Starting Your Job Search: Figuring Out What You Really Want

Koushik Shaw, MD

Disclosures

May 03, 2019

In This Article

Finding the Right Practice Type

Take a fresh look at all choices, not just those that resemble the type of job or training program you have now. Here are some broad-brush descriptions that you can follow up on with your own research.

Solo practice. Fewer new doctors are taking this option—17.9% of physicians who responded to a 2018 Merritt Hawkins study were solo practitioners in 2018, down from 24.9% in 2012. But that's not a good reason to ignore this option. In Medscape's 2017 Resident Lifestyle and Happiness Report, 21% of medical residents surveyed said that they anticipate becoming a partner or practice owner. Although solo practice takes a lot of work to set up and involves financial risks, it gives you a degree of independence that other physicians wish they had.

You can avoid the risks of setting up a solo practice by joining an existing one. But you have to mesh well with the existing physician—who is, after all, used to being on his or her own.

Small group practice. This is still the most typical arrangement for physicians. In 2016, 57.8% of all physicians were in practices with 10 or fewer physicians, according to an American Medical Association (AMA) study.[3] Unlike in a solo practice, you will have colleagues to consult and share call with, and usually you will be able to buy into a partnership.

As with all arrangements, you'll need to examine the efficiency of the practice, because this will affect your income. The organization may be too small to run efficiently. As a rule of thumb, most practices should keep expenses under 50% of gross revenues.

You'll also need to make sure the established physicians won't take advantage of you as the newbie. You may be given most of the difficult or low-paying patients, get more than your share of call, or get a very expensive buy-in. Make sure to discuss this during your job interview.

Single-specialty practice. These practices, which can be any size, encompass 42.8% of physicians, an AMA study found. This arrangement can be very efficient, because all physicians have the same needs. Larger practices, when run right, can introduce economies of scale that can make them even more efficient.

Multispecialty practice. About one quarter of physicians (24.6%) were in such practices in 2016, according to the AMA study. Such groups create automatic referral relationships, but when there are only one or two specialists in a given field, all arrangements can be onerous. However, very large multispecialty groups offer better call arrangements, good continuity of care, and more significant bargaining power with insurers, allowing higher reimbursements.

Large group practice. In these organizations, you may be able to focus more on clinical matters, and you can enjoy the camaraderie of many doctors. The AMA statistics indicate that 13.8% of physicians were working in practices with 50 or more physicians in 2016. These practices include some big names, such as Scott & White, Mayo Clinic, and Cleveland Clinic, which also run their own hospitals. Although this category provides economies of scale, it can be bureaucratic, with many layers of management.

Locum tenens. This involves working on a temporary basis for different providers who need extra physicians. This is a short-term option if you haven't yet decided on a permanent job, and it's becoming a career for doctors who are generally single and like working in different locations.

Working as an Employed Physician

Insurance-based model. This is a less common but significant model in which doctors work directly for an insurance company. Physicians working for Kaiser Permanente, one of the largest healthcare providers in the country, only care for patients who are insured by Kaiser. Doctors at the Geisinger Health System in Pennsylvania have a similar arrangement.

Hospital-owned practice. As of July 2016, 29% of physician practices were hospital-owned, according to study from the Physicians Advocacy Institute and Avalere.[4] If you join a hospital-owned practice, you will be an employee and will not have the opportunity to buy into ownership. You may also be subject to organization-wide compensation formulas and be expected to serve on committees.

Academic medicine. Working in an institution affiliated with a medical school is appealing if you like research, teaching, speaking, publishing, and travel. But you will face competition for research funding, you may work long hours, and your pay may be lower than in private practice.

Veterans Affairs (VA) and military health systems. These are large, self-contained systems where physicians only see patients within the system. To reverse sagging recruitment, the VA announced plans in 2014 to increase annual salaries of new physicians by up to $35,000.

"Remember," Morgan advises, "one setting might be preferable at one stage of life, and switching to another environment might make sense later on. It's important to understand the differences—by doing as much networking and research as you can—before taking a leap."

Editor's Note: This article was adapted and updated from the Physician Business Academy course "Finding the Right Physician Job" by Koushik Shaw, MD. Additional reporting by Gail G. Weiss.

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