It took the premature death of his father to convince Josh Valtos, M.D., to leave a thriving cardiac surgery practice and move closer to family.
Amy Canuso, D.O., made a similar decision when she moved her family from Guam to Iowa. Although she was not unhappy with her practice in child and adolescent psychiatry, “For us, it was the right decision,” she says.
For Jennifer Allen, M.D., it was the end of her family practice residency that spurred action.
Though each of these physicians had different motivations, each found a job search squarely in their future.
Looking for work is hardly a new phenomenon these days for physicians—or anyone else. According to The Balance, an online publication that covers personal finances, the average person changes jobs 10 to 15 times over the course of his or her career.
Physicians aren’t exempt from work transitions. And with that comes the biggest question: Will the change be a good move…or not?
“It’s an employee market out there for physicians,” says Valtos. The market needs you. But how can you decide if a job offer is the right one for you and your family?
Certainly, completing residency or fellowship or deciding on a geographical move are among the many reasons why physicians look for work. But they’re not the only reasons. Pinnacle Health Group conducted a survey several years ago to learn why physicians change jobs. We will look at some of the reasons they compiled as a way to prompt questions you should ask before accepting a job offer.
No matter what questions you decide to ask, however, one thing is clear: The more questions you ask before, during and after the interview, the more likely you will be to find the right fit for you and your family.
First on the Pinnacle Health Group survey on why physicians change jobs (or opt not to take them in the first place) is the need for a higher salary.
“Of course, in a job interview, physicians are primarily focused on getting the job and how much the job pays,” says Jeff Decker, division president, locum tenens for the recruiting firm AMN Healthcare.
“Because of the debt level they assume while training, they’re programmed to get out there and start working as soon as they can for as much as they can. If they’re motivated to pay down debt, though, they can jump into a job too fast without taking other factors into consideration.” But yes, he continues, salary is going to be a substantial part of any job interview.
Before entering any interview, you need to determine your salary needs. There are other questions on this topic that you may want to ask:
Do you have the resources to meet my salary needs now and in the future?
“Physicians who join a private practice may not be given as high a starting salary as physicians who are employed by a hospital or health system, but they may receive supplemental incentives, like relocation, student loan assistance and sign-on bonuses,” says Chris Corde, system vice president of physician recruiting for OhioHealth.
“However, physicians who enter private practice may have a greater long-term earning potential because they can have ownership or are able to retain a greater share of their work.” Before your interview, consider your financial goals and make sure you learn about your long-term salary prospects from any potential employer.
Allen suggests asking about the employer’s overall financial health. “With so many mergers taking place and hospitals going under, you’ll want to know what the employer’s financial strength is,” she says.
Decker agrees. “Don’t be afraid to ask these kinds of questions,” he says. “Ask about the economic health of the business and ask if there are things down the road that could be problematic.” You don’t want to accept a job offer if the hospital is prepared to do lay-offs in the months ahead.
What will my income look like in the first year—and after?
“Income guarantees” are becoming a thing of the past. “With this type of contract, the physician is assured a base income, usually for one or two years. But it is really a loan that has to be paid back,” says Decker. However, the loan is usually “forgiven” in exchange for the physician staying in the community for a certain number of years.
“In the early days, most of our contracts featured income guarantees. Now, it is about three or four percent, as almost everyone recruited today gets a salary,” he says. “After a year or two that may segue into pure production, so you have to be prepared for that.”
If that is the case, Decker recommends asking during the interview what kind of loads other physicians carry. “You can deduct in your head the number of patients you will need to see to meet your compensation goals,” he says.
“Those types of contracts (salary with no payback and bonuses paid when care metrics are met) turn the clinician to a salary employee,” says health care consultant Tom Davis, M.D. “But that’s what a lot of them want.”
If you’re not sure what the best compensation arrangement will be for your practice and family long-term, you can try asking a question to help you understand the review process involved.
Canuso recommends: “Can I re-negotiate pay after my contract ends?” If the answer is “no,” at least you can decide on the job opportunity with that knowledge.
Is compensation here driven by volume or quality?
