12-Month Countdown: Timeline to Relocate as a New Attending Physician

The biggest mistake new attendings make is treating relocation like a weekend project instead of a year-long operation.

You are not just moving apartments. You are moving licensure, credentialing, insurance, loans, benefits, reputation, family, and your nervous system. If you start 3 months out, you are already behind.

Here is the 12‑month countdown I give residents when they ask me how to relocate smartly as a new attending. Month by month. Then week by week at the end. Follow this and you will avoid the worst disasters.

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12–9 Months Out: Define Your Target and Gather Intel

At this point you should not be on Zillow. You should be clarifying where and why.

Month 12: Career and Location First, Real Estate Later

Focus: Strategy, not logistics.

1. Clarify what you actually want from your first attending job:

   • Academic vs community vs hybrid
   • Procedural volume vs lifestyle
   • Research/teaching expectations
   • Call structure and backup support (who covers you when you are buried?)

2. Decide your geographic buckets:

   • Region(s) you will realistically accept
   • States where you already have ties (family, med school, undergrad)
   • States with reasonable licensing timelines (hint: California is not fast)

3. Start a simple tracking spreadsheet:

   • Columns: City, State, Institution, Specialty need, Contact, Notes, Pros/Cons, Compensation ballpark
   • Add one column for “Red flags” (high turnover, toxic leadership, chaos EMR, etc.)

4. Talk to people who already work there:

   • Residents who matched there
   • Fellows who rotated there
   • Former co‑residents now in that region
   • Ask blunt questions:
     • “How many people left in the last 2 years?”
     • “How does administration respond when something goes wrong?”
     • “Would you sign your same contract again?”

You are building a short list of places before you ever worry about moving trucks.

Month 11: Understand Cost of Living and Compensation

At this point you should be comparing reality, not vibes.

1. Pick 5–10 likely cities and run numbers:

   • Use cost of living calculators comparing your current city to each target
   • Look at:
     • Median rent / mortgage
     • Property taxes
     • State income tax
     • Childcare costs
     • Commute times

2. Cross-check compensation:

   • MGMA / AMGA data if you can get it
   • Online physician compensation reports (Doximity, Medscape—imperfect but directionally helpful)
   • Talk to recent grads in your specialty:
     • “What did you get as base + bonus?”
     • “What would you accept as the minimum to live comfortably in ___ city?”

3. Build a basic financial model:

   • Your likely take‑home monthly income (after taxes and retirement)
   • Estimated monthly expenses in each city (housing, loans, childcare, transportation, etc.)
   • Identify which locations are fantasy vs feasible

This is when some people realize their “dream” city pays like a hobby and their actual life would be better somewhere less flashy.

Month 10: Start the Job Hunt in Earnest

Now you move from theory to applications.

1. Clean up your CV:

   • One clear page per 5–7 years of experience
   • Remove fluff (every poster from MS1 does not matter)
   • Keep it structured: Education, Training, Licensure, Experience, Research, Teaching, Leadership

2. Draft a generic but strong cover email you can adjust:

   • Who you are
   • Training background
   • Specific interests (e.g., inpatient ID with transplant exposure, or outpatient general cards with imaging)
   • One sentence naming why their region / institution

3. Start outreach:

   • Message division chiefs or department chairs directly (short, respectful email)
   • Use the hospital HR/physician recruitment portals, but do not rely on them
   • Attend specialty‑specific career fairs or virtual job sessions

4. Track responses by week in your spreadsheet.

You want first conversations happening by 9–10 months out, not 4–5.

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9–6 Months Out: Contracts, Licensure, and the Point of No Return

This block is where people get burned. At this point you should be treating the move like a complex project with legal and bureaucratic landmines.

Month 9: Interview Rounds and Site Visits

Focus: Fit and red flags.

1. Schedule initial interviews (Zoom/Teams usually):

   • Clarify:
     • FTE expectations (clinical hours, sessions per week)
     • Call model
     • Support staff (schedulers, MAs, APPs, scribes)
     • EMR used and how templates / order sets are handled

2. For places that seem promising, push for onsite visits:

   • Non-negotiable:
     • Meet another junior attending who joined in last 1–3 years
     • See actual clinic / OR / ward spaces
     • Ask for a sense of daily patient volumes
   • Use your time wisely:
     • Morning: formal interviews
     • Afternoon: shadow or walk-through, plus informal conversations

3. Immediately after each visit, write down:

   • 3 things that felt good
   • 3 things that felt off
   • Your gut reaction on a 1–10 scale

You are trying to avoid “rose-colored-tour-syndrome” after a free dinner.

Month 8: Negotiating Your First Contract

This is where new attendings either set themselves up or chain themselves to misery.

