Finding A Job; Part Deux

July 16, 2009
Jeff Brown, MD

Docs are now only increasingly coming out of training looking for a salary, benefits, and a ready-made practice, but older docs who are financially and/or emotionally overwhelmed are leaving their current situations and looking for cover.

Last time, I wrote about the changing demographics and attitudes of physicians, particularly young ones. Females now make up about 50% of the medical field, and they have obvious concerns about balancing career and family, but docs of both genders have moved to wanting a more balanced--dare we say "humane"--lifestyle than their predecessors. Coupled with this generational shift in needs and wants are mounting debt, the rising cost of establishing a practice/small business ,and the current difficulty in obtaining the necessary financing.

Docs are now only increasingly coming out of training looking for a salary, benefits, and a ready-made practice, but older docs who are financially and/or emotionally overwhelmed are leaving their current situations and looking for cover. This change in traditional approach has been made more difficult because we as a group of professionals have had little formal preparation to take on the important and daunting tasks of medical business.

I Googled "physician employment" and came up with 17 million hits, so you know this is one hot field. And if Congress in its wisdom opts to extend insurance coverage to 40 million more people, you can only imagine what the demand for docs will be. Sorting out the chaff only makes the task more difficult.

Happily, there are now many sites to scan and many books and programs available to give the job-hunting doc a crash course in how to start getting a job search organized. It can be lengthy, personal, and detailed, so I am only going to hit a few important points.

The most critical is often the most difficult to define, especially for younger docs: who are you, and what do you want to do? You may think you know, but you feel somewhat panicked to find that first something, anything to get a paycheck and then relocate if and when you learn enough to reconsider. I know that thought passed through my head at that stage.

But it is not easy to relocate either financially, emotionally, or task-wise once you have put down even small roots. So stop, take a deep breath, and do your homework. Such habits got you this far, right? And the "right" job is really, really worth it.

So, what do you want to do: clinical practice, small group, large group, single specialty, multispecialty, academia, administrative? Where do you want to live: near your training site, or your family, or your spouse's family (family being the #1 reason for relocation), a small town, a big town, on a coast, near the mountains? Each of these decisions can be critical, so you really need to think it through, have a trusted sounding board, or get professional help. By that, I do not mean a recruiter. One might work out, but always remember, they work for, and are paid by, the hiring group, not you. No matter how friendly or helpful they are, remember that fact.

Historically, docs often listen to, or join, people they know, or people vetted by people they know. Networking turns out to be #1 in medicine, just like other fields. But you still need to do your area and practice homework.

Let's say that, after careful thought, you feel comfortable with a certain kind of job in a specific area. You've talked to other docs, faculty and in practice, and people you know. You've looked into the area's cost of living, housing, schools, estimates of future growth, etc. You've checked out the Web and called the state and county medical societies for openings and insights and think you have found a couple of choices. Always make sure that you have more than one to compare and bargain against.

Be prepared to be interviewed and to interview. Go back several times. You know you may end up spending more time every day with these people than your family and friends. Hang out in the office to watch work flow, the details, the office vibe. Is it a happy, efficient, and attractive second home for you? Don't rush it. Listen to your gut.

It's very important to know that the two biggest problems in any medical group are always money and governance. Ask up front about the partnership track, if it is available, and if you want that path. It used to be a no-brainer, because partnership meant access to much more money and a say in control. But it also used to mean virtually no risk for your hefty buy-in investment, and you just can't say that anymore.

Finally, DO NOT discuss money until the group makes an offer. Just say something like, "If it's a match, we'll work it out." And most important, get the counsel and contract review of a lawyer who does this sort of work. Get some names from local docs or the relevant medical societies. Interview several. Make sure the details of partnership and/or an appropriate exit are spelled out.

Hey, didn't we go into medicine partly to avoid this stuff and set our own course? Maybe, but that is so 1980s thinking, and the medical world has changed, outside of science as well as in it. If your training didn't prepare you for the real world, suck it up and apply yourself to this stuff. Your future, your family's future, and your patients' futures depend upon you in non-medical ways just as well as in directly medical matters. But don't despair; in the end you'll be happy that you did all this and it will work out. Good luck.