Each academic year, I have watched as a new class of residents and fellows prepares to graduate and launch their medical careers. They step out of the structured training environment into a professional world that is exciting, expansive, and, for many, overwhelming. Clinically, they are well trained. But residency rarely prepares physicians to recognize and advocate for what they truly need to thrive in practice. The data reflect this gap. A 2023 survey from MGM & Jackson Physician Search found that early-career physicians are more likely to leave their first job within three years than prior generations. Fewer than half of administrators reported retaining more than seventy-five percent of their new hires beyond three years, and five percent said they retained none.

This pattern of early turnover is costly:

• Financially: Replacing a physician can cost an institution between $500,000 and $1 million in lost revenue and recruitment.
• Personally: Physicians uproot families, purchase homes, and invest emotionally in their communities. Leaving a job so soon can be destabilizing.
• Professionally: Early failure undermines confidence, fosters self-doubt and imposter syndrome, and increases the risk of burnout.

Why does this happen?

Our medical training emphasizes uniformity, not individuality

Residency rewards conformity to the “standard” way of doing things. Individual priorities and personal career goals are rarely emphasized. After years of this mindset, physicians often focus on “fitting in” rather than seeking jobs aligned with what helps them thrive. This does not prepare them to find the right job for their particular skill set.

Misplaced priorities during job selection

New physicians often prioritize salary when choosing their first job. After years of delayed earnings, the financial draw is understandable. But high salaries alone rarely ensure long-term retention. Institutions may lower pay when productivity lags, and few new physicians are given tools and skills to build sustainable practices (referrals, marketing, growth support). In the long run, culture, mentorship, and growth opportunities are far stronger predictors of retention.

Lack of support during rough patches

Building a practice is inherently challenging. Success depends less on avoiding difficulties and more on having the support to overcome them. Without mentorship, guidance, and access to resources (financial, clinical, and business support), young physicians often struggle.

Limited mentorship and guidance

While many senior physicians want to mentor, we are stretched thin by clinical and administrative demands. Effective mentoring requires time, intention, and expertise. Without structured support, early-career physicians may miss red flags in evaluating institutions and contracts, overlooking growth opportunities, and resulting in decisions that lead to short-term rather than sustainable success.

What can be done

We can do better. Training programs and professional organizations can:

• Help young physicians identify their priorities before they enter the job market.
• Teach them how to evaluate opportunities beyond salary and prestige.
• Provide tools and guidance to negotiate resources that set them up for long-term growth.
• Build intentional systems of mentorship and coaching to guide early career physicians through the critical first years.

Physicians do not just need jobs; they need careers that will sustain their growth, well-being, and purpose. By addressing these gaps, we can improve retention, reduce costly turnover, and help our newest colleagues thrive from the very start.

Sharon L. Stein is a surgeon and physician coach.