Post-residency transitions: Choosing your next steps

By Jules Murtha | Fact-checked by Barbara Bekiesz
Published April 5, 2022

Key Takeaways

  • There is a world of opportunity awaiting you following your residency. Choosing your best career path from the many available options will be challenging.

  • Many residents end up practicing in the same state where they did their training.

  • Remember: You have a plethora of career options to explore post-residency, including positions in purely clinical practices, clinician-education, or physician-administration.

As a resident, you may have a clear understanding of which specialty calls to you. When the time comes to develop a career path post-residency, however, you might spend more than a few moments scratching your head in wonder—and you wouldn’t be alone.

Trainee physicians nearing the end of their residencies can rest assured there’s a world of opportunities waiting for them. They can explore the full range of possible career paths to pinpoint the most suitable one.

Your specialty may be a guide

When entering practice upon completion of your residency, one factor to consider is location—that is, whether you will practice close to your residency location or relocate. The 2019 Report on Residents issued by the American Association of Medical Colleges revealed some interesting trends on which specialties tend to end up where.[]

Among residents completing their training between 2009 and 2018, over 54% stayed in the state where they finished up residency. Of those who practiced family medicine and psychiatry, over 64% stayed in-state, as did 60% of pediatricians.[]

Approximately 60% of pathologists (anatomical and clinical) and 59% of vascular surgeons also chose to remain in the state of their residencies.

This was especially true for surgery-based specialties. Those who trained in colon and rectal surgery, thoracic surgery, plastic surgery, ophthalmology, and neurological surgery showed the lowest rates of staying in the same place at which they completed residency.

It’s safe to say that if you’re nearing the end of residency and thinking about where you’d like to practice, the location of your residency and your choice of specialty may inform that decision.

Keep your options open

Trainee physicians who feel uncertain about career development post-residency may find it helpful to read through a list of possible pathways and positions, such as the ones described in an article by Prarthna Bhardwaj, MD published by the New England Journal of Medicine:[]

  • Clinical medicine. If patient care is the reason why you pursued a career in healthcare, clinical medicine may be the most suitable path for you. Clinical medicine allows you to establish a private practice or work in community group settings. You can focus on non-academic hospital medicine, too. On this path, your chief focus is serving patients.

  • Clinician-Educator. This path also centers patient care, but it requires you to incorporate educational principles and scholarship into your work. Clinician-educators often serve as faculty members at educational institutions, develop curricula for trainee physicians, or work as associate program directors of residencies and fellowships while maintaining a clinical practice.

One way to get your foot in the door is by connecting with educators in a community of practice, according to an article published by the Journal of Graduate Medical Education.[] Securing a mentor in addition to hands-on teaching gigs during residency may also prove helpful.

  • Clinician-Scientist. You may discover at some point during your residency that research is your passion, according to Bhardwaj. If this is the case, pursuing a career as a clinician-scientist could bring your occupational goals to fruition. You can take extra classes during residency to hone your research skills. Some Master of Science in Clinical Research programs may even provide tuition aid for residents and fellows.

Taking workshops is another way to broaden your research knowledge. For example, the American Society of Clinical Oncology and the American Association for Cancer Research provide workshops that teach the most effective design methods for clinical trials.

  • Physician-Administrator. Healthcare leaders are an asset to healthcare organizations. Doctors who have real-world experience treating patients can provide invaluable perspectives to healthcare administrative teams. If you’d like to blend the worlds of patient care and a global perspective on healthcare management, you may want to pursue a career as a chair of medicine at your institution, chief executive officer at your hospital, or program director of a residency/fellowship program.

  • Physician advocacy and public policy. Physicians are in a unique position to learn about the breadth of patient needs. If you find yourself wanting to enact change upon healthcare system delivery or mitigate social barriers, you may want to get involved in public policy. Pursuing a Masters of Public Health with a focus on Health Policy, a fellowship, or a position on an Advocacy and Health Policy Committee may enable you to advocate for patients on community, state, federal, and national levels.

What this means for you

You might find that determining your next steps after residency is a complicated process, regardless of whether you’re pursuing an academic appointment, a community-based job, or a fellowship. If you’re feeling unsure of what your options are, take comfort in the fact that you have many: You can pursue a purely clinical practice, or incorporate public policy, research, education, and administration into your career path.

Read Next: Beyond clinical medicine: Non-traditional career options for residents
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