New Practice Pointers

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    I have been reading lately that something like 40% of physicians leave their first position out of residency. Can those of you who are out in the real world tell us about your experiences in looking for a job?

    What about tips on looking for new practices – situations to avoid, particulars of call schedules or salary guarantees that sound good but turn out not to be, etc?

    When did you start interviewing? How many offers did you consider? Did you move far away from home for a new practice? How did this go over with husbands and children?

    Did you use a head hunter or recruiting firm?

    Any really good experiences? Any bad ones we can learn from?



    I have been in the same job since I finished my fellowship almost seven years ago. I think that is unusual, many of my friends have changed jobs, or ended up starting their own practices after they got their ‘feet wet’ and were a bit more familiar with the real world.

    I think the most important factor in choosing a practice is not the money, but the other persons (MDs and others, but particularly MDs) that you will be working with. Your partners are going to be a HUGE factor in your life. It is important that you have the same basic practice style: that you find the same things important (e.g. documentaion, patient care styles, ease of sharing call, if you are a surgeon, for instance, try to see if your partners are ‘aggressive’ surgically or not, to see how this melds with your own style). I have run into some problems lately with a new person that we have hired into our previously 2 person practice. I find his style to be way out of synch with mine and have questions about his ethics, his billing practices, his overall style, etc. (I did not want to hire him but was over-ruled by my senior partner unfortunatly). Try to spend a lot of time with your furure partners during the interview process, maybe talk about some patients and their care. The money can always be negotiated again later on (though of course you need to get clear the mundane deatils of when you will be full partner, what the benefits are, etc), far more important to your overall well-being in a group practice situation is that you mesh well with your partners and that you respect them as people and as physicians.

    I believe there are few good jobs available through head hunters (ironically, my husband is a head hunter for high tech: in that field many good jobs are attainable through head hunters). I did look at some positions through head hunters and was not impressed. Try to target where you may want to live geographically and you can cold call some MDs in your specialty, who may have valuable leads. Also, your training program is a very useful source: many practices, specifically highly specialized fields, will contact fellowship programs with available positions. This is how we recruited our recent new hire.

    Best of luck to y’all.


    Thanks for a great response, BabyEyeDoc!
    Would you mind posting your subspecialty?



    My situation is a bit unique as both my husband, an internist, and myself (neurologist) were both matriculating at the same time. We basically identified 4 different states that we would like to live in. We then only considered offers from those states. I received calls from head hunters from about 2 years before I was done with my training and kept the names of those recruiters that seemed helpful. I also scoured our specialty’s journal ads for positions and talked to former residents from my program that who had settled in the areas in which we were interested. I ultimately went on three interviews and settled on my current position. The job I did take was presented to me by a head hunter. Working with a head hunter costs a prospective employee nothing except the time it takes to talk to him/her.
    Contracts are a pain. I definitely recommend having them reviewed by a contract attorney as a lot of the language in the contract is difficult to interpret. I particularly had to avoid a “noncompete clause” becase my husband was also settling here and even if my position didn’t work out, I didn’t want to be forced to move to work(we live in a fairly small city). My group was willing to waive this clause for me. Looking at journal ads can give you a sense of what the going salary for your specialty is at a given time in a given region. You can also ask the residents who matriculated before you about salary guidelines so that your expectations are not inappropriate.
    Physicians are becoming more mobile during their careers and there is no shame in changing positions if the “fit” is not right. It is a demanding career so you need to like your partners. 😎


    Before I took a job, and after I left that job, I spent quite a bit of time doing per diem work. Where I live (San Francisco area), there is so much work available that I could have worked per diem 7 days a week if I wanted. And since you get paid per hour, I found that I actually could make more money than with most salaried positions. The benefit is getting to see a lot of different practice styles and building a bit of a reputation while having low responsibility. I took a job at one of the places that I was working, but I only stayed there with the group for 15 months. I think I could have avoided that if I was willing to work per diem for longer. I think I was too pressured into thinking that the job security would be a good thing. The things I didn’t know to ask about and I didn’t like:
    1.I had no input into things like what phone system our office used. The one we had was horrible, and I lost patients because they couldn’t get through, but I had no power to change it.
    2.Our salary was guaranteed for a year, but in order to become a full partner after that, we had to meet a certain number of patient visits. If I saw 15 peole with sore throats, it counted the same as if I saw 15 people for complete physicals. Clearly not a fair counting system. Some doctors were money-hungry and would run patients through the mill to get bigger bonuses.
    3.I was told the group was growing and financially stable, but it turned out that most of the offices were operating at a deficit and there was threat of the group dissolving in 2 years if the hospital didn’t continue to subsidize it. Because it was such a large group, a huge amount of money was lost to administration and poor management decisions, things I could not speak into. I would stay away from large groups that offer a salary. Better to join a smaller group that is part of a true IPA, because there is less overhead.
    4. Someone who came to work there after I left asked for a higher salary by at least 10,000 and was given it without question.
    Good luck in your search!

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