I moved a lot of physicians in and out of jobs over twenty years, and this is the part that blindsided almost every one of them. Physicians tend to picture leaving a job as one clean step, where you resign on Friday and start the new place on Monday. Then they run into the least glamorous and most underestimated fact in medicine, which is that you can't simply show up and start seeing patients. Before you can work, and before you can bill a dime, you have to be credentialed, privileged, and enrolled with the payers, and that process runs on a timeline that has nothing to do with how eager you or your new employer are. Plan your move as if that gap doesn't exist, and it will quietly cost you months of income.
So the first rule of making a move is to start the clock early. The moment an offer is real, ask the new employer's medical staff office to begin credentialing, and ask specifically how long enrollment with the major payers takes in that market, because a hospital can grant you privileges and you still can't bill a given insurer until that insurer says so. This is the single most common way a smooth transition turns into a lean quarter, and it's entirely avoidable with a calendar and a little polite nagging.
While that runs in the background, deal with the exit itself, in order. Read your current contract before you say a word, especially the notice period and anything with a clawback. If your signing bonus or relocation money forgives on a schedule, leaving early may mean writing part of it back, and you want that number in front of you before you give notice, not after. The non-compete matters here too, because the day you resign is the day it kicks in, so know the radius, the duration, and whether it even applies when you're the one leaving voluntarily, because the answer changes where you're allowed to work next.
Then there's the tail. If your malpractice coverage is claims-made, leaving raises the question of who buys the tail policy that covers claims filed after you're gone, and if your contract is silent on it, assume the bill is yours until proven otherwise. It's not a reason to stay, it's a reason to know the cost and factor it in, the same way you'd factor in movers.
Give notice like someone who understands the world is small. Medicine is a village, your references live at the place you're leaving, and the profession has a long memory. So resign in person where you can, give at least the notice your contract requires and ideally a little more, and resist the very human urge to finally tell everyone exactly what you thought of the place. A clean exit is worth more over a career than the momentary satisfaction of an honest exit interview, because the colleague you part with graciously today is the one who refers you a partner, or vouches for you to a group, five years from now.
And handle your patients like the professional you are. Depending on your specialty and your contract, there are real questions about how patients get notified, who's allowed to tell them where you've gone, and what you can and can't say on your way out. Some of that is governed by your agreement and some by state rules, so it's worth checking rather than assuming. The goal is continuity of care that reflects well on you, not a scramble that reflects badly.
None of this is a reason to stay in a job that isn't working. It's the opposite. The physicians who move well are the ones who treat the logistics with the same rigor they'd bring to a discharge plan: start the credentialing clock early, read the exit clauses before you talk, price the tail and the clawback, protect the relationships, and mind the patients. Do that, and the ninety-day gap becomes a thing you planned for instead of a thing that happened to you. The exit isn't an emergency, it's a procedure, and you already know how to run a procedure.