September 16, 2015
Oscar Wilde once quipped: “In this world there are only two tragedies. One is not getting what one wants, and the other is getting it.” Never was this truer than of physicians seeking a career change within the medical field: The temptation to focus on compensation to the exclusion of all else may seem irresistible. Here’s a better way.
Step 1: Weigh your values
Put the issue of money aside for a moment, and jot down a quick list of what you don’t like about your current situation and the qualities an ideal position would possess. Identifying your current dislikes-an inconvenient location, abrasive colleagues, conflicts over treatment philosophy, financial instability, and such-will keep you from ignoring them when someone tempts you with money you think is too good to refuse.
Some non-monetary values you may want to consider:
Autonomy. Will a new job give you the freedom to practice medicine-and live life-the way you’d really like? Or will you have to put in unnecessarily long hours and follow corporate protocols of questionable value?
Collegiality. Will you be compatible with colleagues somewhere else? While this may seem hard to judge before you actually take a job, it’s easy to learn whether your interest in skiing or computers or foreign travel is shared by at least some of the doctors with whom you’ll work. Your instincts will also give you instant feedback on their affability or lack of it.
Service quality. Does a potential employer’s work ethic feel fulfilling to you? Is the service level high? This can affect your finances as well as your emotions and intellect. Patients who receive poor service won’t come back.
Leadership. Will you be able to be a decision-maker in the practice, or will the nail that stands out get hammered down?
Achievement. Does the job have partnership potential? Will you receive performance benchmarks and rewards for attaining them.
Recognition. Do you have a sense that you’ll be a valued member of the practice? Are other physicians treated that way? Why not ask them before you accept? You’ll learn a lot.
Variety. Will you have an interesting mix of patients and procedures? What if an internist wants to do some cardiology as a special interest? What if an FP wants to do minor surgery, or an OBG or sports-medicine procedure?. Is it possible-or taboo?
Security. Is the practice fiscally solvent? Why guess? Request a copy of its financial statement for your accountant and/or attorney to review.
Step 2: Compare practice types
Should you choose a multi specialty group? An HMO? A hospital-sponsored practice? In work environment, philosophy, patient load, management responsibilities, and financial stability, each has pros and cons. Think about which mix is most likely to accord with your values.
Groups. Joining a group practice has advantages: a team environment, new technology, and economic security among them. Many groups still offer partnership opportunities after two or three years. In a single-specialty group, you may make more money, contribute equally to overhead, and have call less often. But such groups tend to be smaller, overhead may be higher, and the group may be more vulnerable to being bought out by a larger entity, threatening your autonomy.
Multi specialty groups tend to be larger, with more patients, equipment, and staff support, plus ease of in-house referrals. They may be better-positioned to win managed-care contracts, too. However, fitting in with colleagues in other fields may take more time, your call schedule may be heavier, and, while everyone may contribute equally to overhead, this can be a disadvantage if you’re a top earner.
HMOs. A relatively high starting salary, paid malpractice premiums, a reasonable call schedule, regular office hours, and fewer administrative headaches can make working for an HMO attractive. But your raises may be small and infrequent, your patient load may be large, autonomy is scant, and opportunities for practice buy-ins or partnerships are nil.
Hospitals. Working for a hospital can mean paid moving expenses, paid malpractice insurance, management services, support staff, free office space and equipment, the freedom to set your own schedule, and even a university appointment. But physicians aren’t always happy with hospital policies, conflicts with administrators are not unknown, and hospitals’ abilities to manage medical practices vary widely.
Step 3: Consider location
If you have your heart set on Los Angeles, Miami, New York, San Francisco, or Seattle, join the club. That’s the problem: Such highly desirable locations in terms of lifestyle may be highly undesirable from a professional standpoint. Large metropolitan areas are either already swamped with managed care or about to be. And because competition for jobs is intense, practice opportunities are fewer, compensation may be less, and your financial future may be shakier than in less populous locales.
Among the factors to consider: art and cultural offerings, recreational opportunities, the physical beauty of the region (where underserved areas may have a distinct advantage in unspoiled splendor), educational facilities (day-care centers, private schools, universities, and continuing education options for you), proximity to your extended family and friends, employment opportunities for your spouse, character of the populace, and religious climate.
Don’t rely on physician recruiters and tourism brochures. When you go for interviews, plan to spend time walking around, talking with people, and getting a firsthand feel for the lay of the land.
Step 4: Analyze compensation
I’ve put money last not because it’s least but for the opposite reason: It’s so important that it tends to overshadow other quality-of-life issues that need to be thought through as well.
For example, money and location are not separate issues. According to Money Online’s Cost-of-Living Comparator, the cost of living in New York is nearly 45 percent more than in Stamford, Conn., which is within commuting distance, and Stamford ranks first in the nation in four- and five-star restaurants. Similarly, Paramus, set in New Jersey’s most affluent county, is just 16 miles from New York, yet the cost of living is nearly 58 percent less.
Weigh the compensation being offered against the work opportunity and location to determine the right mix. What’s the starting and potential compensation? What financial benefits are being offered in the way of income guarantees, income distribution, and opportunities for practice buy-ins and partnerships? Will your contract have a restrictive covenant? Will you be expected to assume special expenses? To maximize income, subspecialists should consider heading to the East or South; for primary-care physicians, the rural South ranks high.
Considering all relevant factors instead of rushing into a career move for money alone will ensure that getting what you want is a cause for celebration, not regret.
This article was published by Cejka Search and originally appeared in Medical Economics Magazine. Copyright by Medical Economics Company Inc. at Montvale, NJ 07645. All rights reserved.