Marlene Grenon, M.D., associate professor of surgery at University of California, San Francisco, and adjunct professor at the International Space University, Strasbourg, France, has known since she was a teenager that she wanted to pursue aerospace medicine. Having a clear vision gave her a leg up in career planning because it narrowed her options, but even for those committed to a specific niche of medicine, there are still many choices to make.
"Listening to your gut is so important," Grenon tells her mentees at UCSF. "The environment that you work in, the team that you work with, it’s so important. You need to find the right fit."
Your gut can help you find the environment that will make your first - or next - job satisfying and rewarding. But to engage your instincts and choose well, it’s important first to ask the right questions. That means not only thoroughly examining your would-be employers but also examining yourself. Here are five important questions you may not have considered that can help you tackle important career decisions with confidence - whether you’re contemplating a specific job or just trying to decide on a practice setting.
A strong, diverse personal network is an invaluable asset in career decision-making. One key reason is that not all jobs are posted publicly; your ideal fit may come through a friend or other trusted contact, especially one you’ve worked with before.
Azra Ashraf, M.D., MPH, a plastic surgeon in private practice in Washington, D.C., recently left behind a role that wasn’t a good fit in favor of a job she found through a friend she met in residency. She believes working with contemporaries leads to a natural rapport that fosters a positive work experience. "Now I’ll work alongside friends whose personalities I already know and whose values I know I share."
Even though networking is valuable in career planning, many new physicians are unaware of its importance. After all, it’s not something you’re taught in medical school or residency, where the focus is almost entirely on academic credentials and clinical skills.
"Too many young physicians think that if I tick the right boxes, if I go to the right medical school and do the right residency, that’s enough" to set them on their way, says Andrew Cain McClary, M.D., staff physician with Grand Rounds and consulting assistant professor of pathology at Stanford University. But mentors and connections won’t materialize without effort, he says. "Success is about the hustle, too."
Networking can feel awkward to young professionals in any field, and physicians are no exception. But you don’t have to look too far to establish - or re-establish - a diverse network. In addition to friends from med school and residency, family members and undergraduate classmates can be valuable connections.
"My undergraduate friends kept me connected to the business world, helping me learn where investors see opportunities in medicine," McClary says. He began to see an intersection of technology and the "old-school" slide analysis process of pathology. This first led him to think about a move to Silicon Valley to explore startup opportunities driven by the Sand Hill Road venture capital community.
Josh Parker, M.D., a pediatrician with Pediatric Wellness Group in Redwood City, California, adds that advisers from outside your immediate circle also provide essential perspective in evaluating your career options. "Without help from people with business knowledge or more experience in medicine, it’s hard to even know what questions to ask potential employers." Understanding the implications of contract terms, for example, is easier with help from others with relevant experience.
When student loans loom large, many young physicians are tempted to pursue only those opportunities that offer the highest or most secure compensation. But after working in a role that wasn’t a match for her goals or work style, Ashraf now sees value in being more open-minded about practice settings and compensation models. In her new position, her income will be based entirely on the revenue she generates - and she is confident she’ll be happier.
"Our structure is solo practices with cost-sharing. I’ll have the autonomy to pave my own way," she says. The structure gives her the freedom to make decisions about marketing and staff additions because these costs would come out of her own revenue stream.
Financially this may seem risky, but income promises in more typical employment situations may not be realistic either, especially if they’re based on aggressive, best-case productivity goals. "What I’ve learned is that if it looks too good financially, it probably isn’t realistic," says Ashraf.
McClary also believes it’s important to be open-minded - even when considering your first job and even when loans are a concern. "The financial burden is ridiculous, but you can’t lose sight of how needed we are." If your skills are indispensable, a company that could use them might even help with the loan burden.
Rather than fighting disruptive economic trends, McClary suggests that young physicians can choose to apply their training to new medical and business models. Startup ventures that seek to transform the way healthcare is delivered - like the one McClary works for - are scooping up young physicians and expanding their options for contributing to medicine.
"The skill set you gain in medicine is so valuable. You can apply that knowledge in many settings," adds Grenon. She notes that, even for physicians who start out in a typical practice setting, there are many opportunities to switch to, for example, a pharmaceutical company or a healthcare startup down the road. "You can apply your knowledge to a completely different area."
Every job comes with expectations, both written and unwritten. It’s not uncommon for a physician learning the ropes to encounter surprises and frustrations if the rules for success aren’t clear.
"When you’re a new doctor in a large organization, your superiors will notice if, say, you’re ordering a blood test for every kid with a cough and a runny nose," Parker says. "It’s appropriate for them to question, but it’s also normal to need to learn these things" when you’re in your first job.
Parker advises those evaluating opportunities to ask how they would receive input from more experienced colleagues within an organization - and what that organization’s culture dictates about asking for help. Is it OK just to knock on a colleague’s door - or is there a more formal process? "Before accepting a position, be sure you know what you’ll be evaluated on, how feedback is delivered and how you’ll get help to improve," Parker adds.
Productivity goals are common in physician contracts, and it’s important to understand what is required to meet them. Asking about the number of patients you’ll need to see each day to meet revenue goals will help you clarify expectations - but your ability to keep pace is just one piece of the productivity puzzle. You’ll also need to be sure that enough patients are available for you to see.
