Early-career physicians face many challenges: beginning practice, discovering their path within their specialties, developing careers, answering financial questions, finding time to enjoy the fruits of their labor, and handling general adult life tasks. When I was an early-career physician, I had to learn to navigate all of these challenges: starting a new practice in a different state, developing my clinical area of expertise within pulmonary medicine, reigniting my fitness journey, and being present during the first years of my son's life.

Getting through these challenges requires early-career physicians to live in different timelines:

• Short term: the next 90–180 days
• Medium term: 1–5 years into the future
• Long term: beyond 5 years and into the future

Short-Term Career Goals

In the short-term, the focus should be on improving your visibility. This does not mean that you have to become a medical social media celebrity; but deliberate action must be taken to say “I am here, I am able, and I am available.” To understand the goal of visibility I will divide it into internal and external. Internal visibility refers to the awareness of your output within your institution, while external visibility describes that outside of it. Each goal requires different types of actions to be enhanced, though improving one can have synergistic effects on the other. I would advise early-career physicians to focus their first year of practice exclusively on internal visibility, and then add on the efforts toward external visibility.

At my first job, these efforts translated into taking extra call, which helped me get exposed to more primary team members, ER physicians, and other consultants. These interactions became a solid referral base for both inpatient and outpatient consults. During my first three months, I called nearby primary care offices and asked if I could come and introduce myself to the local PCPs and gave them a brief 5-minute introduction touching upon where I trained and what services I could offer. They became the second stream of referrals for my office.

To increase your internal visibility:

1. Introduce yourself and provide your contact information to colleagues working on the same patient cases, referring clinicians, and staff.
2. Volunteer yourself to work more: extra call or office hours.
3. Join quality improvement efforts.
4. Collaborate with research projects.

The first years of practice should also focus on obtaining credentials that validate your practice, like board certifications, specialty specific certifications, or procedural competence. Personally, I dedicated the first two years of my tenure to obtaining board certifications in critical care medicine and neurocritical care.

Medium-Term Career Goals

In the medium-term, the focus shifts to gravitating toward your ultimate career goals. This is achieved by augmenting internal visibility but focusing a bit more on external visibility. Personally, this translated into becoming more involved with my local chapter of the American College of Physicians (ACP) where I had the privilege of serving as a Member-At-Large of ACP’s Arizona Chapter and also serving in the American College of Chest Physicians (CHEST) in the Asthma-COPD section. During this time I also volunteered my time to the COPD Foundation and helped advocate for the Supplemental Oxygen Access Reform (SOAR) Act (S. 3821/H.R. 7829) by increasing its visibility with my local policymakers.

To increase your external visibility:

1. Become involved in national specialty specific professional societies.
2. Join local medical professional societies.
3. Contact your local newspaper and write an opinion piece or health article.

Navigating the medium-term is probably the hardest part of the physician journey as it lacks the excitement of starting something new and you have yet to reap the rewards of consistent effort. During this period of your career, you must take deliberate action to outline your ultimate career goal and gravitate toward it. If you visualize yourself having an administrative career, this is the time to begin picking up administrative duties. If you wish to pursue research, this would be the time to begin building strong research proposals that focus on multi-year publications and funding.

Throughout your work and learning activities, focus on bringing value. By focusing on value, you will compound both your internal and external visibility. This value can be demonstrated by your impact on patient-centric measures, academic output, improvement of internal processes, or conflict resolution.

As I transition from the short term into the medium term, I am focusing on developing the skills that will help bridge me toward my long-term career goals. I am currently pursuing the Certified Physician Executive (CPE) designation through the American Association for Physician Leadership and plan to pursue further education in health care administration afterward.

Long-Term Career Goals

Finally, for the long term (beyond 5 years), the early-career physician must actively think about their goals. Not having a plan would be equivalent to boat without a rudder. At best, you would stay in the same place; at worst, you might find yourself in a location or situation that you did not want to be in. By answering the following questions, the early-career physician will be able to trim down the different options available and end up at their desired location:

1. What kind of doctor do I want to be? (i.e., purely clinical, clinical researcher, clinical educator, administrative role)
2. What type of practice do I want to be part of? (i.e., large multi-state corporate practice, corporate practice limited to a geographical location, community practice in a community hospital, teaching facility, private practice)
3. What do I want my normal day at work to look like?
4. Is there a point where I foresee myself slowing down my practice? And is my specialty compatible with part-time work?
5. For how long do I see myself practicing medicine?

For this final stage of career planning, be a visionary: write down your wildest and most ambitious goals. Find people who have achieved similar goals and study their profiles (find them on LinkedIn, Doximity, or their institutional profile) and reverse engineer their trajectory. Even better, reach out to them if you have overlapping professional interests (same professional associations, same institutions, or close geography).

As a closing remark, the proposed timeline above is focused on an early-career physician starting on the first year as an attending. However, this framework should be revisited periodically and adjusted to the evolving professional situations of the physician. The only physicians who do not need to think about their careers are those enjoying retirement.

What's next on your career timeline? Share in the comments.

Felix Reyes MD, is a board-certified pulmonary and critical care physician who serves as an attending at El Paso Pulmonary Association in El Paso, TX. He has track record of research, teaching, and professional leadership in pulmonary medicine and critical care.

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