The physician job search process

Doctor entering patient notes on laptop in surgery
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Before the Physician Job Search Has Begun:  Early Decisions

The physician job search process requires a lot of time and consideration. Most physicians have wanted to “grow up and be a doctor” since high school or before.

They understand there are steps to take to be accepted into medical school.  The steps are all laid out:  Maintain the best possible grades, score well on standardized tests, write a convincing essay and get excellent references.

Besides understanding the above requirements, they have precise deadlines and processes. The deadline for applying to college and submitting grades is out a year ahead of college.  The deadline for application to medical school is about a year in advance of accepted medical school. Interviews for residency and participation in the match program are another year in advance.

Timing of the Physician Job Search after Training is Complete

Once a physician has finished training after medical school, the processes and deadlines disappear, and physicians are on their own. They must decide what is important

Many physicians have developed the “year away” cadence, and they continue the rhythm when ready to search for a job that will start after residency or fellowship finished. Just as soon as these physicians settle into the final year of residency, most of the time, in July, they begin searching for a job.

Other physicians wait until the final month or two of residency.  The last-minute job seekers usually are single, with no family to support, and often decide that they would like to take a few months off before beginning a new job.

Various Types of Medical Practice Choices

The physician job search process is more than meets the eye. Single and more “carefree” physicians are also more likely to choose locum tenens to start their careers.  They find it appealing to travel the country, and sometimes outside of the country, to experience different practice settings.  These physicians are more likely to be single, or have fewer restrictions on their social life, as they are not required to be in any place.

Although possible, it is unlikely that newly graduating residents will accept a pure telemedicine position as the first job. Newly minted specialists and primary care physicians need the in-office interaction.  The in-office interaction with patients and staff is an extension of their training.  It is also crucial for the physician to learn systems, processes and politics never- before experienced.

Many physician chose to work inpatient in a hospital practice environment. Some of these physicians have little choice, for example, the emergency medicine physician.  Others choose inpatient over outpatient or traditional practice based on lifestyle preferences.

We have touched on some of the psychology that motivates a physician to chose a practice life-style.  We have reviewed the timing of that choice.  But what comes next?

Physician Job Search Considering Personal Requirements

The first step to finding a job after training is to think, and for the physician to question what they truly want in a medical practice.  What else is important?

A married physician with children is more likely to chose geography as a primary motivation.  The reason is apparent.  The physician may put the happiness of the family as the essential requirement.  Those physicians know that they will be spending a lot of time at work, and if the spouse desires to be near family or friends, it’s crucial.

Physicians have made career choices around more obscure requirements.  For instance, a physician may choose to look for jobs only in towns with an ice rink.  Why?  The son is going to be a professional ice hockey player, of course. It is not unreasonable for physicians to chose to move based on family health issues.  The physician may have a child with special needs due to autism or another serious health issue. They need a particular facility to take care of the healthcare needs of their child.

Physicians with children almost always want the children to be able to attend a highly rated school system. Perhaps the school is a public school, but if the public schools are not good, then the physician will usually require a private school with an excellent academic record to be near the practice.

Physician Job Search and the Spouse Career

Consideration of spouse careers is essential. Many physicians are married to other physicians.  Which spouse’s career will the couple prioritize if job good opportunities are not available in the same location for both physicians?  Physicians can be married to spouses with career requirements demanding they are in a specific location.  For instance, a physician married to a spouse with a career centered around Wall Street in New York City, may need to live in New York City. Other times, the Spouse is a homemaker, and may require the physician practice in a location the spouse chooses.  Many physicians feel the location of the practice is not as important to them as the actual medical practice, and they defer the choice of location to the spouse.

Physician Job Search Considering Practice Environment

Another part of the physician job search process is consideration about practice location. There are times that practice location is not vital to the physician.  Practice location could be of secondary or tertiary importance.

The question of where to practice is out of the way. Now the physician needs to consider WHAT is essential.  The type of practice is a necessary consideration.  For instance, inpatient, outpatient, or traditional?

