For many young doctors graduating residency, the segue into a full-time position at a hospital or within a practice is the first “real” job. Perhaps there have been a few part-time service industry jobs along the way, but unless you had an alternate career prior to medicine, this (finally!) is the time when you get to enter the job market.

Advantages

This tumultuous time for the US and the world is marked with a huge amount of job stress. However, as a newly minted physician (or an established doctor switching practices) you have a distinct advantage over most of the more unfortunately unemployed young folks. Doctors are beyond essential, and our jobs are mostly recession-proof. After putting in the years of hard work and countless hours of studying for various boards exams, we can rest assured that a job is waiting at the end of the tunnel (once those exams are passed!).

The Challenge

As I mentioned in my previous article on final-year residency timelines, an important factor in entering the job market is deciding what you want in a position. Having your personal and professional priorities sorted out is essential to be able to find and decide on jobs that really fit for you. Interviewing and being placed in a position as a doctor is a lengthy process that involves credentialing, background clearance, a litany of pre-clinical training, onboarding, and often even changing state licensure. You want to make sure that the job you accept is the right fit for you and for your financial, geographical, and lifestyle needs. For this reason, you may end up doing a number of interviews at various potential jobs that you will ultimately turn down. Being discerning and willing to wait for the right “fit” is challenging, especially coming out of residency with a mountain of debt and the prospect of finally making six-figures. But waiting and being willing to turn down offers is part of the game and must be done properly.

Remember

There is no big secret to the process of turning down a job offer and doing so within the field of medicine is very similar to that of any other high-ranking position in other fields. It requires tact, exceeding levels of politeness, and gratitude. One thing to keep in mind throughout the interview and the acceptance/rejection process is that employers (hospital departments, practices) want to hire someone who wants to work there, not just someone who accepted an offer because they were too afraid to say “No thanks.” The process of offering a position and having that offer rejected will not be new to any entity trying to hire you, so do not feel bad or guilty about doing so. It’s all part of the process and doing it right every time will guarantee that you maintain a reputation for being courteous and conscientious.

Of Note

The process described pertains to outright declining an offer, with no intention of negotiation. There are certainly circumstances where one might initially decline a particular set of parameters within an offer in order to leverage competing offers in hope of negotiating. This can be useful when a proposed salary or benefits is not to the potential employee’s liking. However, that process has its own set of delicate limitations and is beyond the scope of this discussion.

First

It’s important to decide what medium you will use to communicate your declination. Have you been mainly using Zoom or calling over the phone with your contact at the job? Or has email been predominant? What do you feel most comfortable with? If you are bad with confrontation and feel you might choke up or forget what to say on a phone call, you could consider using email or even writing /typing out what you want to say and referencing that during a conversation. One thing that is not advised would be leaving a voicemail, under any circumstance. It’s impersonal, you don’t know who will end up hearing it (if anyone) and could lead to misunderstandings. Rarely, an in-person meeting could also be appropriate, depending on the circumstances.

Thanks

It’s essential to thank the entity offering you a job for their time, and for showing you what their workplace is like, especially if they took you out for meals, or paid for your travel/lodging when interviewing. Use specific references and emphasize what you liked about the practice or hospital, etc. And mention specific people who may have impressed you or left a good impression. You want to start out with a positive and appreciative tone.

Get to it

Once you indicate that you can’t accept the offer, it’s good to be short and sweet. The person reading your letter or listening to you speak is going to want to know “why” and probably want to move on shortly thereafter. A long song and dance about if’s and’s or but’s is not going to serve anyone. State (honestly!) what about the job is not going to work for you. It helps if the reasons stated are concrete and inflexible factors (location, patient or caseload type) rather than something like salary. Typically, salaries are negotiable so you could open yourself up to an unwanted offer of negotiation when you really just wanted to back out quickly and move on. It’s okay to use terms like “at this time” or “for my family’s current priorities” to couch the specific and temporality of your reasoning. You can also indicate that you gave this decision “a lot of thought,” even if it’s a tiny white lie. It helps to lubricate your “no” in ways that still manage to compliment the hiring entity.

Conclusion

If you want, you can finish your letter or statement with an indication that you would like to leave lines of communication open for the future. Perhaps you might move back to the area at some point or want to switch from hospital into private practice as part of a long-term plan. It’s appropriate to indicate this and be clear if you feel like this particular job could be desirable to you in the future. If you don’t feel that way, wish them luck in the hiring process and thank them once again for their time.

It doesn’t require writing a novel or groveling at the feet of more senior doctors or HR reps to turn down a job offer. You just need to be clear, concise, and remember to always be polite! Good luck!!