When I finished residency more than 20 years ago, choosing a job was fairly straightforward.
Most of us focused on three things: location, compensation, and the type of emergency department where we wanted to work. If the city was appealing and the pay was good, we signed a contract and got to work.
Today’s residents still prioritize those factors, but they are asking a different set of questions.
I spend a lot of time talking with physicians entering the workforce. I recruit residents, teach, mentor physicians at different stages of their careers, and visit residency programs across the country. The conversations I have today are different from the ones I remember having when I started out.
Compensation still comes up, but it is rarely the first topic.
Residents ask about schedules, mentorship, leadership opportunities, wellness programs, and workplace culture. They ask what opportunities exist beyond clinical shifts. They also want to know what support systems exist for young physicians. Most of all, they want to know whether they can realistically picture themselves doing this work 20 or 30 years from now.
Some observers interpret those questions as evidence that younger physicians value work-life balance more than previous generations. There may be some truth to that, but I think something more important is happening.
The next generation of emergency physicians is thinking about career sustainability from day one.
What Residents Are Looking for Today
Emergency medicine remains one of the most rewarding specialties in healthcare, but it is also demanding. Today’s residents are entering a profession that faces significant challenges. They have trained through periods of overcrowding, staffing shortages, rising patient acuity, workplace violence, and increasing complexity. They have seen both the rewards and realities of the specialty early in their careers, and many are thinking more intentionally about longevity and what a fulfilling career in emergency medicine looks like over time. At the same time, emergency medicine offers more career flexibility than many people realize.
Some physicians spend their careers focused primarily on clinical care. Others become involved in education, quality improvement, hospital operations, leadership, advocacy, or research. Some pursue advanced degrees. Others find opportunities to mentor, teach, or improve systems that affect patient care every day.
Emergency medicine does not have to be a one-dimensional career.
At the teaching hospital where I practice, every attending serves on a committee. Some focus on stroke care. Others work on trauma programs, sepsis initiatives, resident education, or quality improvement projects.
Most people get involved because they care about improving something they encounter every day. Over time, involvement often opens unexpected doors.
Careers Rarely Follow a Straight Path
That was certainly true in my own career.
When I finished residency, I didn’t have my career mapped out. I was focused on taking care of patients and becoming the best emergency physician I could be. Over time, opportunities emerged. I became involved in teaching, helped build a residency program, pursued an MBA, and eventually stepped into leadership and operational roles. None of that was part of a master plan.
What made the difference were mentors and leaders who invested in my development, challenged me to grow, and helped me see possibilities I had not yet considered. That experience shaped how I think about first jobs today.
I still hear from former residents who call to talk through a job opportunity, a leadership role, or a career crossroads. Sometimes, they’re deciding between two jobs. Sometimes, they’re wondering whether it’s time to try something new. Those conversations remind me that very few careers unfold exactly as planned, and having good mentors early in your career matters.
Think Beyond the First Job
One of the first things I tell residents is not to focus only on the job immediately in front of them.
Instead, think about where you want to be 10 years from now.
Do you want to teach? Lead a department? Get involved in resident education, quality improvement, or operations? Do you want to build a career focused entirely on clinical medicine, or do you see your interests evolving over time?
There are no right or wrong answers, but they are questions worth asking before signing a first contract.
I also encourage physicians to ask direct questions during interviews.
What opportunities exist beyond clinical work?
Who will mentor me?
What if my interests change in 5 years, will there be room to grow?
What are physicians who have been there for years saying about their experience?
Are physician leaders still practicing medicine and involved in the department?
Sometimes, the answers to those questions tell you more than compensation ever will.
I’ve seen residents turn down jobs that looked great on paper because they couldn’t picture themselves there long-term. The strongest first jobs are not always the highest-paying ones. Often, they have environments where physicians feel supported, challenged, heard, and encouraged to evolve professionally over time.
I’ve spent more than 16 years with the same organization for one simple reason: people invested in my development. That matters.
If a resident finishing training tomorrow asked me for one piece of advice, my answer would be simple: Don’t focus on finding a job. Focus on building a career.
Think about where you want to go. Find mentors who can help you get there. Get involved. Say yes when opportunities come your way, and do not feel pressure to have everything figured out immediately.
Emergency medicine can still be an incredibly rewarding career. The key is finding a place that supports not only the physician you are today, but the physician you hope to become.