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January 1, 2009

Sacrifice as a Career Booster

In a perfect world, as a reward for all the hard work of medical school, you would be able to have a well-paying career with a perfectly balanced life in a fabulous community. Unfortunately, the world of medicine is not perfect. Potential employers have their dream list, too, built on their own all-too-important needs. The dichotomy of physicians’ desires for quality lifestyles against hospitals’ needs for medical services is the biggest battle non-metropolitan hospitals face. Physicians are increasingly placing more emphasis on their quality of life and limiting their availability for certain tasks. Hospitals, however, still have the same coverage needs they have always had, if not more. As the economy becomes more unpredictable, hospitals are going to have to be more particular about whom they hire. As a consequence, some physicians will find it harder to get their ideal jobs, while others are going to be rewarded better than ever.

The difference? The ones getting the great offers are going to be the ones willing to give a little.

Pediatrics is an example of a specialty that has attracted a significant number of providers who do not meet the needs of a large number of communities. A hospital recruiter emailed me this week: "Tell me what I have to do to get a pediatric candidate!" A recruiter for a multi-specialty group in North Carolina desperately needs a pediatrician who will take C-section call; after six months of looking, she still hasn’t found one. A fairly large pediatric group in Arkansas has everything in place including the patient base, but no candidates on the horizon. The problem these facilities are having is that they need someone to take call, cover deliveries and C-sections, and work full-time; yet a large percentage of candidates want to work part-time or on an all outpatient basis.

Physicians’ wants vs. employers’ needs

A random survey of 100 pediatric jobs listed with The Curare Group, Inc., found only two that had no on-call responsibilities and just two more in which the physicians were not expected to attend C-section call. A complementary survey of 100 pediatricians who were actively seeking jobs between January and October 2008 showed that 43 percent of potential candidates were interested only in outpatient-only or part-time jobs. Only 19 percent were definitely willing to take call and attend C-sections and 38 percent were unsure as to their willingness to take call or would do so under certain circumstances. While this is not entirely scientific, it does show the detachment of the workforce from community need. Regardless of the type of work the unknown 38 percent are willing to do, nearly half of active pediatric candidates are unwilling to meet the needs of 96 percent of the jobs. Because of this trend, the 19 percent of pediatricians willing to take call will see more and higher-paying offers - much higher paying, in fact. Five years ago $110,000 per year was considered a good offer for a pediatrician. Now, pediatricians who are willing to take call will get offers in excess of $160,000 per year - a gain that outpaces inflation, which has hovered at 4 to 5 percent per year during that time frame.

Family practice and internal medicine went through a similar retooling about eight years ago. More and more family physicians wanted to do strictly office work. At the same time, a significant number of internists began yearning for more regular hours and less call. The market responded to them and essentially created a new specialty, "the hospitalist." This new way of practicing has given two specialties the opportunity to work together to the benefit of both providers. It has allowed smaller communities to attract both specialties by providing the lifestyle each desire with the opportunity to maximize the strengths of their training. The downside is that more and more primary care physicians expect a hospitalist program, which makes it even harder for rural hospitals - without the means for such programs - to recruit family practitioners or internal medicine physicians. As such, "traditional" family physicians and internists have become far more valuable than they were in "pre-hospitalist" times. Financial offers for primary care providers who are willing to do both outpatient and inpatient work have skyrocketed in the last four years, and as competition for this dwindling group of doctors increases the offers will continue to increase.

Physicians’ wants vs. employers’ needs (Continued)

Nearly every specialty is experiencing a disparity of some sort between what the market needs and what the physicians want to do; the coverage needs of hospitals have not changed, but physician’s attitudes toward practicing have. Many communities in the upper-Midwest need surgeons who can handle emergency C-section calls, yet the number of surgeons willing to take those cases remains insignificant. Small communities all over the country are unable to find family physicians willing to do OB (besides the "on-call" component this brings to the job, many FPs also want no part of OB because of liability issues). These small hospitals also do not have the volume to hire an OB/GYN, so they are closing their OB departments. Between subspecialty training and doing hospitalist work, general internists have become an extremely rare commodity. General internists have seen offers go from $120,000 per year to upwards of $180,000; family physicians can now command upwards of $160,000 to $200,000 per year, depending on what services they are willing to provide and where they are willing to go. Nearly every specialty has seen offers increase similarly, for the right people.

Extra effort=extra rewards

Aside from an overall increase in salary offers, what does this mean for you when looking for a job? What it does not mean is that if you want a part-time pediatric job, you will not be able to find it; you will. What it does mean is that if you are willing to do the work others are not, you can be rewarded handsomely. When hospitals or groups are unable to attract the right candidates, they start putting better and better deals on the table to attract the skills they need. This means that if you are willing to accept more responsibility, you will find more job offers in more locations with better terms. When you are looking at changing jobs or taking your first job out of residency, give some thought to taking on what other candidates might consider to be undesirable responsibilities. Look at ways you can provide a needed service and how to exploit that in the marketplace. Think about offering to take an extra couple days of call as a regular component of your schedule, or talk to potential employers or trusted recruiting professionals about the services that are lacking in your desired area. Then find out what it will take to obtain an additional skill-set to fill one of those niches. It may be just a matter of short-term CME. If you do that, you may find out you can get a much better and more rewarding job than you expected, without having to sacrifice all that much of your lifestyle. And in the end, you’ll be closer to that "perfect world" scenario than the doctor who refused to compromise.

Dave Witte has seventeen years recruiting experience at The Curare Group, Inc., a physician recruiting firm located in Bloomington, IN. Reach him at (800) 909-4883 or

The comments in Remarks are solely those of the author and may or may not be shared by Unique Opportunities or its advertisers.

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