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Starting Off: How to Begin Your Search
You Are About to Make a Very Consequential Decision

For many of you, your job search will be your first shot at a permanent job. Up until now, you've had a series of short-term assignments: 4 years of college, 4 years of medical school, 3 or more years of residency, and perhaps a fellowship.

Now, you're about to enter your first long-term job. You'll be making considerably more money than you did in training, and for the first time, you'll have a chance to settle down. This might be your first opportunity to buy a home or to have children.

For those of you who are already working but looking to make a change, the same advice can help you to find a job that will have more of the features you're looking for.

Get It Right the First Time

If it turns out you don't like the job you choose, you always have the option of moving on. Your new employer, however, will probably make it challenging for you to do so, and in any case, you'll be back to square one in the time-consuming task of finding a job.

For these reasons, it's important to get your job choice right the first time or as soon as possible. Find a job that you will be happy with for the long haul—perhaps even for your whole career.

Ensuring that you'll get a great job doesn't just happen. It involves a great deal of honest self-evaluation, careful planning, good people skills, and a willingness to work through tough issues. In this course, we will give you the tools you'll need to successfully make it through this endeavor.

The Earlier You Start, the Better

Many residents and fellows wait too long to start their job search. In a 2015 survey [1] of new doctors by the physician recruiter Merritt Hawkins,68% began their search during their final year, and fully 32% waited until the last 6 months to start. Here's some advice:

Start your job search 12-18 months before training ends. It's important to start early. Starting your job search any later than 12 months out will probably make your last months of residency a challenging race to the finish, forcing you to make poor choices or even delay the start of your new job.

Why the search takes so long. You will need time for job research, interviewing, writing, rehearsing, and making on-site visits. You also need time to deal with a job prospect falling through or waiting months for paperwork to be approved.

Certain people need to start earlier. This includes people who want to practice in another state, which requires waiting for licensing paperwork; those who seek special arrangements, such as a 4-day workweek, which may take longer to negotiate; people who need to coordinate their search with a spouse who is also looking for a job; and noncitizen international medical graduates, who have to file extensive paperwork to get a visa.

How to Decide What You Want

Before you can begin your search, you'll need to know what you are looking for. Rather than taking the path that all the other residents have been talking about, it's important to forge your own particular path. The right path for others may not be the right path for you.

Start by summoning up a fairly detailed picture of what you want. Put aside your assumptions about what you think you want, and take time to determine what your real needs are. There are many techniques to help you do this, such as:

Put aside your assumptions about what you think you want, and take time to determine what your real needs are.

Ask yourself some basic questions. What kind of practice do you want? Where do you want to live? How much do you want to work? What salary range is important to you?

Imagine your ideal day. Then identify what exactly you liked about it. What kinds of patients would you see? How many of them? What would your interaction with other physicians and staff look like? What time would you want to get home? Do you mind a lot of traffic? Come up with a longer list than this.

Imagine your ideal life. How much would you like to work? What sort of vacation time do you want? How much do you care about making money? If you have a family, what role would you like to play in it? For example, would you hire a nanny so that you could work longer hours?

Understand your personality. Are you an entrepreneurial type who would be happy in a solo or small practice? Or are you more of a team player who'd thrive in a large practice or organization? Ask friends to assess you. Talking to people who know you well can help you define yourself.

Getting Advice From Others

Because you may lack experience in looking for a permanent job, reach out to others who have some experience with this. Some pointers:

Find a mentor. Seek out a seasoned doctor—preferably a physician who practices in the community—who is willing to mentor you. He or she can give you an idea of what it's like to choose a practice and help you assess your choices as they come along in the search process.

Contact fellow trainees who graduated before you. They are already doing or have completed what you are about to do. Physicians who looked for jobs before you know about good locations, job leads, areas to avoid, and current salary ranges. These and other contacts will be discussed in chapter 3 of this module.

Join discussion groups on physician social media. This topic will be covered in chapter 3 of this course.

