Orthopaedic surgeon Elly LaRoque, M.D., has given lectures to residents and fellows from Stanford, UCSF, and at American Academy of Orthopaedic Surgeons annual meetings on how to choose and start a practice. The content of her presentations is based on her own experience, research, and from talking to her colleagues who share accounts of their job searches. Her most valuable piece of advice? “Start looking early, at least a year in advance, unless you’re going into academics, in which case start even sooner,” says LaRoque.
But how early is early? And how do you know what to do, and when? These are the questions that this article seeks to address in a way that will make your job search relatively smooth and painless.
The process can seem daunting and drawn out, but if you take it one step at a time, the end result will be—if all goes according to plan—your ideal job.
At least 18 months out: Decide what you want
Practice management consultant Jack Valancy contends that one of the biggest mistakes physicians make during the job-search process is not thinking through what they’re looking for early enough. “If you don’t know what you want, anything will do,” says Valancy.
Valancy, who helps physicians negotiate employment contracts and gives career guidance workshops to physicians in training, says that doctors need, first and foremost, to determine what’s most important to them both professionally and personally.
For some, it’s locating close to family and friends. For others, the type of practice—small office, large multispecialty group, employed opportunity, academic position, etc.—is high on the priority list. For still others, the most important factor may be finding a practice where the patient mix and types of cases available are well aligned with what the doctor most enjoys doing.
Location, practice type, case mix, compensation—these are important issues, and ones with relatively straightforward answers. The location is either on the coast, or not. The practice is either a small group or it’s not. The pay is either $175,000 or it’s not. It can be more challenging to set search criteria around the more subtle issues.
“One key component is the culture of the practice,” says Valancy. “A survey from a few years ago showed that 46 percent of physicians leave a job within three years, and the number-one reason had to do with cultural fit. You want a place where you’ll feel comfortable.” Some practices are highly structured while others are more laid back, with physicians and staff on a first-name basis, for example.
“Look at different types of practices, and weigh the advantages and disadvantages,” says LaRoque.
Upon completing her sports medicine fellowship in the Bay Area, she chose to go with a medium-sized private practice in part because of the flexibility and autonomy it offers. “There are fewer people making decisions,” she says. “It’s easier to steer a smaller ship.”
LaRoque appreciates being able to send her patients wherever she likes for physical therapy, for example, and schedule surgery quickly when needed. “In a smaller group, you can also set your own hours and call schedule,” says LaRoque.
Another factor that Valancy says physicians should look at when considering a position is the flavor of the community. What’s important for someone who already has a family may be quite different from what someone who is 29 and single wants. “Cultural isolation is another issue, particularly for foreign-born physicians,” says Valancy. “I had one doctor tell me that if he’d wanted to see Russians, he’d have stayed in Russia. But, for many people, having a cultural connection is very important.”
“Be thinking about all of this 18 months out to narrow your focus,” says Valancy. “Go through what your key issues are. Evaluate different types of jobs, and determine if they are consistent or inconsistent with your key issues.”
Once you’re clear on what you want, then and only then should you start talking to your network of contacts, getting in touch with recruiters, and sending out your CV. Start out picky. When you’re open to any opportunity in any place under any terms, the choices can be paralyzing.