The Inpatient Practice Setting

The Inpatient practice provides a fixed schedule, and often more income.  Inpatient practices may involve longer hours during one shift, but fewer days worked during the month. It  also usually involves working occasional weekends. Some inpatient jobs will require a block of night shift rotations a few times a year. An advantage of the inpatient physician schedule is block shifts. The block shift can allow a physician to work seven days in a row, more or less.   If a physician can work seven days in a row, they typically can also take the next seven days in a row off work.

Physicians who work inpatient do not have as much opportunity to establish a patient-physician relationship, at least not long-term. These physicians also have less control over their schedules and working environment.  Hospital politics play a role in the day-to-day working environment. One negative encounter with a nurse or other staff physician could seriously damage the doctor’s career.

The Outpatient Practice Setting

Outpatient practice options usually involve a Monday through Friday office hours type of environment.  Occasional Saturdays required for the primary care physician can hinder time with children.  The advantage of this practice setting is a routine schedule and the ability to have a more “normal” work-life balance.  This schedule will allow a physician weekends with family and friends and give enough flexibility to attend important school events for children. The disadvantage of this practice setting over the inpatient practice setting is the inability to block a week on and a week off.

Physicians in outpatient practice settings have the opportunity to establish a longer-term relationship with their patients.  It is vital to some physicians to follow the patients’ health closely and disease processes.  These doctors are more inclined to become an integral part of the community as they typically live in the towns where they practice.

A physician practicing in a purely outpatient setting is not required to get credentialed with a hospital if they do not admit patients or do any work or rounding in the hospital. However, they must undergo a rigorous credentialing process with the insurance companies to get on the panels of many health insurance providers.

Physicians practicing in an outpatient setting usually do not earn as much income as physicians practicing in an inpatient setting.  Physicians in inpatient settings typically do procedures which drives up reimbursements.  Even if the inpatient physician does not do operations as part of their practice, the reimbursement to the hospital-based medical practice is typically more than to a physician practicing outpatient medicine.

Traditional Medical Practice Settings

Many physicians have little choice but to practice in a traditional setting.  Although hospitals have started setting up inpatient programs amongst all specialties, there are few inpatient options available for specialists and surgeons.

Suppose you are a physician specialist such as a cardiologist, a gastroenterologist, or a neurologist. In that case, you will most likely have many more opportunities to work in a traditional medicine type of practice.

Most surgeons work in a traditional practice setting, although there are some exceptions, such as a trauma surgeon.

The key to work-life balance in a traditional practice setting is the shared call schedule and balance of office clinical days versus procedure days, or morning procedures versus afternoon clinical time.

Many physicians required to be on call with the hospital will work a four-day week or a half-day on Friday to offset the time working on the call schedule.

Call schedule can be an essential consideration for physicians in traditional practice.  There are two types of calls.  One type is practice call.  But exactly how call “works” for one physician’s office may be different for another. A medical practice may state that a physician must take “call,” but when on “call,” there is a triage system that handles all incoming phone calls.  If the triage staff cannot handle a patient complaint, the complaint becomes the physician’s responsibility.  Some practices have a nurse practitioner or a physician assistant set up as the first line of call.  Many times the advanced practice provider can handle most needs without the physician.

Typically, less call equals less compensation to the physician.  More equals more income. It’s a simple equation.  The generation of revenue is usually shared with the physician doing the work.

Physician Job Search Income Considerations

As physicians continue the job search process, they need to consider what is more important?  Additional income, or extra free time?

Another essential element in choosing a practice type is to select a practice tax structure desired. Will the physician be paid as an employee or as an independent contractor? Can the physician be self-employed with an income guarantee from the hospital administration?  If employed, will the physician be hired by a hospital-owned practice, an extensive multispecialty corporate owned practice, or a smaller medical practice? Why does this matter?

It matters because each of these practice set-ups has its pros and cons. It’s critical t to understand the mechanics of each set up before accepting a job offer.   Please read about how these pros and cons in more depth in our next blog; Comparing Job Offers.

The physician job search process is one that requires consideration of multiple important facets. Suppose you are a physician finishing your training program or a practicing physician ready to make a career move. In that case, you must search your soul and prioritize what is important to you in a practice before you begin the job search.

After you have made your priority list, visit www.doctorjobs.com.  Once registered, you, as a job seeker, can set alerts within the system to notify you of opportunities that match your preferences.

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