This is the time of year when most residents in their final year of training begin searching for their first attending job. Getting this move right the first time is a huge happiness/stress/financial blessing. Many physicians just starting out don’t do a good job of choosing their first attending job. They tend to grab the first job offer with a big salary. About half of them find they made a mistake and are looking for another job a couple of years later. If you are looking for a new job because you didn’t like the last one you picked, then here is your chance to get it right the second/third/fourth time.
Choosing the wrong job is very expensive. In the first chapter of The Doctors Guide to Starting Your Practice/Career Right, I detail what it cost one of my friends to move to a new job in a different state. His job change cost a total of $174,800. Since about half of the physicians starting their first practice leave within the first few years, I want to share with you what must be considered to increase the odds of loving your first job, which will save you a fortune.
I carefully made this decision when choosing my first job and stayed there until I retired 20 years later to work as a part-time locum tenens surgeon for my three final years in medicine.
Here are the things to consider before even beginning your job search. If you know the answer to these questions, and clearly define what your dream job looks like, you will know it when you find it. If you skip this step, you will likely be looking for a new job in a few years and enjoying all the headaches that come with another job search and move.
Own or be Owned
This is the most important first branch point in your decision making process for your new job. Will you become the owner of your practice or will someone else own you? There are pros and cons to each employment structure, and you need to know your preference in this area before you begin your job search.
Unfortunately, hospital systems that train physicians are trying their best to convince new doctors that the best choice is to be a hospital employee. Why would the hospitals encourage this? Because they make a lot of money off owning a physician. If they can make a great deal of money with each physician they employ, you too can make that amount of money by being the owner of your business. The owners are the ones who are fully rewarded for your long hours of work.
When you look at the pros and cons of owning vs being owned, in both cases the business owner is the one in charge of your daily life and schedule. Since each individual is different, some of the factors in the pros and cons of owning vs being owned are given greater weight than others. But since many young physicians don’t know what it is like in either situation, they rely on the influence of others.
Unfortunately, many physicians are led astray. I met one physician who found out I was in private practice and commented that he didn’t know a single physician who was not a hospital employee. It turns out that every physician in his town is employed by the hospital. How can anyone make an informed decision if they only get information from one of these options?
Decide if you are the type who wants to control your destiny or the type who wants to give up that control to just go to work, get your job done and collect a paycheck.
Academic vs. Community
This is another important consideration. This factor will shape the type of patients you see in your practice.
Academic physicians tend to see more complex issues and rare diseases. They also tend to be much more highly specialized and have a very narrow focus of patient care. In my case as a general surgeon, if I had been in academics, my practice could have been limited to a single organ.
I think I would have gone batty if my entire practice was limited to biliary surgery, or colon surgery, or burns. I relished the variety my community practice created.
As a primary care physician, if you want long term patient relationships, then you should be leaning toward community care. Academic institutions often are referral centers for the complex and unusual conditions, and once you solve the issue, the patient returns home and you don’t see them again.
Another issue that drove me away from considering academic options was the need to publish papers and do research. That was not my desire and not the reason I went into medicine. But if you love research, you should be looking for an academic position.
Small Town vs. Big City
The type of city you live in will go a long way to making you and your family happy in the long run. I grew up in a small town and could not see myself spending the rest of my life in a big city. My training was in a big city so I was familiar with both big city and small town life.
Many people who grew up in a big city, often feel like there is nothing to do in a small town. Because of that perception, they may never be happy if they live in a small town.
Make sure you and your spouse both agree on the town size you need for your happiness. Many of the physicians who left my small town within a few years of arriving, did so because their spouse did not like small town living. More often than not, the shopping or the entertainment did not meet their expectations.
Also keep your commute in mind. Never choose a job/house combination that requires a commute greater than 30 minutes. You already work too many hours, don’t compound it by sticking yourself with a long commute.
If you are a small town person, never look at a job in the big city and vice versa.
Proximity to Family
One of the most important aspects of my job search was to be close to family. My family and my wife’s family lived four hours apart by car. We chose to only look at jobs between the two families. It was important to us that our kids grew up knowing their grandparents, which would not have happened to the same extent if we lived 1,000+ miles away.
Living close to family also has financial advantages. If you live close to family, they could save you a lot of money in childcare if they are able to watch your kids. In fact, this can save enough to make you a millionaire. It will also save a fortune on travel expenses since you will not have to fly your family home for holidays.
Proximity to Hobbies
If you have a favorite hobby that is location dependent, such as snow skiing, surfing, or fishing, then only look at jobs that will be close to your hobby. The odds of you getting to do something you love will increase as it becomes easier to do. If you live 30 minutes from a ski slope, you will get in a lot more skiing than if you live four hours from the slopes.
Don’t underestimate the joy you will gain by choosing a location that meets your needs. Hobbies help keep you from burning out.
Need for PSLF
If you accumulated a large amount of student debt that will be crippling, consider places where you will be eligible for PSLF (Public Service Loan Forgiveness). I normally recommend not to choose a job based on the PSLF, but some people have painted themselves into a corner and this might be the best way out.
You will notice salary is not one of the considerations. That is because all the jobs will offer you a good salary and your income is not what will make you happy. More income does not equate to more happiness. Only use salary as a tie breaker between two great jobs. Looking back on my life, an extra $50,000 a year would not have made my life or my financial outcome noticeably better. A larger portfolio today would not make a difference.
Anytime you are considering changing jobs, such as at the end of residency or to leave a job you don’t like, first sit down with your spouse and map out what would be the ideal job. If you must change jobs anyway, might as well pick a great one that meets all your desires. If you settle, or don’t bother to figure out what your ideal job looks like, there is a high chance you will be in search for a another job soon.
Since changing jobs is a big life stressor, best to avoid it. You might not think it is a big deal but losing your friends, your local groups, your church, your physician, finding a new house, going through credentialing again, getting new licenses for auto and medicine…….
Give it your best shot to pick the right job the first time and you will be happy for the rest of your life.
At the beginning of your final year of training, (or anytime you change jobs) every resident should read my best-selling/award-winning book, The Doctors Guide to Starting Your Practice/Career Right. There are lots of tips to make it easier to find your dream job on the first try. That alone is worth the four hours it will take to read the book.