EMbark, Residents, Life Transitions - Residents, Career Planning

As You Near the End of Residency, Have a Roadmap for the Future

You’re in your final year of residency, and the light at the end of the residency tunnel is inching closer and closer.

You’ve traveled long and far on a road with twists and turns and bumps and dips and countless exhilarating highs. Greener pastures await — YAY!

But wait — what’s next?! Before your “YAY” turns into “YIKES,” read on. We’ve got you covered with a list of essentials.

Final Year of Residency: A Checklist
It’s fall — and we’re getting full-swing into job search season. By now you should have polished your CV and cover letter, with each tailored to your target practice setting or fellowship. (Check out EMRA’s career-planning resources for more detailed CV and cover letter tips.)

Once you’ve prepared your materials, in September and October it’s time to begin your job search by leveraging your network, starting with your faculty and alumni. The importance of your network cannot be stressed enough. Candidates are often identified through networks rather than official postings. It’s always preferable to use mutual connections for introductions when you can, but don’t be afraid to reach out directly to chairs and directors. If you’re having trouble making a connection, don’t forget — EMRA is here to help.

You can also find jobs through company or department recruitment events, job boards (such as emCareers), and job fairs. Additionally, ACEP Scientific Assembly and EMRA’s Job and Fellowship Fair are great times to connect with employers. You can often undergo interviews on site during these events.

Job or fellowship offers may come in December through February. A few of you may end up on a later timeline, landing a job closer to April (don’t panic!). As you complete your job search, you’ll move into contract reviews, licensing, credentialing, and financial planning for the future.

Licensing and Credentialing
Licensing and credentialing is an extremely long and complicated process. DO NOT DELAY! It can take months for all of these things to happen, and delays can accumulate and ultimately postpone your start date (and, consequently, your paycheck).

Here are some things to keep in mind:

  • Apply for your ABEM certification, and make a plan to study for the written boards. EMRA membership will get you special rates for PEERprep and Rosh Review. Read more about the certification process here.
  • Apply for state licensure AS SOON AS POSSIBLE. This can take months, and many other steps depend on having a license number. States vary in their use of online vs. paper applications (or a combination), so check into your state’s requirements and submit your application. The Federation of State Medical Boards (FSMB) offers two online applications: the Federation Credentials Verification Service (FCVS), which verifies your medical credentials, and the Uniform Application for Licensure (UA) for basic demographics and training information. These online applications are accepted or required by most state medical boards. An advantage of using these online applications is their portability across state lines. The application for a state medical license requires several components, including your medical school transcripts/diploma, USMLE/COMLEX Official Transcripts (included in the FCVS), and fingerprinting.
  • Obtain a U.S. Drug Enforcement Administration (DEA) number. You cannot get a DEA number without a state license, so go through the state licensure process first.
  • Job onboarding. In addition to the paperwork required for obtaining your state license and DEA number, you’ll face additional paperwork from your soon-to-be hospital employer. Be attentive to email communications; there will be many. Your employer will likely administer drug tests, inquire about malpractice coverage and clinical activity from residency, and require ACLS/ATLS/PALS/BLS recertification (not all employers require ATLS recertification after EM board certification).
  • Inquire about independent contractor (1099) status. Does your employer require professional incorporation? If yes, you’ll need to hire a lawyer to do this for you (which costs money, by the way).
  • National Provider Identifier (NPI) number. Update your NPI taxonomy code from student to Emergency Medicine 207P00000X. This will require a medical license number. Get more information here.
  • Know your malpractice insurance coverage. Details should be spelled out in your employment contract. If you’ll be employed full time by a large hospital or in an academic setting, you likely will not need additional coverage. However, if you’ll be working at a small community hospital, or if you’ll have part-time/contracted (i.e., 1099) employment status, then most likely you’ll need additional coverage.

Remember to make time to finish up your program requirements, including Individualized Interactive Instruction (III), conference hours, scholarly activity, and procedure logging.

Finances and Health Insurance
That brings us to a final note about finances and health insurance coverage. As a post-residency emergency physician, you’re embarking on a rewarding, but not cheap, journey. You will need several thousand dollars during this transition. In addition to the fees associated with licensing, you may need funds for moving expenses (e.g., shipping your car across the country or moving into an apartment in a state with a higher cost of living).

Ensure you’re covered with adequate health insurance without gaps between residency and the start of your job. Consider extending your previous plan via COBRA. If your employer does not provide insurance, enroll in either your partner’s health insurance plan or a Health Insurance Marketplace plan.

During this transition, it’s also important to look into disability, life, and malpractice insurance options.

Here’s a great EMRA*Cast episode about finances to get you started.

We cannot stress enough the importance of creating, and sticking to, a budget. Consider refinancing your student loan. Prudent financial planning in the present will save you from headache and heartache in the future.

Congratulations on making it this far in your EM residency journey. Best of luck with your future in the specialty! We’re glad you’re joining the ranks.

Related Articles

Working with Nurses and Alternate Practitioners

Working with Nurses and Alternate Practitioners The following is an excerpt from EMRA's popular Medical Student Survival Guide, edited by Kristin Harkin, MD and Jeremy Cushman, MD. In this chapter ab

Q & A: Blazing International Trails with Dr. Haywood Hall

Q & A: Blazing International Trails with Dr. Haywood Hall International medicine is an ever-growing and expanding specialty within emergency medicine and other medical fields. Amid all of the growth,