Graduating residency and becoming a new physician can be a daunting transition regardless of the practice setting you choose. In one study focused on academic practice, family medicine residents were asked to identify their greatest concerns about starting their careers. Recurring themes included a lack of readiness or mentorship, work-life balance and burnout, a lack of autonomy or flexibility, competing pressures or roles, lower financial rewards in academic practice, politics and bureaucracy, and research pressures.¹ Many of these concerns could apply to other practice settings as well.

For me, the transition from residency at a small community hospital to practice at a large academic health center in New York City was full of successes, as well as obstacles. Here are some of the lessons I learned.

1. Embrace lifelong learning. While studying for the board exam during the last year of residency, many residents think, “This is it! After this, no more studying or training.” But a career in medicine, especially family medicine, is always evolving. You will learn new things every day, so be prepared for that. This leads to the next piece of advice.

2. Don't be afraid to look things up. Guidelines and recommendations periodically change. You cannot know everything. Using evidence-based medicine resources should be part of your practice. Get acquainted with the resources available, such as UpToDate, DynaMed, or Cochrane Library, and find one you like. If your practice does not have a subscription, consider buying one and investing in yourself.

3. Find your people. The best resources are often people, so maintain professional connections with those from your past and find your people in the organization you join. New colleagues, former co-residents, former faculty, staff members (e.g., nurses and librarians), or even patients can be invaluable in helping you navigate your new setting, position, and career. Lean on your people when you need information and advice, and learn early in your career that it is OK to ask for help.

4. Connect with mentors. Traditional mentorship is defined as a formal, dynamic, and reciprocal relationship in a work environment aimed at promoting the career growth of both mentor and mentee.² If you find yourself frequently asking questions of the same person, consider asking them to become your mentor. Chopra et al describe traditional mentoring as a “professional parenting bond rather than a boss-employee relationship,” but other mentor archetypes include the coach, sponsor, and connector.² In my experience, the best mentors help you figure out problems without giving you the exact answer. The goal is for you to eventually develop into someone else's mentor.

5. Learn to say no. As a new physician, saying “no” can be hard. Understandably, you may feel pressure to accept every task or role. Ask yourself four questions before saying “yes” to a new obligation:

• How excited am I to do this?
• How will I grow from doing this?
• How else will I benefit from this?
• Can I realistically make time for this?

6. Understand the CME, board certification, and license requirements for your position. The American Medical Association (AMA) has resources about obtaining and maintaining a medical license on its website. The American Board of Family Medicine and American Osteopathic Board of Family Physicians have similar but not identical requirements for board certification maintenance.³ Every three years, you will need to complete 150 or 120 continuing medical education (CME) credits, respectively, as well as performance improvement activities and cognitive assessments.³ States do not have identical licensure requirements or cycles, so check with your state academy or licensing board or find information at the Federation of State Medical Boards.

7. Remember this is a first job. Everyone hopes a first job turns out to be a great fit with their values and goals. However, an estimated 50% of physicians leave their first job within two years.⁴ Know that your first job following residency or fellowship will not likely be your only job. Before signing your first employment contract, review AAFP physician employment contracting resources. Figure out what, if any, non-compete clauses or other restrictions for future practice are included. You don't want to get locked into a position you may eventually want to leave. Negotiate the best terms and salary you can,⁵ but remember that finding a job that makes you happy is ultimately more important than any amount of money you may earn.

8. Stay balanced. At times, you might feel overwhelmed during your first year. I have found that the things that bring joy (such as work we are passionate about) can also bring burnout. Your health and well-being cannot be ignored. Practice self-care by making time for things you enjoy and engaging in healthy behaviors. Use your vacation and sick days when needed. If you feel sad, depressed, or burnt out, access resources or help from your organization's Employee Assistance Program, AAFP, or the National Suicide and Crisis Lifeline.

The practice of medicine is not just a science but an ever-evolving art. You may not do everything right during your first year as a physician, but give yourself some time. Surround yourself with people who will challenge and mentor you, aim for continuous learning and growth, and say “yes” to what is important to you.