Deciding on a career path after completion of IP fellowship training can be challenging. Pursuit of an academic career can be rewarding however, there are numerous issues which need to be considered to include promotion structures, desire for autonomy and salary discrepancies in comparison to private practice. Additionally, individuals joining active IP programs are rarely given the opportunity upfront to work solely as interventionists, but rather, should expect that contracts will include a significant amount of general pulmonary and/or critical care time. Practicing outside of an academic program however has its own unique set of challenges, including increasing requirement for billing and documentation, rising malpractice insurance costs, as well as challenges for worklife balance. With the implementation of the affordable care act there has been a significant shift in practice patterns. Choosing a career path can be an overwhelming experience. Prior to entering the job market, it is of critical importance for graduating fellows to reflect on the aspects of practice which one would find ideal, acceptable or unacceptable.