My dermatology training has prepared me well clinically, surgically, and academically. Yet, as I started thinking about what comes next, I felt confused and anxious. There wasn’t a decision tree or a Bolognia chart to help me through the uncertainty of how to actually find my first job; instead, this transition from residency to attendinghood felt like a complete unknown. Many people from my program pursue fellowships or private practice after graduation, so while everyone was generous with advice, I was in uncharted territory as the first graduating resident in a few years pursuing a career directly into academics. While I am still in the thick of it, I know that sharing what I have learned thus far can help other residents glean some insight into this process.
Early Reflection (12–18 Months Out)
The earliest stage of finding that first attending job is truly about clarity. While none of us have our entire lives charted out, envisioning what your life might look like and leaning into that narrative is the first step in realizing that future. It makes all the steps that come downstream significantly easier.
For me, I thought about and talked with friends, family, and colleagues about the parts of dermatology that mattered most to me. Each time I had these conversations, certain themes came up over and over. It’s important to ask yourself what sings to you: medical dermatology, subspecialized clinics, research, teaching, collaboration, flexibility, work–life balance, staff support, or leadership opportunities? Then think about the environment. When you think about your ideal, what do you see: academic center, VA, military, private practice (small, midsize, or large), solo practice, urban vs rural setting, or a certain patient population?
For some of these questions, I had immediate answers, but others like “What does staff support actually mean?” or “How is faculty research supported at different institutions?” required that I tap into my network. I spoke with faculty, friends that are early-career dermatologists, and mentors through both the Women’s Dermatologic Society and Vulvar Dermatoses Research Consortium. I also interviewed at a few private practices, both small and large, just to understand the landscape of opportunities. I was surprised that some support research efforts and learned so much about what matters most to me through taking these first few interviews. All of these conversations were eye-opening, but despite my intention to have certainty in decision making, I have found that I can only know so much about a place before actually working there. So even if you look into every possible detail, each practice is fluid: things change, people move, and nothing is permanent. I found that embracing this mindset was really helpful as I progressed into the next phase and I encourage you to allow for nuance and fluidity as you go through this process.
Preparing Materials (9–12 Months Out)
Because I was open to moving anywhere, having that clarity was really important in narrowing and making initial decisions. With an initial sense of direction, I made a shortlist of 10 practices (some academic, some hospital-based practice, and a few private) that I was keen to learn more about and started preparing application materials. I updated my CV to be clean, comprehensive, and current. Then, I drafted a general letter of interest describing my career goals, my values, and what I hope to contribute to and gain from a practice. Useful resources helped me frame my thinking, including the AAD Employment Guide and question lists for interviewing. Being able to clearly articulate your values early on helps both you and potential employers decide on fit.
References, Applications, and Casting the Net (7–10 Months Out)
For academic jobs, I simply emailed chairs directly with my CV and a personalized letter of interest for their program. For private practice, I used a mix of approaches: recruiters, job boards, the AAD Career Compass, and cold outreach when postings looked promising. I also talked to friends who had recently finished the process. Many places replied promptly, so as a reminder, part of your interview process is in this prework—email etiquette matters and your presence with the chair’s assistant or department administrator matters just as much as the vice chair or chair themself.
If you’re hoping for a smooth transition, starting early helps for a number of reasons: back and forth emailing and coordinating can take months, not to mention time needed for core exams, interview days, life, and options with job specifics. I have been told that credentialing can take up to six months!
I learned quickly that most private practices didn’t match the vision I had for the next few years, though the conversations were deeply informative, so I did end up quickly focusing on the academic practice applications.
After emailing chairs for academic positions, the application process was very organic but varied by institution. I typically filled out an online application form with up to five references requested for some places. I decided to choose a mix of faculty to serve as references: my Dartmouth chair, my Dartmouth faculty mentor, my vulvar dermatology mentor from UTSW, and two additional faculty who know me well clinically. No one was asked to write formal letters, so I simply asked them in person if they would be willing to speak on my behalf, emailed them a copy of my CV, and let them know they may be contacted for an endorsement.
Some places had me initially meet with the chair via Zoom. For others, I coordinated with someone else in leadership or an executive assistant to the chair for up to six virtual search committee interviews. At some places, the search committee included folks outside of dermatology, others it was a mix of junior and senior faculty, but all interviews were typically about 30 minutes each. Following these, I flew out for typically 1-2 days of in-person interviewing. These consisted of a dinner the night prior, a tour of the facilities, some in-person faculty interviews, and sometimes giving a grand rounds presentation. I genuinely had no idea how time-intensive the academic interview trail can be, so I do recommend mentally preparing for the fall to have this extra layer of busy and if you can, coordinate core exams, grand rounds, and research with this in mind.
In-Person Visits and Fit (6-9 Months Out)
The in-person aspect of the interview for me was the most important. Flying out to see clinics, meeting faculty, talking with residents, seeing patient flow, understanding support staff dynamics—all of these details helped me picture life there. Since my husband and I would be uprooting ourselves, I needed those tangible impressions. This was also how I was really able to compare offers. I made a simple chart of clinical workload, call expectations, compensation models, benefits, staffing, mentorship, academic opportunities, and general culture. Culture was easier to get a feel for in person through seeing faculty-staff interactions, watching grand rounds, seeing how the department flows, and what is evolving. At minimum I recommend ensuring you will see all the clinics you may practice at, meet any faculty you will likely interact with often, watch grand rounds, have dinner or lunch with some folks, and even shadow a faculty member for a few patients. All of these tiny data points were so helpful for me.
During these in-person interviews, often there are soft conversations of contracts, and then in a few weeks to a month afterwards, you will receive formal offers and contracts. While in-person interactions help to seal the deal, every place is slightly different in structure, schedule, and offer, so it is tricky to think through comparing offers and schedules until you actually have the contracts to review. While I do believe in trusting your gut instincts, I have had to remind myself to thoroughly review all the contracts and details before committing.
Negotiation in academics is often described as impossible, but I learned that creativity matters. Maybe salary is fixed, but scheduling, scope of practice, support staff, or flexibility are areas where you can advocate for what matters to you. I found that most places were much more flexible when you can work with them on your asks and at the end of the day, they want you to be happy working there.
In terms of timeline, applying in August made me ahead of schedule for private practice, but right on time for academics, which tends to move quicker. That being said, it’s not unusual for residents to have to wait until the winter to apply to jobs for a variety of reasons (a partner matching into fellowship or other life constraints). So don’t fret! The job market is still open. What you may notice is that a practice might offer you satellite clinic locations or a work schedule that has constraints because of clinic availability.
Closing Thoughts
I’m still in the final leg of the process of making these decisions and definitely still learning as I go. But what has helped most is starting early, reflecting deeply, seeking mentorship, and giving myself permission to explore broadly before narrowing. There isn’t one right way to find your first job in dermatology. There’s just the way that aligns with your goals, values, and vision for the kind of dermatologist—and person—you want to become. Many mentors have given me this advice while on the interview trail so I will pass it along to you:
Try not to put too much pressure on finding the ‘perfect’ first job. Most people change roles or even practices within a couple of years; this is the beginning, not the final destination.
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