THE PATH TO A CAREER IN MEDICINE can crisscross the country, with bumps along the way. Facing career choices is challenging enough. Throw in moves and adjustments to most new places, and it’s clear why uprooting is among life’s biggest stresses.

“You don’t want to do it again,” says Lauren Pontius Floyd, M.D., a dermatologist at Bellaire Dermatology in Houston. Yet surveys show that at least one in five physicians relocates in their first five years of practice. 

“It gets harder and harder every stage away from medical school,” she says. “…In medical school, you have 100 people who have something in common, all in the same classes and social events put on by the school. And with residency, you’re with people for years. …So unless you stay where you’ve been, or join a practice where you have friends, you have to make an effort to find a community rather than have it fall in your lap, and that gets harder. It takes time.” 

Clearly, such decisions need intel and strategies. So heed the hard-earned lessons of four physicians who went from med school to long-term positions in dermatology, geriatrics, transplant hepatology and vein surgery. 

Before a physician site visit 

After med school at University of Hawaii’s John A. Burns School of Medicine, Resham Ramkissoon, M.D., spent a summer researching online and contacting program directors, med students, interns and residents at Dartmouth Hitchcock Medical Center in Lebanon, New Hampshire, about the internal medicine residency he sought. 

He also took advantage of online housing boards offered by medical centers there and elsewhere. “That’s a trustworthy way to find out where physicians and residents are renting nearby.”

Talk to leadership 

“Introductory phone calls are really important,” Floyd says. “They don’t want you to fly out if it’s a waste of time for them or for you. So be honest about what you’re looking for and learn what they’re looking for in a job and an employee. But stay open-minded, because you may discover more during your site visit.” 

After spending four years at the Mayo Clinic in Rochester, Minnesota, for fellowships in gastroenterology and then hepatology and transplant hepatology, Ramkissoon made many phone calls before and after his site visit to learn about positions in Cleveland. 

“Suss out how much you’ll be valued, and whether you’ll be able to make a footprint and a difference in the program,” says Ramkissoon, whose inquiries led him to become an assistant professor of medicine at Case Western Reserve University School of Medicine and transplant hepatologist at the Digestive Health Institute at University Hospitals Cleveland Medical Center. 

He’d spoken with program leaders up to four times by phone to determine caseloads and whether physicians have time for lunch or chats with colleagues over coffee. He also asked what they were most excited about, to whom he’d report and how much support hepatologists get to do research, attend conferences and take vacations. “I got revealing answers,” he says. 

Be aware that the process can be slow 

Ramkissoon started job hunting in September 2023, well before his Mayo fellowship ended the next June. “I had multiple interviews with different people. It can be a long, time-consuming process.” He signed with UHin April 2024 and reported to work in September 2024. 

Be open to opportunities 

The right place may surprise you. Ramkissoon originally had planned to remain in Minnesota but was swayed by the attitude and candor of leaders at Cleveland’s University Hospitals. 

“If people are forthcoming with answers, put thought into them and email you back, that’s a good sign. They were so welcoming. I wasn’t going there initially, but they changed my mind,” he says. 

He also advises attending conferences in your specialty to network with potential employers and learn about their institutions and cities. “They’re a great opportunity.” 

Perks matter 

Susan Schneider, M.D., was used to being sought by headhunters. “So many reach out that it becomes background noise,” says Schneider, now a geriatrician and professor of medicine at University of California- San Francisco. 

For 25 years, she worked in Florida at her dream jobs, most recently as program director training physicians in the subspecialty of geriatrics. “I didn’t imagine I’d ever leave.” 

When family needs had her searching for inclusive and supportive community, Schneider says, “My 85-year-old mother said, ‘Why don’t you move to San Francisco?’” So she, her two children, cat and dog did. 

Though she’d only been to San Francisco once—30 years earlier— she approached the University of California-San Francisco, and was hired as a full professor and geriatrician. 

“It was a rapid transition,” she says. “I arrived in October 2023 one month before I had orientation and started patient care. They rolled out the red carpet for me.” 

Accommodate your shifting priorities 

Before he married, Ramkissoon felt free to move thousands of miles from his native Canada to attend med school in Hawaii and take a residency in New Hampshire. 

But soon after moving to Mayo in Minnesota, he married. The proximity of relatives became a priority. 

“It was important to us to have a short drive to reach our families in an emergency or for holidays,” he says. “I value family ties, because not only do I want to be a great doctor, but also a good husband, father, son and cousin.” 