At this point you should:

1. Get the offer in writing, even if it is a term sheet first.
2. Hire a physician contract attorney. Not your uncle who does real estate law. A real one.
3. Focus your negotiation on:
   • Base salary and bonus structure
   • Call requirements (number of nights/weekends, in-house vs home call)
   • RVU or productivity benchmarks (are they even realistic?)
   • Non‑compete radius and duration
   • Tail coverage for malpractice (who pays when you leave?)
   • Sign‑on bonus and relocation assistance size and payout timing

Item	Better for You
Malpractice	Occurrence or employer-paid tail
Non-compete	Short duration, small radius, clear carve-outs
Call	Written limits and backup coverage defined
Bonus	Transparent metrics and realistic thresholds
Relocation	Paid directly to you, not only to vendors

If a place refuses to clarify basics in writing, that is not “just how things are done here.” That is a warning.

Month 7: State Licensure and Credentialing Start

You should assume licensure and hospital credentialing will take longer than they promise.

1. As soon as you sign:

   • Start the state medical license application immediately.
   • Some states are fast (2–3 months), some are glacial (6+ months).

2. Collect documents:

   • Medical school diploma
   • Residency/fellowship completion letters
   • Step/Board score reports
   • Current licenses (if any)
   • Reference letters if required by the state board

3. Ask your future employer:

   • Will they help with licensure fees?
   • Do they have a dedicated credentialing team?
   • What is their realistic timeline from “signed offer” to “privileges granted”?

4. Start hospital credentialing packets:

   • These are annoying and repetitive
   • Block a half‑day and just grind through them

Attending Relocation High-Level Timeline

Period	Event
Early Phase - Month 12-10	Define goals, research locations, start job hunt
Early Phase - Month 9-8	Interview, visit, negotiate contract
Middle Phase - Month 7-6	Licensure, credentialing, financial prep
Middle Phase - Month 5-4	Housing, schools, detailed move planning
Final Phase - Month 3-2	Book movers, change addresses, finalize logistics
Final Phase - Month 1-0	Move, onboard, stabilize in new role

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6–4 Months Out: Money, Housing, and Life Logistics

At this point you should be shifting from “Will I move?” to “Exactly how will I live there?”

Month 6: Financial and Insurance Setup

1. Align your start date with your finances:

   • When does fellowship/residency pay stop?
   • When does your first attending paycheck hit? (Often a 2–4 week lag)
   • Plan for a 1–2 month cash buffer

2. Understand benefits:

   • Health insurance: gap coverage between training and new job?
   • Disability insurance: get an individual own‑occupation policy before or right after you start
   • Retirement: 401(k)/403(b) match start date and vesting schedule

3. If you have loans:

   • Decide: refinance vs PSLF vs other forgiveness
   • Confirm your employer’s status (non-profit vs for-profit) if PSLF matters

4. Rough budget for relocation:

   • Movers
   • Deposits (rent or mortgage / closing costs)
   • Temporary housing
   • Travel for house-hunting

Typical Relocation Cost Breakdown for New Attendings

Category	Value
Movers/Shipping	30
Housing deposits/closing	40
Travel & temporary housing	15
Licenses & fees	10
Misc setup	5

Month 5: Housing Scouting and Neighborhood Triage

Now you can let yourself look at real estate. With constraints.

1. Clarify your non‑negotiables:

   • Max commute time both during rush hour and off‑peak
   • Parking (especially in urban hospitals)
   • Schools/daycare options if you have children
   • Safety profile of neighborhoods

2. Make a scouting trip if possible:

   • Schedule housing tours (rentals or homes to buy)
   • Drive your potential commute at peak times
   • Visit grocery stores, childcare centers, parks

3. Decide: rent vs buy first year

   • I strongly favor renting the first year in a new market:
     • You do not know yet whether the job is a long‑term fit
     • You do not know which neighborhood you will actually like after 6 months
   • Exceptions:
     • You are returning to a city you know extremely well
     • Your spouse/partner is already established there and you are certain

Set a deadline for signing a lease or purchase contract: usually 3 months before move.

Month 4: Family, Schools, and Support Systems

If you have a partner or kids, this month matters more than any negotiation point.

1. Schooling:

   • Research school enrollment deadlines (some are months in advance)
   • For public schools, map your housing search to school zones
   • For daycare, start waitlists now, not after you move

2. Partner career:

   • Networking for their job in the new city
   • Timing their job change with your move
   • Assess whether you need one income buffer period

3. Build a support map:

   • Who do you know in that city (even loosely)?
   • Alumni groups from your med school or residency
   • Specialty societies’ local chapters

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3–1 Months Out: The Tactical Grind

Here is where the move stops being abstract and becomes boxes, forms, and deadlines. At this point you should be living in checklists.

Month 3: Lock in Dates and Vendors

1. Confirm:

   • Exact start date (in writing)
   • Orientation schedule
   • First on‑call date (you want some clinic/OR days first if possible)

2. Book:

   • Moving company (or decide on PODs / self‑move)
   • Temporary housing if there is a gap between move‑in and work start
   • Flights or driving route

3. Start the address change master list:

   • Bank and credit cards
   • State medical board(s)
   • DEA and controlled substance registration
   • Professional societies and boards
   • Loan servicers
   • Insurance companies

4. If you own where you are now:

   • List your home or give notice to your landlord according to lease terms

Month 2: Systems, Licenses, and Clinical Readiness

This month is about not walking in blind on day one.

