Physician career moves: List before you leap

When family physician Megan Jensen, MD, was looking for her first job, she wrote down a list of her priorities. The list included location, lifestyle, hours, patient population, procedures and support.

She thought she wanted to practice in a small-town setting where she had grown up and stay in the Madison, Wis., area, where she graduated from medical school and completed her family medicine residency in 2012. But after that, she felt she was guessing about what she desired in a job. “I wrote down a list of what I wanted, but I wasn't sure of the process.”

It was more of a gut feeling, she said, that led her to accept a job at Dean Health System's clinic in Deerfield, Wis., a town of 2,000 that is 20 miles east of Madison.

Physicians like Dr. Jensen often feel uncertain when they're applying for jobs. Many compose a list of priorities, but usually it doesn't go much further than that, recruiters said. Some are able to find great placements by doing this, while others find themselves looking for jobs after two years because they haven't found the right fit. But if physicians want to maximize their chances of making the correct decision, recruiters suggest they use a four-step process to help them decide and strike a balance about what they desire.

“I've seen physicians make decisions based only on the compensation and others who make it only by geography,” said Steve Marsh, managing partner and co-founder of the Medicus Firm, a physician recruitment company based in Dallas and Atlanta. “But I can't stress enough that it's about striking a balance.”

Step 1: Write it down

Recruiters said Dr. Jensen's approach of writing it all down was the first step toward deciding which job was right for her.

Marsh said the list should include categories such as community, practice, income, region and lifestyle. The next step is to write down what each of those categories means to the physician. For instance, community can mean population, safety, educational opportunities for children, shopping and amenities, access to professional sports, restaurants, arts and entertainment, he said.

When considering practices, physicians should ask themselves about call coverage and scheduling. For example, doctors may need to consider if they want to see patients every 15 minutes or every 30 minutes and whether they want to work four days a week or certain days or shifts each week.

Lynn Peterson, manager of physician recruitment at the Fairview Health System in Minneapolis, suggests that doctors brainstorm about what they want in their practices. They should envision their ideal working day and ask themselves what kind of patients and complexities they want to treat. She suggested that physicians have a list of about 10 priorities, one of which should be location.

She said the No. 1 reason physicians say they want to work at Fairview is the location. Most of the time, physicians have connections to the area; perhaps they grew up there and always wanted to return. Sometimes “they have lived elsewhere, and they want to come back,” she said.

Step 2: Explain it

Marsh said the next thing physicians must do is explain why each factor is important to them.

Some may find out what they thought was important really wasn't.

It also helps to spot conflicting priorities. For instance, many physicians want to live near urban areas to take advantage of the arts and entertainment, shopping and access to professional sporting teams. But many urban jobs are very competitive and expect physicians to work long hours and be on call, Marsh said. As a result, physicians may be too tired to enjoy the amenities they sought in the first place.

On the flip side, if physicians lived farther out, working in practices that didn't have such demands, they would have more time to travel to cities where they can enjoy doing what they want, he said. “I find physicians in midsized to small towns who take advantage of the cities by spending weekends there before they go back to their communities.”

The most important thing, recruiters said, is that doctors articulate why the priorities they listed matter. That way, the list becomes clear and can help physicians get a truer sense of how things fit with a job they're considering.

Step 3: Rank it

After writing it all down and explaining why they want each item, physicians are ready to rank their priorities. Peterson said physicians should list their top three priorities in a job. Most of the time they will find between 80% and 90% of what they wanted on their list, recruiters said.

Marsh said physicians should consider many factors, because the road to success means striking a balance. For instance, many young graduates choose money over other considerations because they have huge student loans, but this can be a bad idea, said Chris Kashnig, a recruiter for Dean Health System in Wisconsin.

“No doubt in that situation it makes sense to choose money, but they pay for it in other ways,” Kashnig said. “They may have to work in a remote location or have difficult call schedules. It's foolish to choose money the first year.”

Ranking priorities includes how those choices will affect other people in the physician's life — namely, a spouse or significant other. “People have romantic notions about living in small towns, but sometimes spouses can't get jobs,” Kashnig said. “It's not easy to fit family and practice into a small town with another working spouse.” If the other people in their lives aren't happy, physicians will find themselves job hunting again in short order, he said.

Step 4: Determine if the job is right

When making a final decision, recruiters said it is best for physicians not to put all their eggs in one basket. No single priority should be the reason a physician takes a particular job. Physicians who do that usually end up moving after two or three years. Recruiters emphasized that the four-step process is about finding what physicians can and can't live with, rather than holding out for a job that fits every item on their checklists.

Waiting for the perfect job that fits the bill isn't always the wisest move, said Troy Fowler of Merritt Hawkins, a national physician recruiting firm with corporate headquarters in Irving, Texas.

When a job feels right during an interview and checks off most of the professional and personal want boxes, a physician shouldn't spend more time looking for another job, he said. Some doctors feel they must go on a multitude of job interviews but then find out the first job they interviewed for was the one they really wanted.

“I'll get a call from someone who asks about a job that they had interviewed for two months ago, but it's gone, because other candidates took it,” Fowler said. “Those jobs happened to be the best fit, and now they have to settle for second best. Sitting on a job is a bad idea.”