Among the most challenging aspects of finishing up a residency is the prospect of finding the right career opportunity. Luckily, there are some basic rules to follow to help you determine what you're looking for. The four areas below are critical for physicians to consider before initiating a practice search or schedule interviews.
Physician Job Search Consideration #1: Finances
Physician compensation varies by level of experience and location. Average physician salaries are also widely available — consult the U.S. Bureau of Labor Statistics for recent data on physician salary expectations by specialty.
Physician income packages are often smallest in expensive, desirable areas like New York City, Chicago, Honolulu, San Diego or Miami. Such regions are more competitive than others, and may have an oversupply of physicians. So, as appealing as these locations are, if your priority is earning rather than adventure, you may want to consider working in rural communities where there's a more active need for physicians (like rural Washington State, for instance).
Of course, debt is also a factor for most new physicians. Also to consider are family obligations, investment goals and retirement plans. A physician career opportunity that includes loan forgiveness in exchange for a two- or three-year commitment to the community can have greater financial benefits than may be initially apparent.
If you're still part of an education program, you may want to talk to your advisor or about not only compensation expectations in your region, but the form that compensation should take. There are advantages and disadvantages to salaries, income guarantees, loan forgiveness, signing bonuses and other forms of compensation. (Editor: We've got an article on negotiating physician contracts coming up soon!)
A few questions to ask of potential partners, associates or employers include:
- What is the starting and potential compensation?
- How is potential compensation measured or verified?
- How is income distributed within the group?
- What are the incomes of existing physicians?
- What is the practice's overhead?
- What's the collection rate, percent of managed care and percent of Medicare and Medicaid in the group?
- What's the financial posture of the affiliated hospital?
It's also important to understand the strategic direction of the hospital, medical group or other organization you're thinking of joining. Are they moving toward collaborative, risk-sharing models, such as Accountable Care Organizations and bundled payments? If so, do they have a clear formula for how savings will be shared? Make sure to determine how the compensation structure might change in the short and long-term.
With a little probing, physicians can get beyond the base financial offer and determine whether the opportunity really adds up financially. The key is to determine whether the practice will be viable financially after the income guarantee or salary contract period is over.
Physician Job Search Consideration #2: Practice Settings
Some new physicians prefer employment with a hospital, group practice or other employer. Fewer newly trained physicians today seek to work as a solo practice, though some are still attracted to the autonomy and entrepreneurial benefits of a partnership setting.
Fortunately, today, like no other time before, a plethora of physician career opportunities await you. Check out last month's article on choosing a practice setting for a rundown of the different options for new physicians.
When figuring out what practice setting is right for you, ask yourself a few questions:
- Do you want to do in-patient medicine?
- What hours do you prefer? How much after-hours work you can cope with?
- What type of procedures would you like to do?
- How much input do you need to have in group governance?
- Are you comfortable with managed care, medical home or Accountable Care Organization (ACO) treatment protocols?
- Do you need extensive specialty support?
- Do you interact well with other physicians, or do you need to run your own show?
If you have an entrepreneurial spirit, you may feel more comfortable associating with a private-practice physician or, if you have the means and the opportunity, starting your own practice. Physicians who prefer a more controlled employment situation may seek a group or hospital setting. It's a question of balance: If you enjoy autonomy but can't stand the idea of doing paperwork, you may wish to forgo some independence by becoming a hospital or group employee, where administrative tasks are performed by others. If you want to be "where the action is," you may opt for a hospital-based practice.
In addition to asking yourself these questions, we encourage you to speak with other physicians who have already made their choices and worked in a variety of practice settings. How did their experiences live up to their expectations? What would they change about the decisions they made?
And remember, while practice setting is an important factor, it's often your co-workers who determine how well you fit in. That's why it's critical to ensure, to the best of your abilities, that your personality, expectations and goals will mesh with your employers and co-workers. (This should be covered in your interview phase. Check out our guide to the physician interview process for more info.
Physician Job Search Consideration #3: Quality of Life
What are you looking for when it comes to quality of life? As a concept, quality of life has a different meaning for everyone. Yet, it's arguably the most important factor to consider in your new physician job search. To help define your answer, ask yourself these questions:
- What are the must-have absolutes that I simply can't or won't live without?
- What will I be doing with my free time, and how will I spend my discretionary income?
- Do recreational options have to be within 30 minutes or three hours by plane or car?
- Do I have children, or am I thinking of starting a family? If so, how is this going to affect what I need in a community?
The key may be to not focus on a particular community — i.e., "I must live in Aspen, Colorado!" The key is to consider what you need in a location, and in a community, and to then find a location that meets as many of those needs as possible.
Physician Job Search Consideration #4: Geographic Location
Now that you've established what kind of community you'd like to live in, it's time to figure out what geographical location best matches the parameters of your ideal community. First of all, you need a community where your skills are needed, and where you'll have a viable chance to sustain a practice.
Of course, the community's public schools are important; for many new physicians facing impending loan repayment, the expenses of private schools may not be feasible.
If water sports are essential to your well being, then you'll need to live near a body of water. That makes coastal states, as well as lake-heavy Midwestern states, particularly appealing. If museums, cafes, art galleries and the opera are what you need to be happy, larger more cosmopolitan cities may be where you're most comfortable.
New physicians often select a location based on the fact that they were trained there, raised there, or married someone from there. Often, this choice is made regardless of whether or not the community meets their personal or professional needs. The result? Many new physicians relocate after just a year or two year, dissatisfied. An analogy can be made with finding the right suit, or the right dress. If you insist on buying a particular designer brand, you may never find the right match. If you're open to more options, you're more likely to find something that fits.
Once you've given these four factors due consideration, you'll find yourself in a better position to find the physician job opportunity that best meets your needs. With your thoughts on each of these factors in mind, it may help to think of yourself as shopping for a practice — much like you'd shop for any other high-ticket item. In other words, it helps to know what you want, and the price you'll pay, before you make a commitment.
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Adapted from an article originally published on NewPhysician.com.