1. Follow up aggressively on:

   • State license status
   • Hospital privileges
   • DEA registration (and any state-level equivalents)

2. Get EMR access and training:

   • Schedule online modules before your first day if allowed
   • Ask for:
     • Sample note templates
     • Order sets in your specialty
     • Commonly used phrases or smart phrases

3. Clinical setup:

   • Think through your “first clinic week”:
     • Ideal schedule density (do not start at 24 patients/day)
     • Procedures you do vs refer
     • How refills, inbox, and results will flow

4. Personal logistics:

   • Set up mail forwarding
   • Transfer prescriptions to a pharmacy near your new home
   • Book any needed appointments (dentist, PCP, etc.) before you lose your current network

Time Allocation in the Last 8 Weeks Before Move

Category	Value
Licensing/Credentialing	25
Housing/Moving	30
Family Logistics	15
Current Job Wrap-up	20
Future Job Prep	10

Month 1: Pack, Close Loops, and Mentally Shift

At this point you should be wrapping up, not starting tasks.

1. At your current institution:

   • Finish all notes and charts
   • Close open quality projects or hand them off explicitly
   • Say deliberate goodbyes to mentors, colleagues, and staff

2. Packing:

   • Label boxes by room and priority
   • Keep a separate first‑week bag:
     • Work clothes
     • Important paperwork
     • Basic kitchen items
     • Medications
     • Electronics and chargers

3. Financial and admin:

   • Confirm your last paycheck date and any unused PTO payout
   • Confirm new job’s first paycheck date
   • Download pay stubs and benefits summary from your current employer

4. Mental reset:

   • Take at least a few days of actual downtime between finishing training and starting your attending job
   • You are not a resident anymore; the way you think about responsibility and boundaries has to upgrade too

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Move Week and First 30 Days: Stabilize, Then Optimize

You have actually moved. Now your timeline switches to days and weeks.

Move Week: Minimum Viable Life Setup

Day 0–3:

• Confirm:
  • Housing keys, parking, mailbox, internet setup
• Unpack only what you need:
  • Bed, basic kitchen, work clothes, important documents
• Walk the neighborhood:
  • Nearest grocery, pharmacy, urgent care, gym

Day 4–7:

• DMV / driver’s license if needed for your new state
• Bank branches if you need in‑person help
• Explore at least one non-work place you might actually enjoy (park, café, trail)

First Work Week: Learn the System, Not Just the Medicine

Week 1:

• Arrive early every day. Not a motivational poster thing, a logistics thing.
• Focus on:
  • How nurses, MAs, and APPs actually route things
  • How to get stuff done: stat CT, add-on case, urgent referral
  • Who fixes what: IT, scheduling, prior auths, central supply

Ask one trusted colleague:

• “What do new hires here usually screw up in the first month?”
• “What would you tell yourself on your own first week?”

First Month Onboarding Flow for New Attending

Step	Description
Step 1	Start Day 1
Step 2	Orientation
Step 3	EMR Training
Step 4	Shadow Clinic or OR
Step 5	Light Independent Schedule
Step 6	Full Patient Load
Step 7	Meet Key Staff

Weeks 2–4: Gradual Ramp, Guardrails Up

Weeks 2–3:

• Slowly increase patient volume to your target
• Keep a running “process questions” note:
  • Billing quirks
  • Common order sets
  • Local referral patterns

Week 4:

• Check in with your division chief or mentor:
  • Ask for specific feedback
  • Clarify upcoming expectations: clinics, call, meetings, committees

Do not volunteer for every committee or project in month one. Prove you can function clinically first.

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Final 6-Week Micro‑Timeline (for the Detail-Oriented)

You like specifics. Good.

6 Weeks Before Move

• Confirm:
  • Movers and exact dates
  • Lease or closing date
  • Start date and orientation schedule
• Start:
  • Packing non-essentials
  • Formal goodbye plan to current supervisors and mentors

4 Weeks Before Move

• Mail forwarding scheduled
• Utilities set to turn off/on appropriately
• Childcare and schools confirmed with written start dates
• Final appointments in current city (doctor, dentist, etc.)

2 Weeks Before Move

• Pack most of the house
• Keep only daily-use items out
• Back up important digital documents to cloud
• Print or save offline:
  • License confirmations
  • Contract and benefits summary
  • Credentialing contacts

1 Week Before Move

• Deep clean current place or schedule cleaning
• Turn in keys/coordinate handoff
• Triple-check:
  • First day arrival time and location
  • Parking situation
  • Dress code for orientation

First Week After Move

• Unpack the essentials
• Stock the kitchen enough to avoid daily takeout
• Walk or drive your commute at your actual start time

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The Short Version: What Actually Matters

Three points to remember if you ignore everything else:

1. Start 12 months out, not 3. Job search, contracts, and licensure eat time. If you are not interviewing by 9–10 months before graduation, you are compressing your options.
2. Lock down the boring stuff early. Licenses, credentials, daycare, housing, benefits—these are what derail timelines, not “finding a couch.”
3. Use the first 30 days to learn the system, not prove you are a hero. Slow clinical ramp, aggressive questions, deliberate boundaries. You are building a sustainable attending life, not surviving another rotation.