Deciding Where to Locate

Determining a location is an essential first step in your job search. There are several major factors to consider:

Aim for a specific area. For internists alone, there are probably 20,000 current openings from coast to coast. Even restricting your search to a region, such as New England or the Northwest, would be too overwhelming for large specialties. Before you can even begin a job search, you'll need to get specific.

Focus on one state, if possible. One compelling reason for choosing a specific location early is that you'll need to get licensed in the state in which you practice. If you choose a different state from the one you're training in, it can take months to get licensed. And even after you get licensed, you will then have to get credentialed with the local hospital and insurers, and this can take a while, too.

Do some soul-searching. The start of your search is not the time to be hasty. This is a time to get in touch with your real feelings and to be deliberative about your needs. Your first impulse may be to choose a familiar location, such as your hometown, your spouse's hometown, or the area where you're currently training. Or you might initially want a location that offers a lot of outdoor activity.

Now is the time to second-guess yourself. Let nagging concerns about your choices bubble to the surface. This is the best time to address them. For instance, if you're considering a small town, ask yourself whether you would feel isolated. If you're thinking of a large urban area, how would you cope with the traffic or crime rates? And if you're looking for an outdoorsy locale, will it hold your interest in the long term?

Stay off the beaten track. Keep in mind that picking a popular place where everyone else wants to go probably means accepting less income and agreeing to work requirements you may not like.

Basic choices of locations. The general categories are a large city, suburb, small city, or rural area. New physicians overwhelmingly prefer major metropolitan areas. In a 2015 survey, [2] only 7% of new physicians expressed an interest in practicing in an area with a population of 50,000 or less, and only 2% said they'd practice in a town with 25,000 or less.

Tips on Narrowing Down Your Location

Consider small cities. Job recruiters often ask you to consider smaller cities. There's one great reason to consider smaller cities and rural areas, even if you've never thought of them: Because these jobs are so hard to fill, you are more likely to get a higher income and other incentives, such as signing bonuses, loan assistance, 4-day workweeks, and shorter call schedules.

Think about how you'd fit in. If you and your spouse grew up in a big city, one of you might feel lonely and isolated in a small city. Consider these locations with caution. You might limit your search to small cities that have an unusually lively local arts community, a college nearby, or fairly easy access to a large urban area for a weekend trip.

Research income levels. Income levels for physicians differ by location. In some areas, they may be driven up by highly competitive health systems or group practices. Colleagues who graduated before you may know of certain hot markets, or you can consult websites that show geographic variations in income.

In some areas, income levels may be driven up by highly competitive health systems or group practices.

Other factors to consider. Through a simple Internet search, you can find places that rank well on low crime rates, schools, cultural attractions, outdoor activities, cost of living, and traffic conditions. You can also look for cities with the best restaurants, best music scene, most walkable streets, and even where people share your political views.

Look for places on the basis of healthcare issues. On the Internet, you can also find lists of places with the highest patient satisfaction, most extensive health insurance coverage, or most employer-based coverage. You can also look for cities where people feel less stressed, are more inclined to exercise, or are less likely to be obese.

Pin Down the Kind of Job You Want

Start ruling out jobs from the start. You need to have a good idea of what you want before you start interviewing. You may have to overcome a reluctance to rule anything out. To winnow down choices, establish priorities and focus on the jobs at the top of your list.

Money isn't as important as the right fit. You might make all the money you dreamed of, but if you have a 50- to 60-hour workweek and have to deal with burnout, it's not worth it.

Look at the major job categories. You might be drawn to a kind of job that looks a lot like your training program, such as an employed position at a large organization, but that may not be where you'd really thrive. Try to understand the other choices you have. The following are some broad-brush descriptions that you can follow up on with your own research.

