The end of training is finally in sight, and you’re eyeing the brass ring: your first job as a practicing physician. The search process may feel like one more test to ace—the culmination of a gauntlet that began years ago. You might assume you can handle career planning solo. After all, you’ve competently tackled everything from premed classes to the MCAT. But if you’re married or in a long-term relationship, going it alone is likely a mistake.
For one thing, your life partner can help you manage the array of new time-consuming tasks. But much more importantly, they can help you make a better decision. Together, you can find a job that’s right for you and your family — and avoid one you’ll both regret.
What’s behind first-job turnover?
Industry experts say half or more of new physicians leave their first jobs within a few years. There’s plenty of possible reasons for this. But one that seems clear? Residents aren’t choosing jobs that suit them for the long haul.
Shane Halvorsen, business consultant and former president and board member of Advocates for the American Osteopathic Association (AAOA), has some insights. A med spouse himself, he’s gotten to know many other physician spouses and their families through AAOA.
He says that when they’re looking for a first job, some physicians don’t fully take their family’s needs into account. This is one reason first-job turnover is so high. However, he adds that this seems to be changing. Both physicians and employers are increasingly aware of spouse and family priorities.
Shane’s spouse, Vanessa Halvorsen, D.O., is currently completing an otolaryngology/ facial plastics residency at Freeman Hospital in Joplin, Missouri. After that, she’ll do a one-year fellowship in rhinology and skull base surgery. But recruiters are already reaching out. Vanessa and Shane are working together to analyze their priorities as they consider her decision.
Location is one of the Halvorsens’ main concerns. It will affect Shane’s potential consulting income. Shane and Vanessa also want their new community to have the resources and amenities their growing family needs. Every time Vanessa is presented with an opportunity, they discuss it together.
“We always sit down and talk about it and go through it first together,” Shane explains. “Before she’ll [accept an] interview, we ask ourselves, ‘Could this actually work for me as well?’”
While Vanessa will likely earn a significantly higher salary, her career isn’t the only consideration. The Halvorsens want to find a location that works for both of their careers.
Even if your partner doesn’t work outside the home, it’s important to involve them in the decision.
Liz Mahan is the director of professional development and solutions with the Association for Advancing Physician and Provider Recruitment. She has often met candidates searching for new positions because their current locations didn’t work for their spouses. In fact, she says spouses are often the ones researching and finding the opportunities.
“When we got into why they were looking, the answer always was, ‘My partner or my spouse is not happy where we are, and I work crazy long hours,’” she recalls.
Mahan adds that it’s not unusual for physicians to say they don’t care where they live. They just want to practice. If that’s you, it’s a good idea to put your spouse’s location preferences at the top of the list. They likely have reasons for their preferences. If you don’t take those into account, they may struggle to adapt while you work long hours in your new practice.
“There’s a lot of alone time for your spouse, not just while you’re training, but even while you’re working,” adds Napoleon Bonaparte Higgins, M.D., a psychiatrist in Houston, Texas, and author of “Transition 2 Practice: 21 Things Every Doctor Must Know in Contract Negotiations and the Job Search.” “You may actually be working more as an attending than you did as a resident. So now your spouse is in a city where they may not want to be or where they may not know many people facing a lot of time alone.”
“I’ve unfortunately seen physicians over the years who ended up leaving our practice for the sole reason that their spouse wasn’t happy in our rural area of East Texas,” says Jennifer Holman, M.D. Holman is a dermatologist and regional president of U.S. Dermatology Partners at the Center for Aesthetic and Laser Medicine in Tyler, Texas.
Holman says choosing a location that suits your family isn’t just good for them. When they’re happier, it improves your well-being, too
Spousal support: Inventorying family needs
Listing all your needs and job considerations may seem like a daunting task. That’s one more good reason to involve your spouse in the process. Encouraging their participation ensures their voice is heard and makes the workload more manageable.
It also makes the process more efficient. When you hash out priorities, you’re able to rule out opportunities that don’t tick the right boxes. That way, you don’t waste time and effort on unnecessary interviews and site visits.
Location is usually the most important consideration. That’s why Peter Moskowitz, M.D., recommends starting with a list of possibilities and ruling out any nonstarters. Moskowitz is the founder and director of the Center for Professional and Personal Renewal in Palo Alto, California, which offers physician coaching. He’s also an emeritus clinical professor of radiology at the Stanford University School of Medicine.