“That’s one question to ask that will help you determine some answers,” says Decker. Different employers have different values, so it’s a good idea to determine what drives an employer before accepting a position there.
Salary, productivity, even academic systems have their pros and cons. “You need to know what system you are most comfortable working under, and choose the job accordingly,” says Canuso.
Also ranking high on the Pinnacle survey are several items that translate to lifestyle. Lengthy hours or a high call schedule are two reasons many physicians opt out of a job offer or the job itself. Other lifestyle reasons include underutilized medical skills and an unmet need for growth and upward advancement.
“As we grow older, we need to ask ourselves, ‘have my priorities changed?’” says Valtos. After you have paid off medical school debt, your focus may shift from money to lifestyle.
Again, that means you need to first establish your priorities before looking for work. With priorities in mind, your questions can focus on what’s important to you. If lifestyle is at the top of your priority list, here are a few questions you might want to ask a prospective employer:
What’s the call schedule?
If you are interested in maintaining a work/life balance that works for you and your family, this is an important question to ask. You will not only want to know what hours you will be expected to work, but where you will be expected to work.
Some facilities have satellite clinics where you may be assigned, so even if you do not object to the late-night or early morning shift, you may have a different perspective if you need to factor in a 45-minute commute to the satellite facility.
“If you’re applying at a hospital that has a network, ask if there are ancillary facilities you’ll rotate to,” says Decker. That’s true whether the work is during regular hours or on-call shifts.
It’s also a good idea to ask if you will take call from community-based providers, says Corde. If so, how will that impact you? It is conceivable you might be taking on all the late-night work from community providers who would rather not work outside their regular hours.
Another question to pose is, “Can I take scheduled vacation?” Hospitals with high patient volumes may not be thrilled with the idea of new physicians scheduling vacations in the first year, but, says Decker, if vacations are frownedhttps://magazine.practicelink.com/magazinearticles/Enough-about-call-what-about-vacation/category=Physician%20Employment%20contracts/publishedin=Fall%202012 upon as a general rule, you will want to know about that policy upfront.
How much time will I spend on nonclinical activities?
“One question I wish I had asked during the interview is, ‘How much time will I spend finishing charts?’” says Allen. “Electronic records didn’t work, so I was spending an hour and a half beyond my scheduled time to complete charts each night,” she says.
Davis says the complaint is not uncommon, so he urges job applicants to ask about time commitments needed for all non-clinical activities, including completing records.
“Ask about any meetings you’ll be expected to attend as well as any additional training that will be required,” he says.
Know before you sign up for the job exactly what kind of hours will be required to complete each day. “If you find yourself working outside of your regular hours, you might ask, in the case of completing records, if you can leave the hospital and remote from home to finish your work,” says Allen.
If it appears you will be expected to spend your own time on non-clinical tasks, she adds, “ask if you will receive some sort of compensation for the extra time in terms of cash or vacation, or if it’s simply expected of you.”
Have a potential employer walk you through a typical day at the facility. “Ask ‘What will my first week be like?’” says Corde. Then go further. “Ask ‘What will my first month be like? My first year?’” This will give you a better idea of the employer’s expectations and how they match up with your priorities.
“I ask for details of the day-to-day job,” says Allen. The information you learn will help you better decide if this is the right practice fit for you.
“Will I see mostly inpatients? Outpatients? Will there be a mix? I ask myself, ‘In what sort of setting do I enjoy practicing the most, and with what patient demographic?’” says Canuso. The answer will help you with your job decision.
What kind of growth opportunities will I have?
If advancement opportunities are important to you, remember to ask about them during the interview. “Ask ‘How can I make partner?’ if this is a path that interests you,” says Valtos. Or if your goal is to rise higher in hospital leadership, ask “What is the pathway to medical director?’”
“Many new physicians will sign up with an employer in a part of the country where they want to live, work there long enough to pay down their debt, and then decide their career move,” says Davis.
So, before you ask an employer about growth opportunities, make sure the job and community is a place where you see yourself and your family staying long enough to advance your career.
Questions for the family
Number 10 on the Pinnacle survey on why physicians leave (or do not accept) jobs involves the family and its comfort level in the community.
