As a resident physician, are you thinking about where you want to build your future in medicine? Meet Sydney Brehany, MD, a hematology and medical oncology physician and a featured voice in the AMA’s “Finding My Place in Medicine” series.
In this series, physicians reflect on what influenced their decisions when choosing where to work—and what they wish they had known earlier. Explore her journey to help guide your own path toward a fulfilling medical career.
If you are looking for your first physician job after residency, get your cheat sheet now from the AMA. In addition, the AMA Transitioning to Practice series has guidance and resources on deciding where to practice, negotiating an employment contract, managing work-life balance, and other essential tips about starting in practice—including in private practice.
"Following” Dr. Sydney Brehany
Specialty: Hematology/Medical Oncology.
Practice setting: Community-based oncology group with hospital-embedded and standalone clinics.
Employment type: Employed by Mission Cancer + Blood, a part of University of Iowa Health Care, in Des Moines. University of Iowa Health Care is part of the AMA Health System Member Program, which provides enterprise solutions to equip leadership, physicians and care teams with resources to help drive the future of medicine.
Years in practice: Three.
Key factors that led to me choosing to work at University of Iowa Health Care: When I looked at job options in Central Iowa, Mission stood out because of its strong presence and its proximity to where we wanted to live, which was closer to family. I also liked that it’s a larger practice group, which brings diverse perspectives and better coverage, such as not being on call every month.
What stood out to me during the interview and hiring process: Everyone I spoke with at Mission was genuine and welcoming. I interviewed just before the announcement that Mission would join UI Health Care, so there were things they couldn’t share yet, but I still felt comfortable and could see myself working with, and learning from, these people. That was important to me, especially early in my career, as I was looking for mentorship and guidance—not just in building my medical knowledge and working with patients, but also in navigating the business and group dynamics.
I also appreciated the flexibility to shape my practice. There weren’t rigid expectations around patient volume or schedule. They were open to working with me to support both my career goals and family life.
How feedback from peers and mentors influenced my evaluation process: Hearing from people with varied experiences, whether in private practice, academic settings or systems like Mission, was really helpful. Their insights helped me understand what to look for during interviews and contract discussions, as well as what challenges might come up that are not immediately obvious. That perspective helped me evaluate the opportunity more thoroughly.
Why I chose to work in this practice setting: After Mission joined UI Health Care, I liked that Mission retained some private practice qualities—like flexibility in shaping your own practice—while gaining the support and resources of a larger health system.
For example, the clinical trials program was already strong, but now it’s expanding through UI Health Care Holden Comprehensive Cancer Center. There’s also more opportunity to collaborate with specialists, which is exciting.
It feels like the best of both worlds: the autonomy of private practice with the stability and reach of a health system, which is especially valuable given the current healthcare landscape.
The top three qualities for a great place to work for physicians: First, being part of a supportive group that helps you grow into the physician you want to be—while also respecting your life outside of work—is essential. It’s important to have an employer that values both your career and your personal well-being.
Second, mentorship. Especially early in your career, it’s crucial to work with people you can learn from and see as professional role models.
Third, feeling appreciated and having the resources to do your job well, such as having adequate clinic personnel, charting support and systems that reduce administrative burdens. A productive environment depends on feeling supported and not overwhelmed by inefficiencies.
How my current practice supports physician well-being and work-life balance: For me, having two children under 3, it was important to find a group that supported maternity leave and a flexible schedule. Most physicians here work five days a week, but I didn’t want that, and the group was supportive.
There’s also flexibility in patient volume. You can see 12–15 patients a day or more than 20—it’s tailored to your goals and capacity. There’s no rigid productivity benchmark, which allows for a more individualized approach to practice. That kind of flexibility isn’t always available in other health systems.
The workplace attributes that contribute most to my job satisfaction at University of Iowa Health Care: One major benefit was being able to choose my own team members, rather than having them assigned to me. I interviewed nurses and selected someone who aligned with the kind of practice I want to build.
Also, some of the tools brought in through the University of Iowa, like AI-assisted charting, have helped reduce documentation time and improve work-life balance.
The biggest challenges I faced when transitioning from residency to practice: I started in more of a private-practice setting in Colorado after residency and fellowship, and it was a big adjustment. At the time, I didn’t have much exposure to the business side of medicine, which is more prominent in private and group practices.
Another challenge was not knowing what questions to ask to set myself up for success. The mindset and expectations in practice are different from those in training, and it takes time to learn how to navigate that shift.
What I wish I had known about evaluating a job offer before choosing my first position: With that first position in Colorado, I wish I had understood more about the business side, such as compensation models, productivity expectations, and how success is measured. Every group does it differently, and those details really matter.
I also wish I had known what questions to ask during contract negotiations. In training, we didn’t have experience with that, so finding a good contract lawyer who explains the clauses and their long-term impact was something I learned to value later.
What I would have done differently when choosing my first job after residency: I would have asked more questions—especially about what it takes to be successful in that specific practice. Understanding the metrics, how revenue is generated, and what levers physicians can control is key.
I also would have prioritized finding mentors early on—not just on the clinical side, but also those who could guide me through the business aspects of practice.
Why I changed practice settings: I wanted to move back to Iowa to be closer to family, so that was a driving factor. There were also some economic challenges in healthcare at the time that made staying in my first position in Colorado less sustainable. Given where our family was, it made sense to make a change and find something more stable and supportive near home.
