This post was authored by Anjlee Mehta, MD, a member of the ACC Women in Cardiology Member Section and assistant professor in the Division of Cardiology at the University of Texas Health Science Center in San Antonio, TX.

As fellows-in-training are acutely aware, today’s health care environment is rapidly changing. Paralleling these changes in health care is an ever-evolving job market. With cuts in research funding, training grants and reimbursements, today’s job market isn’t even comparable to a few years ago, and it is even less similar to the market many more established cardiologists may remember. How do graduating fellows navigate this uncharted territory?

As I started writing this article, I realized just how much variability there is amongst the factors that one considers when choosing a job. Proximity to family, financial compensation, location, climate, practice environment, malpractice environment, work hours, benefits and numerous other factors all play into an individual’s decision tree when selecting a job.

The first piece of advice that I’ve heard consistently is to start looking early. This means beginning the process over a year before you are planning to finish rather than waiting until you are already a few months into your final year. There are many reasons for doing this, but one practical reason is that licensing and credentialing can take months or longer depending on the state(s) where are you are pursuing jobs. Check on state licensing timelines and talk to colleagues in states where you may want to practice in order to see how long this process can take. If you want to start working right after you finish, you will need to have initiated the process much earlier. You’ll quickly find that it’s really never too early to start thinking about your post-fellowship plans.

Second, where and how does one start looking? One of the benefits of our internet-driven/social networking era is that finding resources has become easier. Sites like LinkedIn, HealtheCareers, Doximity, career resources on ACC.org, NEJM CareerCenter and individual practice websites are just a few of the numerous places that you can start researching potential job opportunities. Obviously, the more you can narrow down personal factors in your search, the more easily you can focus your search.

Another approach that some advise is to start cold calling places (you can ask to speak to the office manager and get more information from there) and send your CV with a letter of interest to practices. Depending on where you are looking, you may hear back right away or you may not be contacted at all. Sometimes reaching out in this way can also lead to informal opportunities to learn more about a practice even if they don’t have a specific job opening right away.

Of course, reaching out to any of your contacts can often lead to opportunities and help get your name out there. Great places to establish contacts include many of the ACC and AHA committees. For me, joining the ACC’s Women in Cardiology Member Section provided me the opportunity to informally speak with many practicing cardiologists (both private and academic) and establish correspondence with faculty that proved to be helpful in my job search.

Third, start building contacts at your own institution. Even if you plan on leaving, you may end up asking some of your attendings or colleagues to write you letters or provide peer references. As a fellow, you naturally start to build relationships with faculty and attendings where you are training, but it is important to remember to maintain those relationships, especially in your final year.

Fourth, while you may have decided that you will, without a doubt, join a private practice that is not hospital-based, or you refuse to accept anything besides an academic position, it is ideal to remain flexible. The health care practice environment is changing due to many external factors, and you may find that the job you thought you wanted has a completely different set of expectations/duties than what you initially thought. Additionally, the lines between different sectors (e.g., academic vs. private) continue to blur and new startups and continued technological advancements may provide new and non-traditional options for graduating fellows.

Finally, just because you are fellow doesn’t mean it’s too early to start defining a role for yourself that may help lead you down a certain career path. The article, “Finding Purpose as Fellows: Opportunities Through Organization” by Tomey et al., recently published in the Journal of the American College of Cardiology, reminds us that there are many organizations at the local, state, and national levels that fellows can join to get involved. Often, getting involved in these organizations may help you better define your long-term career goals and interests, and help you develop a collaborative network.

It’s a never-ending journey in a time of enormous changes in medicine, but hopefully we can find ways to make it a fulfilling one.

To get involved in the ACC’s WIC Member Section, visit ACC.org/WIC. To learn more about the ACC’s career resources, visit ACC.org/CardiologyCareers.

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