Well, if you find a position and get licensed in your new state before you graduate residency/fellowship, or stay in the same state you trained, then you could start right away, as soon as you completed any mandatory institutional onboarding. Of course, I don't know who you're going to operate on electively if you've never met any of your new patients, but I suppose in theory you could be a trauma surgeon who took your first shift right after you did your HR training and got your badge printed. Most people take time to move, settle in, and whatnot. Some people set it up to travel a little and start later. Really depends on the situation, and how much you need to make money and they need a warm body.