Tailor your Search

Choosing a practice can be one of the most important—and daunting—decisions of your career. Take the guesswork out of getting started and begin your search with confidence.

By Jon Vanzile

Unique Opportunities® Mar/Apr 2009

The summer of 2007 was a heady time for Scott Silver, MD.

His fellowship in vascular surgery at Wayne State University in Detroit, Michigan, was drawing to a close. Finally, after all those years of study and specialized training in cutting-edge endovascular surgeries, he was about to graduate into the job market. Medicine was an open field.

“The first thing that happened is I got pretty excited about being finished and how great life was going to be afterward,” Silver says. “So you get on the Internet and there’s all these ads all over the country, and you see the money and you think it’s a lot, and you think it’ll be awesome.”

He imagined practicing in a picturesque small town, similar to the ones in North Carolina where he’d done his residency, but his first interview was a sobering experience.

“The hospital was too small. The town was too small,” he says. “I didn’t know exactly what I wanted, and I knew I had to figure it out.”

That’s when the work began.

The challenge ahead

Silver’s experience isn’t unique to his specialty or his fellowship program. Residents and fellows often report they emerge from their programs fully prepared to handle patients but unprepared to confront the job market and the complicated process of landing the right job. There might be some job counseling near the end, but many young physicians report they get no counseling at all—and even the physicians who know exactly where they want to practice can find themselves confronted with a bewildering array of decisions.The result can be a chaotic start to a demanding career.

As the associate vice president of professional staffing for the Geisinger Health System in Danville, Pennsylvania, Cindy Bagwell is responsible for finding the right match between her organization and the residents and fellows who are looking for jobs.

For Geisinger, this means that references check out, there is a clear path to board certification, and that the job applicant will like Danville.

“We look to see if they’re a fit for our community,” she says. “Do they have ties to the community? We try to figure out why this area of the world interests them. In addition to geographic fit, we’ll find out what other things are important in their lives beyond a career. What extracurricular activities are important? What about their families?”

Gloria Parrish, the vice president of marketing Medical Doctor Associates (MDA), a contract locum tenens and search firm in Norcross, Georgia, agrees.

In Parrish’s experience, one of the leading reasons physicians quit jobs is because of a clash with culture—either with the work setting or the community.

“I’ve seen firsthand how quickly doctors can become disgruntled with a situation, and often it's the spouses. They might not be included in the recruitment process, and when they get to town, they aren’t as smitten,” she says. “When we ask [the doctors] where they’re going, about a quarter don’t know,” she says.

Parrish urges young doctors to think about a wide variety of factors, ranging from the obvious (“Do I want to work in a hospital or a private practice?”) to the subtle (“Are they negotiating fairly?”).

“It’s more than, ‘Can I be happy in this location?’ ” she says. “It’s ‘Do they practice medicine the way I like? Am I exposed to new innovations? Is the pay there?’ ”

The picture is complicated by the sheer variety of options available to young doctors: Rural or urban? Group or solo private practice? Hospital or university or some kind of hybrid?

Starting the search

Everyone in the physician placement industry agrees that the first thing doctors should do when embarking on a job search is to draw up a list of non-negotiable items. These are the things you simply won’t bargain away. Maybe you want to live near family. Maybe you want to work in a large hospital. Maybe you want the option of buying into partnership.

Bagwell says it’s important for job-seekers to evaluate all of their options. Even in a single health system like Geisinger, there are multiple career paths, including staff physicians, affiliated practices, and even academic positions.

In the beginning of their careers, Bagwell says, many physicians “model what they know,”

either sticking with the organization where they trained or going right into academics.

Whatever they are, “must haves” will frame your job search. Immediately, you’ll probably be able to exclude most of the job opportunities you’ll come across.

For Silver, this meant he wouldn’t be able to work in the picturesque small town he had once imagined.

“It takes a certain population base to support a vascular surgeon,” he says. “In a metropolitan area, that’s not a concern.”

Silver also knew he wanted access to the catheter labs and advanced imaging tools he had been trained on. He specializes in placing aortic and carotid artery stent grafts, in addition to technically demanding surgeries. This means he needed to find a hospital with a robust vascular program and sophisticated diagnostic imaging capabilities.

Surprisingly, money dropped off his list pretty fast. “I had some idea of what I was worth,” he says. “I had worked hard and deserved a certain amount, but I didn’t think about it much after that. I had specialized training and I wanted to do a certain kind of surgery.”

In some cases, your list of non-negotiable factors will be influenced by outside events. This happened to Y. Melissa Chan, MD. Chan graduated from her residency in anesthesiology from the University of Texas-Houston in 2007. It was her plan to accept a job with the university and pursue an academic track.

But five days before she was to start working, she learned of a rule change in the state of Texas. Under the new rule, she would need to take the Texas Medical Jurisprudence Exam before she could get a medical faculty license. Before the change, faculty licenses had been exempt from this requirement. Without that license, she couldn’t work.

“They couldn’t tell how long it would take to get the license, so I had to find something quick,” Chan says, and she quickly accepted a locum tenens assignment in Yuma, Arizona.

Making the list

To help narrow the focus and come up with the list of must-haves, it’s crucial that you—and your spouse or significant other if relevant—take a hard look at the various components of a practice opportunity and rank them. According to Silver, each job opportunity only has a gallon of value—it’s up to you to decide how to fill that jug. The following considerations are key:

The setting. Private practice, group, solo, hospital, academic? Each offers a different work experience, as well as different career paths.

In a hospital, for example, doctors are on staff, so they are employees of a larger system. For some, like John Schmitt, MD, an otolaryntologist who practices in Portsmouth, Ohio, this is perfect. They don’t want to worry about staffing issues, rent, billing, and all other things that go along with a private practice.

Other physicians, however, have no interest in being a staff doctor and dealing with office politics and seniority.

This fit Silver’s needs. “I decided I wanted to be in a private practice and be my own boss someday,” Silver says. “I didn’t want to blaze a trail for myself in a solo practice or be an employee.”

Some physicians, like Chan, seek out an academic setting. This, too, comes with its own set of considerations. Do you want to teach? Is the tenure ladder too slow? Do you enjoy the university hospital environment?

Each of these questions must be answered before considering any individual opportunities.

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