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?