Abstract
Most palliative care (PC) physicians will change jobs over the course of their career, yet few supports exist to guide them through this often unfamiliar process. Job transitions frequently elicit stress and uncertainty, as individuals balance personal and professional priorities, navigate complex negotiations, and assume the inherent risks of pursuing new opportunities. Yet, when approached intentionally, a job transition can also be a transformative process that allows for self-discovery, cultivation of new skills and connections, and reshaping of one’s professional identity. This article, written by a team of PC physicians who have made job transitions themselves, offers 10 tips for navigating this professional step successfully. With emphases on authentic communication, skilled mentorship, relationship building, and exploration of local culture—the article offers practical advice to help PC physicians navigate a job transition confidently, while staying grounded in their personal values and the work they find most meaningful.
Keywords
Introduction
Physician job transitions are common within medical practice. Most physicians change jobs within the first five years after training, and many will make a transition at later career stages as well. 1 Within palliative care (PC), concerns regarding clinician burnout and sustaining the clinician workforce make the topic of how to support physicians through a job transition especially relevant. However, existing literature on PC physician job transitions focuses almost exclusively on early-career physicians starting their first position post-training.2–4 Minimal literature exists to guide PC physicians through a subsequent job change.
PC physicians change jobs for a variety of professional and personal reasons, including opportunity for leadership advancement, a shift between academic and community practice, evolving family and caregiving needs, and a desire to live geographically closer to loved ones, among others. In our experience, physician job transitions can encompass significant time investment, stress, and uncertainty. There can even be moments of isolation (Who can I talk to about this?) or feeling like a “fraud”—as one tries to remain present in one position while simultaneously exploring others. Concurrently, job transitions provide the opportunity for tremendous professional growth, including building new relationships, reevaluating professional identity, and experiencing one’s effectiveness in a new setting.
This article offers 10 practical tips to help PC physicians navigate their second and subsequent job transitions. Our author group includes physicians who have all navigated mid-career job transitions or have mentored others in doing so. Additionally, while we focus on PC physicians given the unique elements of physician recruitment, hiring, and onboarding within professional practice, we believe many of the tips can be useful for interprofessional team members making a job transition as well.
Tip 1: Before Considering Specific Jobs, Start by Meeting with Yourself to Reflect on Your Personal Values, Professional Goals, and the Work You Find Most Meaningful
When considering a job transition, there are parallels to the care planning we do with our patients and families. Before focusing on concrete opportunities, it can be helpful to intentionally step back and situate this decision within the broader context of your life and career goals. 5 This self-reflection allows you to clarify your own values and priorities so that your decision-making is guided by what matters most to you, rather than being driven primarily by external pressures or constraints.
Start by broadly identifying what is motivating this potential change, recognizing that there may be one or multiple contributing factors (e.g., professional growth or change, moving closer to people you care about, transitioning to a leadership role). Physician PC jobs generally come in two types: (1) a “who you are” job and (2) a “what you do” job. A physician with broad interests outside of medicine or significant family obligations can be misaligned with the expectations of a “who you are” job, while physicians who define their identity through their work can feel underwhelmed and bored in a narrower “what you do” role.
At this stage, resist the urge to narrow prematurely. Instead, keep your focus broad and deliberately reflect on your core values and priorities (Table 1). Consider desired outcomes at a conceptual level, rather than fixating on specific job titles (e.g., wanting to enhance education or clinical leadership skills, rather than a particular title). Even when a transition is prompted by an untenable or unsustainable current role, try to articulate what you are moving toward, not only what you are moving away from. This forward-looking framing can orient you toward a values-aligned next step rather than merely a reactive change.
Questions to Ask during a Job Transition as a Palliative Care Physician
Before you explore available options, recognize that tradeoffs are likely. Explicitly identifying where you have flexibility versus firm boundaries can support clearer decision-making (e.g., I would prefer to work in the outpatient setting, though am open to a mixed role; but it is very important that my work reliably ends when I leave the office). In addition to hopes, worries, trade-offs, and nonnegotiables, name the aspects of your current work that feel most meaningful, as these provide important clues about the type of role in which you are most likely to thrive.
Tip 2: Seek Out Well-Connected, Experienced Outside Mentors Who Will Speak Frankly with You and Support You During the Job Search and Transition
Skilled mentorship is essential to professional growth4,6 and is particularly important during career transitions. Physicians should seek transition-focused mentors to support them during their exploration of job opportunities and through their transition to a new position. In our experience, while having multiple mentors may provide diverse perspectives, asking a single trusted colleague to serve as one’s primary mentor for the job transition can be particularly beneficial—allowing for deeper relationship building and more frank conversation as the transition unfolds.
