Burning Bridges

Q: I am about to finish my Internal Medicine training and I want to try to find a non-clinical job. I am not sure that will work out, so I am concerned that if I ask for recommendations from my attendings, they will see me as less dedicated to clinical medicine, and I will lose my chances at good recommendations for clinical jobs if I need them.

A: You don’t need to worry about your attendings seeing you as less dedicated if you ask for letters of recommendations for more than one job or for more than one type of job.
It is typical and in your best interest to evaluate several options before you accept your first job offer. Unless you have specifically heard your attending criticizing a particular work environment, you should not worry.
However, sometimes it can be best to ask an attending who may have observed you in one setting (as a senior resident on the wards for example) recommend you for one type of position while another attending who has observed you in another setting (presenting grand rounds) recommend you for another type of position. For example, if you are applying for a job at a medical consulting company, you may want to ask for a recommendation from a faculty member who saw your work when you volunteered on a hospital committee. If you are applying for a job in a substance abuse treatment setting, you might want to ask for a recommendation from a faculty member who supervised your interaction with difficult patients.
An important factor to keep in mind is that regardless or whom you list as a reference, future employers are more likely to call their acquaintances in the department where you are doing your training- even those who you have not listed as references.