The jump from residency to your first job is exciting, and it can be overwhelming. You are choosing more than a paycheck. You are choosing the environment that will shape your clinical confidence, your referral relationships, and how quickly your schedule fills.
In this episode, Dr. Neil Zachs and Dr. Diwakar Kinra walk through what residents actually need: a clear timeline, a practical way to evaluate fit, and the habits that separate a smooth first year from a stressful one.
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Why this conversation matters right now
Some residents will go straight into traditional private practice environments. More residents are also considering DSO affiliated practice models as they weigh mentorship, flexibility, and operational support. Regardless of the setting, the decision framework is the same: start early, evaluate the right variables, and build a plan for your first year.
One mindset shift to keep front and center is simple. Your first job is not a finish line. It is your launchpad.
Start early enough that you can choose, not rush
The most avoidable stress in a first job search comes from timing. Many residents wait until the final stretch, then try to compress conversations, site visits, and contract review into a short window.
Dr. Kinra offers a rule that removes the guesswork:
“I look at the fall before the year you graduate. So, let’s say you’re graduating in 2027. I always say by the fall of 2026, you should start narrowing down your ideas of where you want to practice because it takes time.”
That “it takes time” is not a vague warning. It is practical reality:
“You have to go to have a discussion with a doctor, you have to then go into a site visit. I would never want anybody to practice until they’ve gotten done a site visit and then it takes time to get a contract, maybe have somebody review it and then sign for it. And you don’t want to lose out on a position because somebody was just one step ahead of you.”
-Dr. Diwakar Kinra
Dr. Zachs adds an important layer: the best job outcomes often start with relationship building before the formal job hunt even begins. He explains why meeting people earlier can be valuable:
“You could meet somebody in their first year… and you’ve known them for years… over the course of time you get to know them, and they understand our brand and what we’re about as a company. So all of a sudden, you blink of an eye, it’s their third year and now they’re ready for really to start looking.”
The takeaway is not that you need to be “job hunting” on day one of residency. It is that you should build awareness and relationships early, then get serious with your search early enough to avoid rushing.
A timeline you can actually follow
The goal is to break the process into stages, so nothing important gets skipped.
Fall before graduation: narrow and explore
This is when you move from “I should look soon” to “I have a plan.”
- Narrow your geography and lifestyle priorities
- Identify your must haves (mentorship, culture, clinical autonomy, ramp support)
- Start conversations and schedule site visits
- Build a short list of places you would genuinely be excited to join
Winter: compare and pressure test
This is where residents win by being organized.
- Do second visits if needed
- Compare opportunities using a simple scorecard: culture, mentorship, ramp plan, clinical philosophy, referral support
- Start contract review early so you are not negotiating in a rush
Spring: finalize and prepare to ramp
Signing is not the end of the process. It is the beginning of your transition.
- Finalize the decision and sign with clarity
- Confirm onboarding details and ramp expectations
- Plan your first 90 days of referral introductions and relationship building
Location is important, but fit is what you live in every day
Residents usually start with location, and that is smart. Family, lifestyle, and partner considerations are real. Still, the episode makes a strong point: fit and culture matter just as much because they dictate what your day actually feels like when things get busy.
Dr. Kinra frames culture in a way residents can evaluate quickly:
“One thing you have to do is figure out what is the culture of the practice you want to be in. And the culture of the practice for most private practices are the personality of the senior doctor…All of you are going to be well off eventually, but you got to love the place that you go to work every day.”
Dr. Zachs also encourages residents to keep an open mind geographically, especially if you want to maximize opportunity early:
“It’s really nice when someone can look beyond that a little bit and say, listen, I just want to go where the best opportunity is.”
He notes that some residents are drawn to major cities, but there can be real advantages in less saturated markets.