“My family was entrenched in our community, so when I looked for work, I decided not to move them. It was better for everyone if I commuted to work,” says Allen.
That meant she needed to restrict the area in which she searched for a job, but it was a solution that worked best for everyone. “I was already commuting for my residency. The job I found was actually closer than my previous commute had been.”
If you do have family, like Valtos, you will want to spend as much time as possible learning about the community before you step foot into the interview.
“My wife and I are pretty good researchers,” says Valtos. Before moving from Missouri to their new home in northeast Alabama, they went online to find the best community fit for their family.
“We looked up the health of the community, school rankings and school performance records, crime statistics, even weather reports,” he says. By the time of the interview, you should not have many questions left to ask about the community, he says.
Still, here are a few you might ask to help determine if you and your family will feel comfortable there:
What is the community’s demographic?
If you’re looking to surround yourself and your family with people of similar ages, what part of town would be best for you to look in? What activities are available? Are there places for colleagues and friends to meet outside of the workplace?
Whether you are interested in fine dining and theater or professional sports and barbecue, you need to know if this is a place where you and your family will fit in for an extended period of time, says Allen.
Says Valtos: “You want to ask yourself if you can see yourself here in 30 years.”
Also, says Decker, ask what the pace of the community is like. “An urban environment is going to be a different pace from a rural or even a suburban environment.” Which pace best suits you and your family?
What help do you offer families?
It is not unusual these days for hospitals to work with realtors who can help find homes for physicians moving into the area. The realtors are familiar with school districts and can likely introduce you to school administrators as well as provide up-to-date information on school performance records and rankings.
Canuso, who recently moved from Guam to a small Iowa community, says, “When I interviewed for my job, the hospital administrator even arranged for us to tour the schools and meet with the principals.”
Help with house hunting as well as school introductions can be a significant asset for new physicians. So can job placement services that can help a spouse find work in the new community. Hospitals often tap their networks to find employment opportunities for trailing spouses who left their jobs behind.
If any of those services would be helpful, ask about them during the interview.
What help do you offer to new physicians?
During the interview, Allen suggests asking if there is a support system in place for new physicians. If networking and collegiality is important to you, then ask if the physicians mingle outside of work, says Allen. Becoming familiar with other staff members, even making friends, can be a crucial part of fitting into a new workplace.
Before you accept a job offer, it can also help to talk with physicians who work or have worked at the facility.
“I asked to speak to a few physicians who work for the hospital,” says Canuso. “I also wanted to meet the clinical managers and nurses on the inpatient ward. Ultimately, you are going to spend more time with co-workers than you do with family, so I wanted to get a sense of potential for mutual respect and general temperament of potential co-workers. This is a rural hospital, so the professionals who work there want to be there—and that means a great deal to me.”
You can also get help from your hospital’s recruitment team. “Recruiters can also be phenomenal in terms of research,” says Valtos. “They can give you insights into the job, the employer and the community you can’t get anywhere else.”
Of course, any question you ask during an interview will be unique to your own situation. The questions already covered are general in scope and will benefit most applicants. Here are a few questions that are slightly more specific. Chances are, you’ll want to ask a few in your interview:
- What are your turnover rates? How many new hires stay after the first year? Davis says this will give you a feel for how satisfied employees are who work there. Valtos also suggests asking the employer about turnover rates. “Ask the recruiter how many physicians have come and gone from this location and why. Or, ask the employer why they’re looking for a new physician,” he says.
- How long has the job been posted? If the employer has been looking for a while, says Corde, you may want to ask why.
- Is there a non-compete clause? You’ll want to understand any restrictions if you choose to look for another job in the area in the future.
- What is the employer’s mission? Do they have serving community at the top, or is it focused on profit? Ask how the mission affects daily life at the organization.
- When can I expect to hear back? Candidates can forget to ask this following the interview, says Corde. Ask what the next step is before you leave.
“Don’t be afraid to ask questions,” says Valtos. “After all, you’re the one who is ultimately going to work at this place, in this culture and live in this community. Make sure you ask all of the questions you need to help you make the right decision.”