Major Job Categories

Solo practice. Fewer new doctors are taking this option—16.5% of physicians were solo practitioners in 2016, down from 18.4% in 2012, according to a 2017 study [3] by the American Medical Association (AMA)—but that's not a good reason to ignore this option. In Medscape's 2017 Resident Lifestyle and Happiness Report, 21% of medical residents surveyed said that they anticipate becoming a partner or practice owner. Although solo practice takes a lot of work to set up and involves some financial risks, it gives you a degree of independence that many physicians wish they had these days.

A 2014 Medscape article discussed the "ideal practice" model that simplifies and updates solo practice for the current healthcare climate. "Every day I feel this sense of accomplishment that I can't imagine in a group practice," said a physician who operated this model. "There is this entrepreneurialism that I didn't expect I would care about when I chose this model."

You can avoid the risks of setting up a solo practice by joining an existing one. But you have to mesh well with the existing physician—who is, after all, used to being on his or her own.

Small group practice. This is still the most typical arrangement for physicians. In 2016, 57.8% of all physicians were in practices with 10 or fewer physicians, according to the AMA study. Unlike in a solo practice, you will have colleagues to consult and share call with, and usually you will be able to buy into a partnership.

As with all arrangements, you'll need to examine the efficiency of the practice, because this will affect your income. The organization may be too small to run efficiently. As a rule of thumb, most practices should keep expenses under 50% of gross revenues.

You'll also need to make sure the original physicians won't take advantage of you as the newbie. You may be given most of the difficult or low-paying patients, get more than your share of call, or get a very expensive buy-in.

You'll need to make sure the original physicians won't take advantage of you as the newbie.

Single-specialty practice. These practices, which can be any size, encompass 42.8% of physicians, the AMA study found. This arrangement can be very efficient, because all physicians have the same needs. Larger practices, when run right, can introduce economies of scale that can make them even more efficient.

Multispecialty practice. About one quarter of physicians (24.6%) were in such practices in 2016, according to the AMA study. Such groups create automatic referral relationships, but when there are only one or two specialists in a given field, all arrangements can be onerous. However, very large multispecialty groups can provide better call arrangements, good continuity of care, and more significant bargaining power with insurers, allowing higher reimbursements.

Large group practice. In these organizations, you may be able to focus more on clinical matters, and you can enjoy the camaraderie of many doctors. The AMA said 13.8% of physicians were working in practices with 50 or more physicians in 2016. These practices include some big names, such as Scott & White, Mayo Clinic, and Cleveland Clinic, which also run their own hospitals. Although this category provides economies of scale, it can be bureaucratic, with many layers of management.

Insurance-based model. This is a rare but significant model in which doctors work directly for an insurance company. Physicians working for Kaiser Permanente, one of the largest healthcare providers in the country, only care for patients who are insured by Kaiser. Doctors at the Geisinger Health System in Pennsylvania have a similar arrangement.

Hospital-owned practice. About one quarter of all medical practices, no matter what type, are hospital-owned, according to a 2015 study. [4] This means that if you join these practices, you will always be an employee and will not have the opportunity to buy into ownership. You may also be subject to organization-wide compensation formulas and be expected to serve on committees.

Academic medicine. Working in an institution affiliated with a medical school is appealing if you like research, teaching, speaking, publishing, and travel. But you will face competition for research funding, you may work long hours, and your pay may be lower than in private practice.

Veterans Affairs (VA) and military health systems.These are large, self-contained systems where physicians only see patients within the system. To reverse sagging recruitment, the VA announced plans in 2014 to increase annual salaries of new physicians by up to $35,000.

Locum tenens. This involves working on a temporary basis for different providers who need extra physicians. This is a short-term option if you haven't yet decided on a permanent job, and it's increasingly becoming a career for doctors who are generally single and like working in exciting locations.

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Koushik Shaw, MD

| Disclosures | January 01, 2017

Authors and Disclosures


Koushik Shaw, MD

Urologist, Austin Urology Institute, Austin, Texas; Author, The Ultimate Guide to Finding the Right Job After Residency (McGraw-Hill Education, 2005)

Disclosure: Koushik Shaw, MD, has disclosed no relevant financial relationships.