Primary mentors should be experienced, outside individuals who are not affiliated with the institutions that one is leaving or potentially joining. This allows mentors to provide unbiased input, keeping the well-being of the mentee as the primary aim. Consider mentors who have navigated a second job transition themselves, as they are best positioned to speak to the challenges and opportunities inherent to this process.
Additionally, mentors who are well-connected within the field of PC can assist with networking to ensure that program leaders are aware of the mentee’s interests. To identify such individuals, consider colleagues from across one’s career to date, including those who may have provided mentorship during the training years. Beyond traditional senior mentor relationships, peer mentors can also be highly effective in supporting individuals through mid-career challenges, including job transitions. 7
Once mentorship is established, early meetings should focus on understanding the mentee’s personal values and professional goals that will inform the job search (i.e., Tip 1). In later meetings, the mentor can help weigh the benefits and drawbacks of specific job opportunities, discuss negotiation concerns, and offer grounding and reassurance during periods of uncertainty. After the transition, mentors and mentees should check in periodically, particularly during the first 6–12 months, to support the mentee as they acclimate to their new position.
Tip 3: Remember the Field Is Still Small; Stay Mindful of the Flow of Information and Maintain Professionalism Throughout the Transition
Despite the substantial rise in the PC physician workforce over the past two decades, there are still fewer than 5000 PC physicians nationally. 8 As such, the field is still a small community, and searching for a new position is likely to connect you with colleagues who have close working or personal relationships with those at your current institution. Be mindful of how information flows as you prepare for and navigate a job transition. Choose mentors, support persons, and references carefully, and proactively communicate your wishes about confidentiality.
Regardless of your motivation for seeking change, maintain professionalism in describing your current working environment and your vision for the future. Have a clear message about what gives you meaning in your work and how you see the new opportunity as a way to connect with that meaning. Speak constructively and professionally about known dissatisfiers. Stressors and frustrations at your current position may motivate a transition, but these are best discussed by minimizing emotional charge and framing challenges as opportunities for improvement.
The job search can be a valuable opportunity to meet new people and develop new relationships. Even if a specific position or program does not fit your current professional and personal goals, an interview is a chance to meet new people, discuss shared interests, and build a wider network of colleagues nationally. Although some may not become your direct colleagues, you may find that you wish to work together in other ways in the future. A well-executed career transition should build bridges, not burn them.
Tip 4: Communicate Authentically During the Job Search and Negotiation; be Transparent About What You Can and Cannot Commit to and Align Your Words with Your Values
The terms of a position are often much more negotiable than may be intuitive to physicians. 9 One of the hardest transitions for trainees and junior faculty is conceptualizing that any job offer has numerous negotiable elements, as opposed to residency and fellowship match, where effectively no negotiation occurs. 10 Be clear and honest about how a new job opportunity meets your needs for career growth and compensation. Be transparent about your salary needs, especially in geographic markets with a high cost of living, and ask that agreed-upon terms be listed in the offer letter or contract. 11 Clarify which compensation benchmarking table the employer is referencing, to ensure the compensation reflects the current market and geographic region. Physician groups and hospitals typically use the salary reports established by the American Association of Medical Colleges or the Medical Group Management Association.12,13
If you are seeking a position in a nonacademic setting, your primary negotiable as a full-time clinician is salary and benefits. In academic settings, time is often more valuable and negotiable than money, especially if your salary is tied to academic rank. Protected nonclinical time is difficult to increase without grants, extramural funding, or philanthropy once a contract has been signed. If taking on a clinical, educational, or other leadership role, ask how much nonclinical time that role is currently allotted and discuss how much time you feel you need to do the job well. Additionally, clarify how protected nonclinical time will translate to a clinical schedule (e.g., 10% of time in an outpatient clinic = 4 hours = ½ day of clinic). Benefit programs, such as retirement programs, basic health and disability insurance, and life insurance policies, are generally nonnegotiable. However, benefits such as annual continuing education allowances, reimbursement for licensure and board certification fees, signing bonuses, and relocation allowances are often negotiable elements. Remember that $5000 in salary recurs annually where $5000 in relocation is a one-time event. Table 1 offers more detailed questions for the negotiation period.
We recommend sending a summary e-mail with documentation of offers after any interview when items are negotiated to be sure that transparency is achieved, especially prior to signing a contract. Confirm all negotiated items are written into your contract or offer letter before you sign. 14 Be timely and collegial in communication regarding negotiations. Finally, consider hiring an attorney for complex contract negotiations, especially in the more flexible private practice realm, to provide coaching and expert review.
Tip 5: While Considering a Position, Explore the Local Values and Culture, Including the Strategic Priorities of Leadership and the Position of Palliative Care Within the Organization
It is critical for physicians to evaluate the local culture of an organization and how PC operates within it. PC clinicians frequently embody qualities that organizations need: collaboration and shared responsibility around workload, empathy about the emotional challenges of serious illness care, strategy around program mission and operation, and support for well-being within their teams and broader organizational staff.15,16 These values position PC physicians well to lead programs and affect change within the organization.