Ask away 

Floyd moved from Atlanta to Houston as a dermatologist. She narrowed her selection before a site visit by conversing with leaders at several practices. 

“It all begins with a phone call,” she says. “Dr. Craig Teller of Bellaire Dermatology and I talked for an hour for our first interview about values, patient care and what mattered to us as physicians. That was helpful, laying out what I was interested in and what they were interested in. It’s important to know before you show up for an interview.” 

Mentors’ input can be invaluable in choosing the best centers for your field. After his Mayo fellowship, Ramkissoon asked his mentors which medical centers would be the best fit. That cut his list of potential programs in half. “I can’t thank them enough for helping me choose a great job,” he says. 

During site visits 

Ramkissoon learned the hard way that 40 hours onsite wasn’t enough to find a home. “You may see 10 places in a day,” he says. “Video and second phone calls really help narrow your selection.” 

Once you know your top contenders, stay all day to observe how the practice or program operates, Floyd says. And chat with everyone, especially those with whom you may work. 

Observe culture and growth 

Ramkissoon says he chose University Hospitals in part because “it’s an expanding transplant program. It’s fun and fulfilling to help it grow.” 

During site visits, Ramkissoon and Floyd both paid attention to interactions between interns, residents, support staff and physicians. “If they’re bright-eyed and excited about their work, that’s a good sign,” Ramkissoon says. “How happy the ancillary staff is reflects how well the hospital or practice is run.” 

“You should do a lot of observation and see the office in action,” Floyd says. “Ask to spend an entire day there. Don’t just go in on Saturday to talk to the office manager. It’s important to spend a day when the practice is open and see how the staff treats each other and the patients.” 

“Your job interview isn’t just a chance for you to make a good impression,” says Floyd. “It’s two-way. We’re both getting a feel for each other and seeing if it’s a good fit. 

For instance, take the time to discern what your average day at work will be like. 

“What times does my day start and end, realistically? Will I see 50 patients with one nursing assistant?” Floyd asks. 

Bring your spouse along on your site visit as well. He or she may go job-hunting on the same trip—and you both should feel it’s a place you want to live. 

Before moving to Phoenix to open a practice as a vein surgeon and specialist at Metro Vein Centers Varicose Vein & Spider Vein Treatment Clinic, Mason Mandy, M.D., explored the area with his wife. He then spent another week there with his family so his three children would feel comfortable and considered. 

Engage a Realtor 

Ramkissoon networked to find a Realtor in Cleveland before signing his job contract. “When you’ve narrowed your choices to one or two cities, don’t wait to pounce on expert perspectives,” he says. “I was able to learn of new, up-and-coming neighborhoods, the east side versus west, and downsides and upsides to locations.” 

“You spend half your time at work and half in your community, so you have to enjoy both,” says Floyd. “You want to establish roots so it’s home.” 

Though Mandy made multiple trips to Phoenix, “Some things you have to learn by living the routine, day to day. There’s no way to experience that on short trips. …It’s helpful to talk to people in the area and to visit several times. I wouldn’t go just once. We did a couple of weekend trips, then a longer trip over spring break. And taking the kids definitely helped with their enthusiasm.” 

After the visit 

UCSF eased Schneider’s adjustment to a cross-country move. 

“They provided faculty housing for up to five years. I call it a doctor dorm,” she sasys. “I love it, and my kids love it. They also let me bring an emotional support cat and dog.” 

Near her door, she can board a university shuttle or city transportation. Her housing includes laundry service, a pie shop, a coffee shop and a Mexican restaurant. “They have social activities and lots of families, young people who are going through training,” she says. 

Take into consideration that the time from your first interview till your first day in a new position can take months. 

“If you have kids, you may want to arrive in your new city between school years,” says Schneider, whose children are 11 and 15. 

When Floyd got to Houston in June, she didn’t work for a month. “I spent the time getting unpacked and getting settled,” she says. “That really helps, since otherwise you don’t know where to get groceries, do dry cleaning, get your car washed or find a dentist and primary care. It helps to have your work start at least two to three weeks after your move date.”

The effort certainly can pay off. A year into their new jobs, both Ramkissoon and Schneider are enthused. 

“My late-career move has been a dream come true,” she says. “Keep an open mind, consider options and if your gut instinct says move, don’t be afraid. Do it.” 

And Ramkissoon’s first job since his fellowships—after 11 years, starting with med school—is a keeper, he says. “I see myself staying here for a very long time.” •