“Regardless of how exciting the first new job may be, the life portion of work/life balance is still important. The culture of the community, the geographic location, the weather, the opportunity to do things that are fun and so forth all also matter. If you have a spouse and you’re involving them in the process, they can help you evaluate all these things,” Moskowitz says.
Moskowitz suggests that spouses take the lead on evaluating unfamiliar cities. They can start by contacting alumni of their college who live in the area. That way, you both get reliable input from people in the know. You can ask about things as big as the political climate and school systems or as mundane as gyms, restaurants and shopping.
Two-career families: getting the calculus right
Quality of life isn’t the only consideration. Relocating may also impact your partner’s employment.
Mark Fleischman, M.D., is a dermatologist, fellowship-trained Mohs surgeon and regional president with U.S. Dermatology Partners in the Kansas City metro area. He points out physicians are often married to other health care professionals. In those cases, the spouse might find employment in the same organization as their physician partner, and their compensation might stay roughly the same or be easy to project.
When the spouse works in a different field, it’s not always apples to apples. It’s important to consider the availability of similar job opportunities in a new area. This goes beyond comparing pay scales.
“A lot of times, there won’t be family nearby in the new community,” Fleischman says. “If the physician and their spouse have children, they’ll have to be sure there are opportunities for quality childcare and education.” And these costs also need to be factored into the equation.
It may seem like the physician partner’s career opportunities should take priority because their compensation is so much higher. But that’s not always the case. Higgins says it’s critical to test that assumption.
For example, what if your spouse can earn a pension by staying in their current job for a few more years? Your household could miss out on a huge source of income if they leave prematurely, even if the physician salary is much higher.
“That could be a $3,000 or $4,000 monthly check that your spouse would receive until death,” he says. “That could be 20 years or more of income you didn’t even have to work for.”
Or what if your spouse is positioned for promotions and raises in the coming years at their current company? Starting fresh in another city could change their trajectory—especially if their work involves building clientele over time. Moskowitz adds, “Even in dual-physician families, there can be an assumption that the highest-paid doctor’s career should come first. That can become problematic for the relationship if both physicians decide they want to make a change or if their top job choices are in different cities.”
When he coaches couples like this, he suggests they work out “sequential transitions.” One partner gets their ideal situation for a time, then the other gets their turn.
“When both partners are physicians,” he says, “career change for one almost always means an involuntary change for the other. The [implied] question is always: ‘Whose career happiness is more important?’”
Negotiating these tradeoffs and career changes isn’t always ideal, since it means more disruption and effort. But Moskowitz says, “It’s perceived by dual-physician couples to be equitable and fair, which is ultimately much more important.”
Higgins adds that while money is important, it’s not the best or only way to compare opportunities for your family
“You may be thinking, ‘I’m going to be making $310,000 a year, and my partner only makes $48,000, so they
should find another nonprofit to work at,’” he says. “But if that individual feels like they’re really doing the work that they need to do and they love the work and it’s making a huge impact, then money may not always be the only consideration.”
“You can be a doctor almost anywhere,” he adds. The job your spouse loves at a church or local nonprofit may not be easily replaceable.
Sharing the administrative workload
As you search for your ideal first job, there’s a lot of new administrative work: research, correspondence, writing, editing and managing timelines. Your spouse can help with many of these things.
For example, you’ll want to customize your cover letters and CVs for each prospective employer. If your spouse has corporate experience, they may be able to help you market yourself. And it never hurts to have an extra set of eyes for proofreading.
To expand your leads, your spouse can also help you set up profiles on LinkedIn and job boards, such as PracticeLink. And once you’ve identified communities and practice settings you’re interested in, they can also help research additional opportunities and track down contact information.
Consider setting up an email address specifically for your job search. That way, you can both monitor messages, and your regular inbox won’t get clogged with job-related messages.
Site visits: Divide and conquer
Once you start site visits, be sure employers will allow your spouse to come along.
“When physicians who are married interview in our practice, we try to be sure a dinner includes our physicians’ spouses — and kids, if the candidate’s kids are visiting — as well,” Holman says. “Candidate spouses’ conversations with our physicians’ spouses can reveal insights on lifestyle and the job opportunity.”