What to pay attention to on a site visit
Signs of a healthy culture
- People communicate clearly and respectfully
- Expectations are specific, not vague
- Doctors and team members seem aligned on how the practice runs
- Mentorship sounds structured and consistent
Red flags worth noticing early
- Answers feel overly polished or evasive
- Nobody can describe what “success in year one” looks like
- You sense tension, disorganization, or unclear leadership
- Mentorship is framed as “you’ll figure it out” rather than a real plan
The skill residents underestimate: building referral relationships
Many residents assume that joining a busy practice means staying busy automatically. The doctors challenge that assumption. Even in strong markets, long term success often comes down to whether the community knows you, trusts you, and thinks of you when a patient needs help.
Dr. Kinra addresses the word that trips residents up:
“I think the word marketing gets a negative connotation. It’s really about what type of relationships do you have with your referrals? You could join the most successful practice in town. And if you don’t want to talk to the community, they will never circle your name. They will never want to refer a patient to you. No doctor wants to refer a patient to a specialist that they’ve never met before.”
Dr. Zachs reinforces the mindset that strong candidates understand early: success is built, not handed over.
“Someone who just understands that not everything in life is going to be handed to them and that they understand that going out there and building their brand and working and meeting referrals and putting a little bit of time and effort into their growth, I think is super important.”
A better way to think about it
Relationship building is not self-promotion. It is part of patient care. Referring doctors want to know who is treating their patients, how you communicate, and what the patient experience will be like. A strong practice can open doors and create introductions, but your long term success is still built through your own consistency. You earn trust by showing up, following through, communicating well, and becoming the specialist they think of first, not once, but repeatedly.
In practical terms, your schedule growth is often tied to three things:
- The reputation of the practice
- The relationships the practice already has
- The relationships you build once you arrive
The expectations exercise that prevents most first job regret
A large number of associateships struggle because expectations were never made explicit. The episode offers a tool that is simple and extremely effective: write down expectations on both sides before you sign.
“I want them to set up a list of expectations that they have with that practice. And I always make sure that practice sets up a list of expectations they have from that doctor. Remember most associateships don’t work out… When you write that out and you present that to the other party, that’s where I know it’s going to be successful.”
-Dr. Diwakar Kinra
What residents should put on their expectations list
Mentorship and support
- What does mentorship look like week to week?
- Who is available when you are stuck, and how quickly?
- How are complex cases handled early on?
Ramp and schedule growth
- What is a reasonable ramp at 3 months, 6 months, and 12 months?
- What support exists if volume is lighter than expected at first?
- How are cases distributed and how is scheduling managed?
Referrals and community integration
- How will you be introduced to referring doctors?
- What is expected of you in building those relationships?
- How does the practice communicate with referrers?
Clinical philosophy and autonomy
- What kind of dentistry is valued here?
- What decisions are yours versus the practice’s?
What you should ask the practice to write down
Ask the practice to be specific about:
- Community outreach and referral introductions
- Communication standards with patients and referrers
- First year productivity expectations and what “success” looks like
- Team leadership and collaboration
Contracts matter, but do not get stuck on small numbers
You should absolutely have your contract reviewed. The point in the episode is not “ignore details.” It is “do not lose the big picture.”
Dr. Kinra describes how residents can get pulled into the wrong decision frame:
“If you’re looking at a signing bonus… and the signing bonus at another place is a couple thousand dollars more… ‘This is non-negotiable. I need those $3,000 more or $5,000 more’… My suggestion to them is look at the overall opportunity.”
Dr. Zachs agrees, and adds a practical way to think about comparing offers:
“You’re comparing apples to oranges. I mean, you really do need to compare apples to apples… What’s really the long-term benefit? The mentorship… Hyper focusing on this relocation or the signing… when you really have to look at the bigger picture.”
A simple way to compare two offers
When you are deciding between opportunities, ask:
- Where will I get the best mentorship and feedback early?
- Where are expectations clearest and culture healthiest?
- Which ramp plan is most realistic and supported?
- Where will I build the strongest referral relationships fastest?
- Which environment sets me up for long term growth?
Your next step
A strong first job is rarely an accident. It is usually the result of starting early, choosing culture and mentorship on purpose, and treating referral relationships as part of your clinical responsibility.
Explore open opportunities for Endo and Perio specialists
If you are beginning your search or narrowing your shortlist, you can also view current roles and learn more about what different opportunities look like here.