You’ve spent a decade or more in the trenches learning the basics of medicine, learning your specialty, your subspecialty. You have devoted long hours to mastering your area of expertise. Looming on the horizon is the end of your formal training, the beginning of your career, the light at the end of the tunnel: your first job.

This is the goal you have been working toward since you first envisioned yourself as a doctor.  Maybe you’ve known since preschool that you wanted to be a doctor. Maybe you figured it out during your first career as an artist or a stockbroker. Regardless, you have been focused and worked hard to get to this point, and you deserve a pat on the back for making it this far.   Will the next step put you closer to your dream, or will you jump from the frying pan into the fire?

Hopefully, you are viewing this exciting turning point from some distance, perhaps a year or two from finishing your residency or fellowship. If so, you have plenty of time to consider your options, see what is out there, make choices, interview, negotiate contract(s), sign, and perhaps even enjoy a stipend and/or signing bonus during your last year of training.

Perhaps you are at the beginning of your training,  in medical school or early residency. Planning for your first job after training is like planning for retirement (and sometimes may seem about the same distance away !). The earlier you start to think about it, the better off you will be.

So, how do you begin? Where do you start? First, honestly ask yourself, “What are my priorities?”  There is no wrong answer to this question.  The answer, however, can definitely guide you in your search.  Is your top priority Location?  Academics versus private practice versus employed scenario? Schedule? Salary potential? Paying off student loans? Satisfying your significant other’s work or personal priorities? Do you want to be a big fish in a small pond (the only specialist of your kind in the area), or a small fish in a big pond (have many colleagues in your specialty in the area)?

Of course, your answer will be some combination of those.  Finding the right job is a lot like shopping for real estate.  You’ll have a wish list.  You are not likely to get everything on your list, but starting with such a list can be helpful.  Rank the categories above in terms of priority, and add a few of your own.  Feel free to be as specific as you need to be.  Then step back and look at your list.

How specific is your location? A specific city? An area within a state? A whole state? A group of states? A region (northeast, northwest, southeast, southwest)? Are you open to exploring locations? Do you want a certain size city or town? Do you prefer urban or rural living? The more specific your location requirement, the more limited you will be regarding all of the other choices.  It seems like many people start out with a specific location requirement, but may not succeed  in finding the job of their dreams in that location.  This is where compromise comes in.  If this happens, choices come down to choosing a job that may not be ideal but is in the right location, or choosing to venture out of the desired location in search of the ideal job.

What is fun and fascinating is how the ultimate decision you make may surprise you based on your initial priorities.  On the other hand, creating a priority list can help you stay focused, and keep you from being distracted by falling in love with a job/location that is kind of the opposite of what you said you wanted… (on the other hand, if you consider yourself to be a spontaneous person, you may actually enjoy musing at the morphing of your priorities through the process…).

Finally, just keep in mind how much time you will likely spend working.  There’s a good chance you’ll spend more time working than time off, so keep that in mind when prioritizing work characteristics that appeal to you. It is extremely important to consider personalities of colleagues, staff and administration at any work location. If you do venture out to explore various location options, keep in mind that you can always work in one location and travel to your favorite places when you’re off, especially if you choose a job where your specialty is in high demand.