How To Survive Your First Medical Job

After you see  and feel the bruises associated with practicing medicine you realize very quickly:

Practicing Medicine is a FULL CONTACT occupation.   Gone are the days when you casually join a friends on a handshake, now there are too many risk both financially and socially to not take get the right job seriously.  The last thing you want is a bank account full of regret from getting the wrong job with the wrong employer.  Take this sage advice; Do what you know!  For everything else either learn in-depth, like languages, hobbies, etc or get Expert advice.   One huge mistake I see many young and veteran physicians continuously make is not to seek financial or legal counsel when dealing with the legal and financial aspects of a new job or when potentially changing jobs.   After meeting many physicians @ SEAK who have had serious run-ins with medical staff, human resources or partners, one thing is clear to me.  Physicians need an Agent.  Like many very talented people in society who have total representation like actors, sports figures and authors, we need Physician Agents to help negotiate a contracts, work expectations, HR investigations, and medical staff issues.  Like Leigh Ann O’Neill from my podcast says, “If you don’t have any representation you are at a huge disadvantage since your employer will.”

Here are the Key steps to surviving your First Medical Job:

    1. Know your Market
      • Not all docs get paid the same depending on specialty
      • Every region pays differently in the country and abroad
      • Data exists for everything you can imagine including
        • salary
        • vacation
        • RVU (Relative Value Units)
        • work hours
        • call
        • benefits
      • What are the trends of your speciality/industry?
      • Familiarize yourself with independent salary benchmarking by MGMA. I will do a larger blog about this in the future.
    2. Know your employer
      • Reputation in the community is very important.
      • What are the real core values?  Money, reputation or outcomes?
      • If it is a not for profit, what did the 990 form say for the past 5 years?
      • What is the organization attrition for nurses and ancillary staff?
      • Do they offer and ownership stake immediately or after a waiting period? Is there a buy-in?
      • What is the size of the organization and patient population it serves?
      • Are they private practice, hospital physician group or academic?
      • How long is their contract with the hospital if private?
    3.  Job expectations
      • What are the expected duty hours including after hours?
      • How much call will I take?
        • Nights?
        • Weekends?
        • Post Call Day expectations?
        • Multiple hospitals?
      • What is expected outside of clinical work?
        • Chart reviews
        • Prior and Post insurance authorizations
        • Lectures, journal clubs, teaching, rounding
        • Meetings, if so how many per week?
      • Who is my immediate superior in the chain of command or am I on my own?
      • Will I have to maintain EHR and compliance education?
    4. Know your partners or coworkers
      • This is what I call the greatest intangible character of the job.
      • What is the group/department attrition and of the nursing serving that department?
      • Do any of them have serious financial, legal or social issues?
      • What is the spread of age in the group?
        • Are they evenly spread or all about to go part-time when you start?
        • How many coworkers will be close to your age?
      • Has the group been recently sold or about to become insolvent?
      • How many locums or travelers work for the organization?
      • Do any them have very strong political positions to either ideology?
      • Is it every man for themselves or all hands on deck in terms of support?
      • Do they hang out with each other outside of work?
      • Does anyone seem narcissistic or have a borderline personality disorder?
    5. Community
      • There is always a trade off between money and location.
      • Rural versus larger cities
      • How safe is the community you will live in or practice in?
      • Does the area have good schools for those with kids?
      • Access to airports really matter as we get older and need to travel more.
      • What is the housing market like within a reasonable commute?
        • Keep this at all possible less than 2o mins!
      • What cultural activities exist that you will enjoy?
        • Dining
        • Art and entertainment
        • People and Networking opportunities
        • Outdoors and sports
    6. Money
      • This is the hardest to talk about but the more you study the better off you are.
      • Get an attorney to review your contract.  Non-negotiable.
      • Will you get paid by what mechanism?
        • Salary
        • Salary + Productivity bonus
        • Salary + Quality Metrics Bonus
        • Base + RVUs
        • Lump and divide after all expenses
        • “Eat what you kill”(really bad analogy but I have heard it for years)
      • Signing bonus
        • They still exist but if you get one there is a good reason.
        • Usually requires a time commitment of 1-2 years.
      • Relocation Fee
        • Still very common among highly paid specialties.
        • Sometimes the group will give a distribution to be paid back in labor.
        • May offer an interest free loan which must be paid back with interest if you back out at a later date.
      • Most contracts are time limited and require renegotiation.
        • Ask to see old contracts or see how the reimbursement has changed over the years.

So this is a ton of information to go over and process.  If you fail to take most of it into consideration there it could end with disastrous results in many ways.  We haven’t even mentioned contracts which could take up book volumes but must be saved for a later date.   If you are lucky enough to get a job where you finished your residency then part of the work is done but if not then prepare to get overwhelmed.   I made a spreadsheet comparing and contrasting in table format each employer side by side and I highly suggest you do the same.  I recommend Steven Babinski’s book on physician negotiations, but I will warn you it isn’t light reading.   Good Luck and I wish you the best.


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