Beginning The Job Search

William Levine, MD

August 16, 2019

Thinking about your first job search can be daunting, but this post will share some insights to help you prepare. We’ll break it down into Residency years 1-4; Residency year 5, and Fellowship.

Residency Years 1-4

  1. Keep your eyes and ears open as you see your senior residents and fellows approach the job search.

  2. Learn from your chief residents (PG-5) and fellows. Ask them lots of questions.

  3. Write down on the back of a napkin what your ideal day in the operating room would be like as a good way to figure out which sub-specialty to pursue. My mentor, John Richmond, asked us to do this and it was an awesome way to be introspective about defining goals.

  4. Build your portfolio for fellowship as well as for potential jobs. For those of you leaning towards “academic” fellowships, greater focus on research and education throughout residency will be helpful.

  5. If you are targeting a specific geographic area, it is NOT too early to express interest by sending a cover letter and curriculum vitae (CV) introducing yourself and your reasons for bring interested in that area. It may be best to do so after you have decided what sub-specialty you are going to pursue.

  6. Seek advice from your mentors, especially younger faculty, about how they dealt with the process. Sharing your goals and asking specific questions you have will help them to better help you.

Residency Year 5

  1. You will be deluged by recruiters’ calls, emails, texts with the “best job in America.” Some opportunities may be worth investigating, but, in general, be very wary that these jobs may not be as good as advertised.

  2. Most of you will have procured your fellowship by this point (about 98% of you will be doing at least one fellowship). The big question you have to decide is: Should you accept a job offer during your PG-5 year before you start your fellowship? I have had mentees do this very successfully and others fail spectacularly. The key is to not jump at an offer that sounds too good to be true – do your due diligence and consult with your mentors!

  3. Residents may accept a job in their hometown or from their residency program well ahead of starting their fellowship. The advantages are obvious – security, an immediate financial bonus and the opportunity to dive head first into the fellowship without the pressures of the job search or the concerns about traveling for interviews. The disadvantages include having less time to determine what you really want, not taking advantage of any connections your fellowship mentors may have and potentially, you took a job early that turned out to be not exactly what you feel you could have achieved had you waited.


  1. If you are starting your fellowship without having accepted a job (which will be the case for the majority of you), make sure you let your fellowship mentors know during your chief resident year. They will be your advocates. Let them know where you would ideally like to live and what type of practice you would like to have. Remember that the practice you want and the practice that is available when you are finally ready to look are not always aligned. That is okay – remember that your first job does not have to be your only job. 70% of us leave our first job within five years (50% within two years!). I was in private practice in San Diego for my first job, so you just never know how it will turn out.

  2. Your residency and fellowship mentors will play a large part in introducing you to potential jobs and advocating for you. Remember how important these relationships are because ultimately this stage of career progression is all about the personal contacts; they will be getting calls from friends about possible jobs and you want them to have you at the top of their list.

  3. Develop your “Must have” list (red line), “Would like to have” list, and your “utopic” list and make sure you are clear about this. Remember that your best time to negotiate the terms of your contract are BEFORE you sign the contract, not after. Verbal and handshake agreements are always fraught with potential problems. A top 5 negotiations list can be found HERE.

General Tips for Job Searches

  1. Approach every interview as if it is the place you will be hired.

  2. Know your CV by heart.

  3. First impressions are critical; make sure yours is good, even from your earliest communication with the administrative assistants scheduling your visits.

  4. It can take 2-3 visits to a program/group before you settle on a job, so be prepared for a marathon, not a sprint.

  5. Listen carefully. You’re trying to determine if this is the place for you, so ask questions and listen carefully to the answers!

  6. Be prepared for potential conflicts. For example, you may receive multiple, simultaneous interview invitations, or a job offer from one program/group while you are waiting for a response from another. In these situations, remember that transparency and communication are key, and that you can consult your mentors for help with the process.

For additional resources to help you in your job search, visit the AAOS Career Center.

DISCLOSURE: Dr. Levine is Editor-in-Chief of the Journal of the American Academy of Orthopaedic Surgeons, Rosemont, IL, and the Frank E. Stinchfield Professor and Chairman, Department of Orthopedic Surgery, Columbia University Medical Center, New York, NY.
Dr. Levine or an immediate family member serves as an unpaid consultant to Zimmer Biomet.

Read the AAOS Discussion Group Terms, Conditions and Disclaimers HERE

Copyright© 2019 by the American Academy of Orthopaedic Surgeons

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