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THE IDEAL JOB
To find the ideal job, each physician needs to start thinking about the kind of person they are and the type of opportunity that will best fit their needs and personality
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Ask yourself what kind of practice setting is right for you?
- If you are independent and entrepreneurial, you may feel more comfortable associating with a partner or starting your own practice.
- If you enjoy autonomy but can't face the idea of doing paperwork and supervising a clerical/support staff, you may wish to forgo some independence by joining a group, or working as an independent contractor with shared offices, call and overhead.
- If you need a set schedule and freedom from the strains of building and maintaining a practice, you may prefer a multi-specialty group or clinic setting.
- If you want to be "where the action is," you may opt for a hospital based practice.
While practice setting is an important factor, it is often the people who you will interact with more than the setting itself that will determine how well you fit. That is why it is critical to ensure as best you can that your personality, expectations, and goals will mesh with the practice's medical, administrative and support staff. |
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Solo Practice
Hospital-Sponsored |
Solo Practice
Independent Contractor |
- Great for the entrepreneurial spirit!
- Lucrative -- Tax advantages
- Be your own boss
- No restrictive covenant/non-compete
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- Solo practice with shared expenses
- Shared office space decreases overhead
- Shared call coverage
- Possible shared practice management
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- Call coverage
- Responsible for all employees
- Running a small business
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- Shared responsibility of running an office
- Running a small business
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Single Specialty Group
Small Practice (2-4 Physicians) |
Single Specialty Group
Large Practice (5+ Physicians) |
- Call coverage
- Partnership
- Shared overhead
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- Great call coverage
- Little office responsibility
- Partnership or Corporation shares
- Possible shared practice management
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- Restrictive Covenant/Non-Compete
- Shared responsibility of running an office
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- Restrictive Covenant/Non-Compete
- Higher office overhead
- Getting along with other physicians
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Employed Position
Multispecialty Group (Clinic)
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Employed Position
Hospital |
- No office responsibility
- Built in referral system
- Corporation Shares
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- No office responsibility
- Built in referral system
- Be where the action is
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- Restrictive Covenant/Non-Compete
- Higher office overhead
- Getting along with other physicians
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- Restrictive Covenant/Non-Compete
- Fixed or limited income potential
- Getting along with other physicians
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It is important to balance your practice career with your time available for your family and outside activities. Each opportunity will have to be considered on a case by case basis according to your personal and professional needs. Quality of life means something different to everyone. To determine the quality of life attributes you need, ask yourself several questions, including:
- What are the must-have absolutes that I simply cannot dispense with?
- What will I be doing with my free time and how will I spend my discretionary income?
- Do recreational options have to be within 30 minutes or three hours by plane or car?
- Do I have children, or am I thinking of starting a family, and how will this affect what I need in a community?
The key is not to focus on a particular community – e.g., "I must live in Gotham City, New York." The key is to consider what you need in a location and a community and to find a place that meets most of your needs. |
Number one is – you need a community where your specialty is needed, where you will have a viable practice for the long-term.
The location you select will have an effect on your earning potential. Sunny and warm, coastal regions, sandy beaches or large cities like New York or Chicago are locations that lots of us view as the ideal place to live. Unfortunately, they are not the ideal places in which to practice medicine. It is important to make sure you understand the economics of taking a job in a saturated market.
Rule: If it sounds like a cool place to live, then it's a bad place to practice medicine. Why? Many other doctors in your specialty have already thought the same thing and the competition will be fierce. Plus the more doctors in your specialty the more leverage managed care will have to lower reimbursements. Physician saturated markets also mean that more practices have to cover several hospitals in order to get an adequate amount of referrals. Every job is a trade off in some fashion, if you insist on a location that is physician unfriendly then realize that your earning potential and quality of medical practice will be lowered.
Many of our candidates often select a location based on the fact that they trained in the community or that they like the community - regardless of whether or not the community meets their personal or professional needs. That is one reason many of them end up relocating after one or two years. An analogy can be made to buying a home. If you insist on buying a particular house in only one neighborhood, you may not be able to find a house that meets all your needs in the timeframe you have to work with. If you are more open to other options, you are more likely to find something that fits for the long haul.
A lot of our physicians are looking for balance in their medical practice and in their personal life and they are increasingly selecting jobs in mid-size cities or college towns. The ideal job will be in a practice set-up that fits your personality, working with doctors that you enjoy, in a community with an acceptable amount of managed care, good reimbursements and reasonable competition. The community should provide enough stuff to do, have a variety of cultural and sporting events, good schools and housing, and be a place where you are comfortable raising your family. |
Income guarantees pay your income for the first few years in a practice, but what you really want to know is 'what can I expect to earn a few years from now'? Remember the location plays a large role in what you will earn as well as the type of practice set-up you select.
Compensation does vary by region. Income packages often are the lowest in expensive areas. These locations are typically desirable urban areas, from New York City to Chicago to San Diego. Such regions also may experience a good deal of competition and an oversupply of physicians. Both conditions make these areas ripe for managed care fee discounting and, consequently, lower incomes for physicians. For example, from New England to New York City, the range is on the low end of the scale with few to zero fringe benefits being offered.
You also must factor in debt, family obligations, and investment and retirement goals when considering the financial potential of a practice. An opportunity that features bonuses and a high level of compensation may ultimately be more attractive than an opportunity in a metro area that pays poorly and offers little job security.
An informed decision on financials requires some knowledge of the current business realities of medicine. Ask not just about how much you should be compensated, but the form that compensation should take. There are advantages and disadvantages to salaries, income guarantees, production bonuses, signing bonuses and other forms of compensation.
Questions to ask your recruiter and potential employers include:
- What is the starting compensation?
- What is the income potential?
- How is income distributed in the group?
- What are the incomes of existing physicians?
- What is the overhead, collection rate, and payor mix of the practice?
By asking these questions of yourself, your recruiter and potential employers, you can get beyond the base financial offer and determine whether the opportunity really adds up financially. The key is to determine whether the practice will be viable financially after the income guarantee or salary contract period is over. |
| Once you have examined these three areas you will be in a better position to find what you need. You will be able to seek and ask for the type of finances you want, you will know which type of setting to look for and you will have an idea of what kind of community you would like to live in. You will find that "shopping for a practice" is much like shopping for other items - it helps to know what you want and the price you will pay before you enter the market. |