Mahan says in-house recruiters can help candidates and their families learn about local jobs, real estate and schools, plus amenities and activities. Don’t hesitate to ask for help.
“Recruiters are exceptional networkers,” she says. “And we’re people people. If you have a consideration or your spouse does, we’re more than happy to connect you with people who can give you a full picture of what your life would be like.”
During your visit, your spouse should schedule as many fact-finding expeditions as they want to. This will help you both with your decision. Be sure to tell recruiters and employers about anything that’s important to you — no matter how tangential your questions may seem.
Who knows you better?
Your spouse can also provide extra perspective. They may spot issues you overlook as you focus on selling yourself.
“A spouse can be the sounding board for what’s really going to make you happy in your career and what’s going to make you happy in a new community,” says Robyn Alley-Hay, M.D., a retired OB/GYN physician and current physician coach in Dallas. She says that because your spouse knows you so well, they can help you consider all the possibilities — including out-of-the-box opportunities.
Contributing special expertise
No matter what they do for a living, your spouse can be an extra set of eyes for any offers you’re considering. They can help you understand the details and how the terms will affect your family, says Alley-Hay. But if your spouse has relevant career expertise, that’s even better. Don’t hesitate to involve them.
For example, if your partner works in health care administration, they might have insights on productivity pay. A spouse who’s a lawyer could help with the legalese of offers and contracts. And anyone with human resources or corporate experience could help evaluate salary and benefits.
Mahan encourages physicians to ask recruiters about involving their spouse in relevant discussions. “When meeting one-on-one, I found some physicians would say, ‘It’s my husband that knows all about insurance. Can he come in here so he can ask questions?’” This is usually perfectly appropriate. Of course, in some instances she says the organization must deal only with the candidate.
“With the financials, you want to negotiate with the candidate because there are legal implications,” she points out. The physician is the one who signs the contract, not the spouse.
It’s also worth noting that too much direct spousal involvement can be considered a red flag. For example, if an attorney spouse tries to act as an intermediary, employers may get nervous. This is especially true in private practice settings. Practice partners may fear the spouse will interfere in decision-making down the road.
Facilitating your partner’s involvement
Your partner might already be over-scheduled with career and family obligations. If so, you might assume they don’t want to be involved in your job search. Given their responsibilities, they may not even complain if you exclude them. But the best advice is not to let that happen. Instead, try to find ways to involve them without adding unnecessary stress.
For example, you can take the lead on asking recruiters for information about the community. Your spouse should still attend any site visits, but you can help plan fact-finding expeditions. If your spouse hasn’t come up with a list of questions and concerns, the recruiter can make suggestions. They can even help your partner meet other spouses during your visit or reach out to them afterward.
Remember that your recruiter might hesitate to ask about your spouse or family. Unprompted, those sorts of questions can come across as intrusive or discriminatory. That’s another reason it’s important that you let the recruiter know how they can help you and your spouse.
Alley-Hay says, “It helps to have your recruiter know more about you.” Unless you share family concerns with the recruiter, they might never address them. It’s up to you as the candidate to ask.
Supporting each other
Job hunting might be exciting, but it’s also stressful, says Alley-Hay. Throw a move into the mix, and your family is going through two of life’s most stressful transitions at the same time. With a little communication and consideration, you and your spouse can help each other get through.
“You know, it’s not a bad time. It’s just a really difficult one, or it can be,” she says. “Any time we go into transition, there’s stress. So having that in mind and being very understanding of each other—possibly talking about: ‘Let’s be more understanding of each other right now’—can help alleviate stress.”
Moskowitz says maintaining regular family routines is a priority. Ideally, the job search won’t interrupt kids’ activities. Your spouse may be able to help with that, or you can work on it together.
“Schedule family fun,” he says. “Children’s needs can get lost while you and your spouse are hashing out compromises until the wee hours every night.”
Above all, remember why you and your spouse are together in the first place.
“Most doctors will say that their spouse is their best friend,” Moskowitz says. “But if they are your best friend, then you want to treat them with respect and love. And the way you do that is by communicating, being transparent and making win-win decisions.” •