The integration of PC within an organization is also essential for high-quality serious illness care. When considering a position, explore the degree to which PC staff participate in strategic initiatives and planning within the organization and how the organization’s goals and priorities align with PC principles. Such alignment allows PC leaders to implement programs and deliver care most effectively. Additionally, organizations that clearly articulate strategic goals for the PC team often develop a healthier and more supportive work environment for the interprofessional team. 16 Physicians should ask during recruitment how the organization supports PC efforts and what strengths and challenges exist regarding the position of PC within the organization. Table 1 offers additional questions for exploring local culture.
Tip 6: Identify Structures in Place to Support Your Career Growth and Professional Development at the New Institution, Including Local Mentorship and Leadership Opportunities
Beyond dedicated mentorship for the job transition process (Tip 2), PC physicians should also closely examine the formal and informal structures that support ongoing growth and professional development within a new institution. Ask about structured mentorship, professional development programs, and the degree to which PC staff are sponsored to take on meaningful roles across departments and service lines (Table 1). Strong mentorship, coaching, and willingness to sponsor are particularly important;4,17 clinicians should look for a breadth of local mentors who can provide guidance on clinical excellence, quality improvement, research, academic advancement, and leadership formation. Many institutions offer formal mentorship pairings through the division or department, alongside informal mentorship embedded in interprofessional PC teams, moral distress rounds, case discussions, and collaborative clinical models. For academic positions, faculty development committees or equivalent structures can provide essential support for promotion-related coaching, leadership skills acquisition, and goal setting around scholarship.
Early- and mid-career faculty should also assess the leadership landscape by asking about potential roles leading clinical service lines, quality initiatives, or education programs in the months and years ahead if this aligns with professional goals (Table 1). Note whether PC has a visible presence on departmental, hospital, and institutional committees, such as ethics, quality and safety, digital innovation, or care transformation groups. When PC is represented in these governing structures, it can signal that the institution values the specialty’s voice and provides fertile ground for physician leaders to grow and shape system-level strategy.
Tip 7: After the Transition, Focus on Building Relationships; Say “Yes” to Opportunities That Foster Networking and Familiarize You with Institutional Culture and Leadership
After transitioning to a new institution, early work should focus on learning the environment and building social capital. Build relationships with those who can share institutional history and who you can draw upon when inevitable missteps occur. Relationship development should consider two domains: the institutional power ladder (higher-, equal-, and lower-power individuals), including your referral sources, and the interdisciplinary team.
A useful method is advice-seeking. 18 If someone only gives information, there will be no investment in a positive outcome for you. When someone gives advice, though, advice givers are naturally more invested in your success. When meeting with program founders or those with institutional memory, consider this framework: Be Curious About and Honor the Past; Be Honest About the Present (but not too soon); and Be Hopeful for the Future. This approach conveys seeking understanding, not criticism. Seeking advice over a casual cup of coffee helps colleagues attribute any later missteps to your learning rather than evidence of character flaws or bad intentions. Also, deliberately use “we” language that includes your new team and avoid first-person pronouns about prior organizations. Your new team is now your “we,” and your language should reflect a shared future.
Finally, build social capital by—inversely quoting Nancy Reagan—“Just Say Yes.” Accepting speaking requests or small, time-limited projects can connect you with new colleagues and create momentum around your work. Understanding the worries of program or institutional leadership and partnering to solve one specific problem can simultaneously build social capital and enhance your reputation.
Tip 8: When the Transition Encompasses a New Leadership Role, After Building Relationships Focus Initial Work on Something Simple to Get an Early Win
By starting a new position, you have made a courageous choice to embrace change. Often, the appeal of a new position is an opportunity to grow professionally, so new positions frequently include a leadership role. Because leaders define what the future will look like, leaders change things. 19 Change is often met with reluctance, if not outright resistance, even when all agree that change is necessary. For change to be accepted, it requires trust from your team, your peers, and your superiors.
Earning trust from others tends to require three elements: authenticity, logic, and empathy. Sometimes, this is called the triangle of trust. Others will trust you if they feel they are experiencing the real you (authenticity), believe in your competence and judgement (logic), and feel you understand and care about them (empathy). 20
When a suggested change requires individuals to adjust a practice that was comfortable and established, they may question whether the leader understands their perspective. This is an example of a breakdown of empathy in the triangle of trust and underscores the importance of making sure everyone feels heard. Much of the early work of building relationships (Tip 7) is about gaining this trust, so you have the buy-in to succeed in making needed changes.
