The Job Seeker Perspective: Nirali D. Soni, MD


When Nirali D. Soni, MD, completed her residency at the University of Arizona last June, she knew she needed to keep a tight schedule to meet her goals: First, she would study for her boards during July, August, and September; and then she would turn her attention to job search, devoting the months of October, November, and December to landing her first role as a practicing physician. At the same time, of course, she would be mastering her duties as an epilepsy fellow at the University of Arizona. Does that sound stressful? Soni admits to feeling some strain but says that, for the most part, it wasn’t over the top.

“It was moderately stressful,” she reports, “but I’m very happy with the results. The general trend for fellows is to have your future job lined up and the contract signed by December and I wanted to reach that goal. But I put everything on hold while I took my boards, because that was my first priority.”

To make the most of a compressed timeline, Soni created a careful structure of decisions for herself. Her plan was to streamline the process as much as possible without compromising. “As soon as I finished my exam,” she says, “I narrowed down my search in two ways. First, I wanted to decide if I would be in academic neurology or take the non-academic route. The second decision was about region. I think that was very important in making my search efficient.”

As it turns out, both decisions were relatively clear-cut for Soni. She knew from her experiences in training that she wanted to focus on patient care—specifically on outpatient care—and having been away from home for her entire medical training process, she knew she wanted to practice in the Washington, DC, area, where she had been raised. Once she had developed a radius on the map, the next step was straightforward: “I started contacting recruiters to see what jobs were available. I wasn’t being picky, because I knew I would have the options to make modifications to potential roles.”

Using this system of outreach, it wasn’t long before Soni had three interviews lined up. Well, four actually, but one fell through at the last minute. She was disheartened by losing one of the interviews but then she learned from others that it’s a fairly normal phenomenon. Understanding that such cancellations usually aren’t about the candidate helped her stay focused on performing well in the other meetings.

What she learned next surprised her. “When I interviewed at the three places, I found out they had completely different structures,” she says. “They were different in financial structure, in patient scheduling, everything. I just expected practices to be set up similarly to where I did my residency and fellowship training.”

For example, Soni notes, the practices she interviewed with all followed a model of separating outpatient and inpatient neurology as a way of avoiding physician burnout—whereas in her training programs, the two disciplines had always been mixed. Although facing an unanticipated decision gave her pause, she felt clear in her choice: “I knew from training that I cherish outpatient care,” she says. “That continuity of care was something that really gave me gratification.”

At this stage, the decisions began to get tougher. None of her three potential employers could meet all her criteria. Only two had an emphasis on outpatient care, only two provided more opportunity to practice her specialty in epilepsy, and only two were directly in the geographic region she had drawn for herself. “This is where the decisions started to get tough,” she says. “I didn’t want to move too far away from my ideal region, and I didn’t want to give up epilepsy from the final equation.” Complicating the situation, one of the options was in a small private clinic with one other neurologist as a partner. Since working for herself is one of Dr. Soni’s longterm goals—and the practice was ideally situated—she was very tempted by this opportunity.

In the end, she had to acknowledge that no one position would meet all her criteria, so she shifted her decision-making to this question: Which criteria was she willing to take out of the equation? Ultimately, she let go of the location as a decision point and chose a position that would fulfill her professional goals while situating her in bucolic Fredericksburg, Virginia—about 30 miles outside the farthest edge of the radius she had drawn. In August, after completing her fellowship training, Soni will be an outpatient neurologist at Mary Washington Health, joining another neurologist in doing the hospital follow-ups and seeing new patients in a clinic setting. She’ll also be involved in doing epilepsy monitoring, on the inpatient side. It’s a choice she’s very happy to have made.

“I really feel like it’s the perfect position,” she says. “With the smaller practice, I wouldn’t have had as many people to learn from, but here there are five neurologists on the team. The energy was great with them and they helped me with the concerns I had about the location. They were thinking about me as a person and I appreciated that.”

Having made her decision, managing the contract was the only detail left in the process. “One thing I was concerned about was signing too early,” she notes, “because I didn’t want to find out later there was something better. But one of my instructors told me, ‘Remember, you can always change later. Whatever decision you make, it won’t be wrong but it if it is, you can find a way to move on from there.’ That was helpful to keep in mind for me.”

Soni signed her contract in December and, because the job matched what she’d been looking for, she didn’t find much that needed to be changed. Even so, she followed the advice she had always heard, to go through the contract “with a fine-tooth comb.”

Having successfully completed her search, Soni reports that it’s a relief now to focus attention on her fellowship duties without the added stress of scheduling meetings with potential employers across the country. With that in mind, she has some advice for others who may be planning a search for their first job out of training:

First, decide whether to focus on academic or non-academic positions. If academic careers are your pathway, you might benefit from a looser concept of geographic territory. But if you’re planning to follow a non-academic route, it’s more important to more narrowly define the region. That allows you to schedule interviews with multiple employers in the same trip, which is an important trick for streamlining the process. As Soni notes, “To be traveling to three or four states while I was in training would have been almost impossible.”

And finally, don’t feel too stressed about the choices you make. “At the end of the day,” she says, “you’re never stuck. I wouldn’t worry too much about making the wrong decision. Put the legwork in and then just have some faith.”

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