"One challenge was that it was hard to attract referrals because we accepted only a handful of insurance plans," Ashraf explains. "Primary care physicians want to refer to surgeons that meet their patients’ preferences," and most patients place the ability to use their insurance at the top of the list.
When compensation is tied to revenue goals, it’s always a good idea to be sure you’ll be able to accept the health plans that are most popular among your target patients. And if the practice doesn’t already have enough overflow demand to keep you busy, you’ll also need to know what help you’ll get to attract more patients. For example, have important marketing channels such as hospital relationships and an informative website already been established?
Other aspects of the practice infrastructure - such as EHR and other technologies and the number of support staff members per physician - also contribute significantly to physicians’ ability to be fully productive. If possible, it’s helpful to meet the staff who would support you in order to gauge their commitment to growing your practice. Benchmarking data from organizations like the Medical Group Management Association is another excellent tool to help you infer how well a potential employer supports its physicians with staffing, as well as its comparative financial performance.
The pace of change in healthcare and the increasing demands placed on physicians make burnout more of a consideration than ever. Even when considering your first position, it’s not too early to think about how you’ll stay challenged, motivated and committed to medicine.
"In medical school, you’re learning all these facts," says McClary. "If all you’re going to do at work is repeat those facts, you’re going to burn out. Burnout is real."
"We’re all searching to make a difference in the world and help others," Grenon adds. A mix of activities - from practicing, to teaching, to performing research - helps her stay engaged. "When we’re doing research, we’re at the edge of science, and we have to think of new concepts. We have to be creative to find better ways to solve problems."
While Grenon’s academic post helps her stretch her intellectual muscles, physicians in large health systems and private practices can also find opportunities to grow and contribute in new ways, even if they have to look a little harder. Clinical research pairs well with private practice, for example.
Other physicians look to give back through volunteer opportunities at home or abroad. Ashraf takes an annual trip to Pakistan, where she works with a colleague to treat victims of domestic violence. The flexibility to commit time to this volunteer work was another factor that she weighed in choosing her current position.
"You become unidimensional in medical school," Ashraf says. "When you start your career, it’s your chance to go back to your original vision, to what led you to seek your degree." In addition to her volunteer commitment, for Ashraf, getting back to her original vision meant reconnecting with her interest in public policy, which led her to pursue a master’s in public health during medical school and also influenced her choice of a new practice.
McClary also notes that it’s more possible than ever to pursue multiple tracks at the same time and that variety keeps your career fresh. "Our training involves a rigid system. But your career can be flexible - there’s pharma, outpatient work, digital health. You can freelance and participate in several options."
When you’re considering options for your first job after a lengthy academic journey, your long-term career may be the last thing on your mind. But even if your future goals are yet to be determined, it’s useful to pin down some of your priorities - if only to avoid feeling stuck later on.
"Don’t forget to consider what happens when the contract ends," advises Parker. If the contract you’re evaluating doesn’t specifically discuss renewal or extension, you may not be able to stay with the practice at the end of your term. That can be a problem if the contract also includes restrictions that prohibit you from joining another organization in the same area - especially if you’ve invested a lot of time and energy creating a patient panel you are no longer allowed to serve.
Building a practice in one spot can also make it financially unattractive to start over in another community later on, which can be a big challenge if you had your heart set on settling down somewhere else.
"I recommend thinking about where you want to live and trying to find a position there, keeping in mind that there has to be enough demand for your specialty in the area," says Ashraf. Contracts that include financial perks that have to be earned out, such as loan repayments or relocation expenses tied to the contract term or revenue goals, can also make moving costly if your plans change before the terms are met.
Location may also be a factor if you’re hoping eventually to switch from a traditional practice environment to another industry such as pharmaceuticals, devices, biotech or health IT. In that case, it pays to do some research before deciding where you’ll land; your options extend beyond the best-known venture capital hubs of the Silicon Valley, Boston, New York and Los Angeles. Energy and capital for pharmaceutical research, biotech ventures and other types of healthcare startups have coalesced more recently in places like Tampa, San Diego, Houston, Austin, Nashville and the Research Triangle region of North Carolina.
And what if the job you’re considering is one you hope to stick with for the long haul? It’s important to get a close read on the practice’s own five- or 10-year plan. For example, if you’re joining a small private practice and expect you’ll prefer that environment, try to assess the practice’s commitment to staying independent.
"Smaller practices often end up selling and joining up with larger groups because a senior partner decides to retire and none of the other partners wants to deal with managing," Parker points out.
If you believe you’ll want to be a partner yourself someday, try to understand the motivations and priorities of the current partners - as well as what it would take to join them down the road. For example, would you need to buy in to become a partner? And should you think about management training along the way?
Regardless of how sure you are that the setting attracting you today is the best one for you long-term, you may find that it’s a perfect fit once you’ve started - so find out whether the organization plans to keep moving in the same direction in years to come.
A common theme shared by Ashraf, Grenon, McClary and Parker is the benefit of remaining open to a wide variety of possibilities. After so many years of studying and preparing, it’s natural to want to make the best possible choice in your first role on your own as a physician. But remember that your vision of an ideal career may change as you progress.
In many ways, there’s never been a better time to be a physician. Opportunities abound in many settings. Wherever you land in this job search, you’ll learn something to help you in your next role. The key at every stage is to consider - and be open to - your many potential options.