The location of a new practice is more than a geographical choice. It’s not just a question of deciding between urban or rural setting, or between living in the mountains or on the coast. When considering location, first decide your priorities. Distinguish between those aspects of geographical choice that are merely appealing to you and those that are absolutely essential. Do you need a good school system for the kids? How important is climate? Do traffic and commuting times make you crazy? Will your spouse have good career opportunities in the area you're considering? Does the area have the cultural amenities, outdoor recreational opportunities, shopping, or fine dining options you're seeking? Does the area have a multicultural community and or religious community that meets your family’s needs?
A helpful resource for choosing a location is the Places Rated Almanac. It includes a quiz that helps you identify what factors are most important to you in choosing a place to live. It also ranks metropolitan areas in the United States according to a number of factors, including transportation, education, health care, climate, and economic growth and others. Sperling's Best Places is another useful guide and has a Web site that gives school statistics, crime rates, and data on climate and cost of living.
Academic or private practice—this is a key first choice, and one you may have already made. If you think you are open to either, make sure you have an accurate concept of what each career path entails. Test your assumptions. You might think you have a good idea about the academic side, because of your years in training. But the culture of academic institutions varies a great deal. There are sometimes variations within a single institution. Keep in mind that most academic institutions offer either a clinical track or a tenure track, which have different criteria for promotion and different requirements for teaching, research, publication, and clinical care. When considering an academic position, investigate those options, and determine whether it's possible to change from one track to the other in later years.
A good resource to find out about academic salaries is the annual Report on Medical School Faculty Salaries, published by the Association of American Medical Colleges (visit www.aamc.org and click on "Publications"). Balancing the demands of clinical, research, or teaching responsibilities is one of the challenges of academic practice.
M any physicians decide to join a private practice while maintaining an academic affiliation to take advantage of teaching and research opportunities. The amount of time you’ll be expected to devote to your academic affiliation will vary greatly with each practice group and academic institution, so be sure to drill-down on that when considering an academic affiliation.
M ost physicians begin their professional career by joining a group practice, either in a single specialty group or a multispecialty group. You should be familiar with the different legal structures of medical practices and understand the advantages and limitations of each.
G roups can provide collaborative environments for newly graduated residents and fellows, since they offer more experienced physicians in a variety of disciplines. Large groups also have the means to employ professional staff with the expertise and training to handle management tasks, which in a smaller group, often fall to the physicians. Of course, you give up a certain amount of independence when you join a group. But remember also that group practices can often afford equipment and provide ancillary services that a solo practitioner often cannot. (And many of those additional services are billable and thus income generators.) Larger groups also have more clout when negotiating with insurance companies for reimbursement rates. In selecting a group that matches what you want in a practice, consider how these factors compare with your goals and desired practice style:
When joining a group, you will typically be offered an employment contract with a guaranteed salary for the first one or two years, which serves as a trial period for both you and the group. The road to partnership, ownership, or continued employment after that period should be clear in the contract. Sometimes, there is a buy-in requirement to become a full owner.
P hysician employment by hospitals has once again become a popular strategy for health systems and physicians alike. It's seen as an attractive option by both established practitioners as well as those recently completing training. Downward pressure on physicians’ incomes and skyrocketing malpractice insurance premiums are contributing to this increasingly popular option.
Hospitals, in turn, are faced with shortages of key physicians in many regions of the country. Hospitals with a physician shortage have difficulty maintaining on-call coverage and can’t expand services, which results in a constraint on revenue. So those hospitals are increasingly willing to employ physicians – at very attractive compensation packages. Those packages often include student loan forgiveness and a comprehensive list of benefits not typically available in group settings, particularly in smaller groups.