The time to start thinking about life after residency begins on your first day!
First Year of Residency
Though you are super busy keeping up with the material, you should start planning ahead during your first year of residency. Ask yourself where you want to be in five, 10, and 30 years? Regardless of your path, there will be challenges! If you prefer to tackle challenges alone, then starting a solo practice may be in your future. Alternatively, if you enjoy working with colleagues, joining a group practice may be the right fit. You likely had to publish to get into a dermatology. If your publication experience was pleasant, this is a soft sign that you are suited for academia where it’s “publish or perish.” Even if you haven’t rotated through the derm subspecialties yet, it is not too early to ask your senior residents what they liked and disliked about their rotations in pediatrics, pathology, and procedural dermatology, and ask their plans for after residency.
This is the best time to plan for life after residency. Use your elective time to rotate with a dermatologist that specializes in one or more subspecialties that interest you. The American Society for Dermatologic Surgery (ASDS), American Society for Laser Medicine and Surgery (ASLMS), and the Women’s Dermatologic Society (WDS) can help you locate and fund preceptorships where will gain hands-on experience. Also, attend as many conferences as you can for additional exposure to the subspecialties and the key leaders in the field. Make sure you get your loved ones involved in your thought process. Continue to talk with your mentors and senior residents and ask them for advice. As you get closer to a decision, put pen to paper and write out the pros and cons.
You will have likely already decided if you are going to subspecialize and, if so, which subspecialty. If you have decided not to specialize, think about your future practice environment (academia versus private) and (solo vs group). In academia, you will have instant access to a cadre of senior colleagues, a certain level of prestige, less pressure to see a high volume of patients, and the opportunity to teach. However, academia usually pays significantly less than private practice (think 25- 40% less) and is notoriously rife with politics which, to some, feels like high school all over again. In a group practice, you can often start seeing patients on day one without putting a penny down, but in doing so, you can lose a tremendous amount of managerial control and even perhaps be locked out of practicing within a certain geographic area should you decide to leave (GOOGLE: non-compete clause). Unless you are starting your own practice, a contract lawyer will be key. Make sure the lawyer is familiar with dermatology as a specialty and the healthcare laws in the state in which you want to practice.
After the Decision
Know that whatever you decide, most dermatologists change jobs within a few years after starting their first position. Accepting that the only thing constant in life is change will keep you from stressing out and help you enjoy your career, wherever it may take you.
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