background.

    • Consider if you’ll need a personal loan. If so, we have some resources here under resources for personal finances and investing.

    • Some people elect to put expenses on a 0% APR credit card that they know they can pay off in a few months before interest kicks in. We have some popular 0% interest cards on our credit cards for physicians page.

  • Write thank you notes to all of your mentors, your program director, and anybody else you may need a reference from in the future. In addition to being a nice way to express your gratitude, it will ensure you leave on a good note.

  • Forward any important emails and contact information from your email accounts. Many email accounts will be suspended or migrated to an alumni account the day that you graduate, so don’t assume you’ll have access to those later. Make sure there’s no patient related PHI or other HIPAA violations on any of those emails.  

  • Make sure that Human Resources as well as your residency program coordinator have all of your new contact information, including a new mailing address and your non-institutional email address. This will ensure that your last paycheck, your W2 next year, your training certificate (if the official copy isn’t given to you before leaving), and other important correspondence gets to you in the future.

  • If you funded a retirement account during training, contact HR to review the distribution options. Some institutions or account types will allow you to keep your accounts there, whereas others will require a rollover or a distribution. This can have important tax implications, so do not forget to do this in a timely manner.

  • Get a copy of your verification of training certificate that you will need for future credentialing through your program director or GME office. If they have other documents that you currently count on them for, such as CME logs, procedure logs, in service exam results, or anything else you may need for your board certification process, get those as well.

  • Get your immunization and PPD records from employee health. There are lots of records that you may need in the future that you never bothered keeping track of yourself, which can hold up credentialing in the future or that you may want to have for your own records (last tetanus shot, Hep vaccination series, titers, etc.).

  • Turn in anything that is the institution’s property and pay any outstanding invoices, including badges, electronic devices, access keys, overdue fines at the library, charges at the cafeteria, etc. These are the types of little things that can hold up getting your graduation certificates, or just be really annoying to take care of once you’ve already moved.

Resources for Right After Graduating From Residency or Fellowship

First of all, celebrate! You have earned this and more. It’s important to enjoy the time off between finishing training and starting your first job - the chance to have multiple weeks or months off all at once may not come again for a while. 

We have many additional resources that we find our graduating trainees often ask for, including things like scrubs discounts, business cards, personal loans, and even travel discounts and perks on our Resources, Discounts, and Perks for Physicians page. We hope these guides are helpful! If there’s anything that you need that you don’t see here as you navigate the last year of training and that you think we should develop, please let us know, or as always, you can ask on our physician communities for lots of opinions from other physicians who have successfully navigated this transition!

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