At the end of medical residency, a big question looms: Is it better to stay at the institution where the residency occurred or move to another facility?

Opinions seem to be divided, even among millennials and Gen Z, who are generally characterized as “job hoppers.” In medicine, much of the decision to stay or search for greener pastures depends on whether the physician is planning a research-oriented career. “There are a lot of factors that go into taking that first faculty position, but clinically inclined residents tend to consider geography more while aspiring physician researchers lean more towards staying where they’re trained,” observed Saul Siller, MD, PhD, whose cohorts at Yale School of Medicine fell into the pattern.

“It can be a trap to focus solely on money for startup costs. Now I understand the importance of time. If you’re in the clinic 50%-60% of the time, you’re destined to fail. Having a chair committed to seeing you succeed and willing to provide a technician crew when you have seven other things going on is invaluable.”

There are advantages either way. Some trade the familiarity of an institution for the chance to work somewhere more renowned in a certain specialty, be exposed to a different clinical practice, or start a clean slate as a more “independent” physician without carrying baggage from residency. Paul Riegelhaupt, MD, PhD, now at Weill Cornell Medicine’s Department of Anesthesiology, learned first-hand about some of these nuances when he left University of California, San Francisco after his research track residency so his wife could pursue a publishing career in the established New York market. In California, he was in an amicable situation and receiving productive time but was the only clinician in a lab full of PhDs. “You’re essentially working on someone else’s projects,” he reflected. A decade later, Dr. Riegelhaupt believes he made the right decision and, in the process, learned a great deal about negotiation and what it takes to succeed in a first faculty position.

Switching institutions may be a little more work in the beginning for candidates who have to “sell themselves” rather than segue into a new position. A strong CV, excellent clinical skills, and references are important for anyone. According to Dr. Siller, non-researchers should consider a fellowship at an institution of interest. If there is not a fellowship on one’s resume, then the residency institution takes on a higher level of importance.

Presenting at conferences – including ASA meetings – is a great way to demonstrate interest in new areas, he noted. One of Dr. Siller’s peers had amazing opportunities to take part in ASA’s policy elective and become involved in state advocacy. Others have taken education leadership courses, then found a natural fit as a chief resident or medical school teacher. In addition, degrees like MBAs and committee leadership positions carry a lot of weight, depending on institutional priorities.

Those anesthesiologists with strong research interest need to focus on publication. There’s still a great deal of cache to someone who can complete the publishing process, but this requires protected research time. In addition, the kind of application that will impress an external hiring team requires a K-level grant, which Dr. Siller acknowledged is not easy to come by for an individual who just completed residency. It’s also acceptable to tell hiring teams that you’re interested in high-level clinical research but haven’t had the opportunity.

Protected research time can be a defining factor in the success or failure of a first faculty position. Dr. Riegelhaupt cautions early-career physicians to approach these discussions with intention when negotiating with a new employer. “When you start on a research track, the department will promise time and funding to get started. From this perspective, it’s easier to stay in the institution where you completed residency. When you move to a new position, you must figure out for yourself what to ask for.”

Complicating matters, there is no “perfect” amount of research time, as different amounts of time are needed for different projects. All training grants will offer 80% protected time, which is necessary as sequential days are required to plan and conduct experiments. Dr. Riegelhaupt noted that, early in one’s medical research career, time is even more important than money or anything material the institution can offer. “It can be a trap to focus solely on money for startup costs. “Now I understand the importance of time. If you’re in the clinic 50%-60% of the time, you’re destined to fail. Having a chair committed to seeing you succeed and willing to provide a technician crew when you have seven other things going on is invaluable.”

Protecting one’s time doesn’t end when you accept the position. New physicians are perceived as eager and, as such, presented with opportunities to write or take on administrative projects or committee work. There’s a balance between developing into a well-respected member of a new institution and becoming over-leveraged. That said, Dr. Siller guides new physicians to take call with some frequency to maintain clinical skills.

Dr. Riegelhaupt’s best advice during a negotiation – which he learned from Foundation for Anesthesia Education and Research meetings – is to negotiate with new employers from a place of shared motivation. “First, I deliver what I’d like to accomplish. Then, couch it in context about barriers. That makes it easier to understand when you round out the discussions saying, ‘here’s what I need to accomplish what we both want,’” he shared.

Beyond research time, Dr. Siller counsels physicians negotiating their first faculty position to ask what they want in terms of call schedules, salary, clinical versus nonclinical time, support for career development, and lab funding, if necessary. There’s a wide range of normal as far as startup funds go, with some projects only needing lab equipment and others requiring a substancial monetary investment.

He also reminds physicians that, whether they stay or go after residency, most find the right path to success. A decade after his cross-country move, Dr. Riegelhaupt attests that he made the right decision. “I landed in a nice situation with numerous mentors on overlapping projects. I found expertise that I wouldn’t have gotten otherwise to build out a lab and receive multiple grants.”