Being new to a leadership position or institution has the advantage of giving you an easy “view from the balcony.” 19 Either from prior experience or just the vantage point of an outsider, you will identify opportunities for improvement or have experience with alternatives that work. When new to a leadership position, choose a change that is easy “low-hanging fruit,” especially if it improves quality of life for team members.
For example, when one author was tasked with integrating the ambulatory PC practice beyond the cancer center, they started with neurology because the neurologists demonstrated a strong understanding of PC and were ready to refer patients. This allowed them to weather the inevitable challenges that arose because both services were invested. From this partnership, they learned valuable lessons that they could apply to make the process smoother when integrating into other specialties less friendly to PC. A successful change early on builds confidence in your leadership and sets the stage to navigate more challenging changes in the future.
Tip 9: Frame the Job Transition as an Opportunity to Reevaluate and Reshape Your Professional Identity
Transitioning to a new job can feel disorienting, as there are new people, expectations, and cultures to learn, yet it is also a powerful moment to start fresh and reshape your career. This is especially freeing if you trained at your prior institution; a new setting brings fewer preconceived views. Begin by reassessing who you are and where you want to go, using Schlossberg’s 4S (Situation, Self, Supports, Strategies) to name what is changing, what you will keep, and where you want to grow. 21 Consider both professional and personal aims, and then budget time for exploration, experimentation, and learning. 22 Table 1 details further questions for reflecting on professional identity.
Early in a new role there is often proverbial white space before committees and standing obligations fill your calendar. Use it. Rather than over-planning, test “possible selves” through small experiments and say “yes” (Tip 7) to a project you would not normally do or a class you would not usually teach. 23 Prototype potential pivots to your professional identity with low-risk trials (e.g., shadowing in a new clinic, giving one-hour talks, co-leading a teaching session) and use evidence such as the impact of the task or energy required to decide what to double down on and what to stop. 24 Enlist mentors or coaches as sounding boards while you run these tests. In parallel, stack short skill sprints into your week; you cannot pivot your career without building new capabilities, so protect time with calendar blocks, audiobooks on commutes, an online course on Slicer Dicer or Excel, or targeted evening courses. 25 Finally, normalize that careers are nonlinear and reinvention is the rule, not the exception. Expect to repeat this cycle as your goals and context evolve. 26
Tip 10: Anticipate Uncertainty, as a Job Transition Requires Bravery and a Leap of Faith
Professional transitions inherently involve uncertainty and vulnerability. 27 Role changes can disrupt routines, relationships, and professional confidence. Even seasoned clinicians may experience a resurgence of imposter syndrome when starting over, as transitions amplify self-doubt and perceived inadequacy.28,29 Learning new responsibilities, workflows, team dynamics, and institutional norms can be challenging and error prone.30,31 Yet, approached with humility and openness, these transitions can catalyze reflection, accelerated learning, and renewed growth,31,32 especially if development had plateaued in a prior role. Clinicians who embrace uncertainty and demonstrate adaptability are more likely to thrive and adjust effectively.33,34
Both preparing for and managing the emotional aspects of a job transition are equally critical.27,34 Job changes can evoke excitement, insecurity, and even grief for what one leaves behind. 35 These feelings are normal and not markers of a poor decision. In this context, stress, heightened emotions, and positive coping can foster resilience and deepen professional engagement.34,36 Identifying emotions and discussing them with trusted peers or mentors can normalize the experience, provide reassurance, and help maintain perspective.7,37
Remember that transitions are rarely irrevocable. A new role may serve as a detour, launchpad, or experiment in one’s career. Framing transitions as iterative rather than irreversible can reduce pressure and further foster flexibility. By anticipating and tolerating uncertainty, leaning into discomfort, and viewing transitions as opportunities rather than endpoints, PC physicians can transform a destabilizing experience into one of intentional growth. When grounded in goals and values, a “leap of faith” can become an act of professional courage that realigns work with one’s evolving sense of mission and meaning.
Conclusion
Physicians’ long and largely prescribed training years can leave them underprepared to navigate the complexities of job transitions. While some support exists for physicians completing training and those at early career, few supports exist to guide physicians making a subsequent or mid-career job transition. The tips above highlight how an effective transition begins with reflecting on personal goals and identifying effective mentorship. Discernment among specific jobs requires professional, authentic communication and exploration of local culture—especially as it pertains to the position of PC within the institution and discrete opportunities for professional growth. After the transition, we emphasize building relationships, gaining early wins, and reassessing professional identity as high-impact initial steps in a new position. Throughout the process, uncertainty is inevitable, and courage is required. Yet who better exists than PC clinicians to navigate uncertain spaces? We believe these tips can help PC physicians to not only navigate the transition effectively but also experience tremendous professional growth in the process—gaining wisdom and cultivating skills they might never have otherwise.
Footnotes
Author Disclosure Statement
No competing financial interests exist.
Funding Information
No funding was received for this article.