How I Got the Career I Wanted:
Family Physicians Share Their Stories

Drs. Ravi Grivois-Shah, Beth Loney, and Michael Oller describe how planning for the practices they wanted helped them recognize and choose the opportunities that matched each of their visions.

Dr. Beth Loney and Dr. Michael Oller approached rural medicine as a married couple. They own their practice, Solomon Valley Family Medicine in Stockton, a rural community in Northwest Kansas. Opened in September 2011, their practice provides full-scope family medicine including OB, ER, and inpatient medicine.

Dr. Ravi Grivois-Shah is employed by Cook County Health & Hospitals System, one of the largest local, government-run health systems in the nation. Its ambulatory network of community health centers has locations throughout the Cook County, Illinois. Dr. Grivois-Shah has focused his work in Cicero, a predominantly Latino community immediately west of Chicago. He is also the AAFP New Physician Board member.

How did you structure your search for a practice? What criteria were important to you?

Grivois-Shah: "My search for a career after residency was very specific. I knew that I wanted to practice full-spectrum family medicine, including OB, and work with underserved Latino communities in urban Chicago. This limited me a lot to practice opportunities. For example, in the Chicago area, few if any family physicians in private sector deliver babies. This is reserved mostly for residency faculty and FQHC/public practices. So I focused my search on the latter."

Loney/Oller: "It was very important to be able to have input into the delivery of patient care in our practice. Starting our own practice made the most sense. This was made easier by the fact that the rural environment was important to us as well. The balance between work and family was perhaps the most important factor in the search."

How did you identify practice opportunities? What is your advice for a resident who is about to begin this process?

Grivois-Shah: "I contacted a number of FQHC's (federally-qualified health centers) in Chicago that met my criteria. But in the end, it was my involvement with the Illinois Academy of Family Physicians (AFP) that led to the position I actually took and still hold four years later. I contacted our Illinois AFP executive vice president to see if he knew of folks that might have any opportunities I sought, and he connected me with one of the directors for Cook County's ambulatory system who was a former Illinois AFP board member."

Loney/Oller: "It was a community that Beth spent two months in during medical school rotations, and thus had made contacts with the local physicians. When she started residency, the community asked if she would be interested in practicing there. They were considering building a new medical clinic, but thought that they would need two new medical providers to make it a feasible action. Our process was probably a little atypical, but we think it proves that sometimes it is in fact 'who you know and not what you know.' We would encourage residents who are starting the process to make a personal contact in the medical community in which you would like to practice."

When did you begin your search for practice opportunities?

Grivois-Shah: "I think I began in earnest around March of my third-year in residency."

Loney/Oller: "Beth's search was over before it began. She was offered a job the first year during residency. Michael contemplated some different options for practice, and started in the second half of his second year of residency. However, once we became engaged, it was clear that we would be going to the same place. Luckily, Stockton was that place!"

Do you have tips for negotiating your complete compensation package? Are there crucial items to include or avoid?

Grivois-Shah: "There really wasn't any negotiation in the opportunity I accepted, so I don't have any specific advice."

Loney/Oller: "Put your happiness first. Whether that's call, or money, or skiing. There will be some give and take, but make sure you know what makes you happy before you start the negotiations."

What is your scope of practice? How important was practice scope in choosing a practice?

Grivois-Shah: "I deliver, see children and adults, lead an adolescent clinic, supervise residents in the wards, perform office procedures from colposcopy to skin biopsies, and used to staff an HIV clinic and precept residents. The scope of practice was very important to me leaving residency. I felt that if I didn't to everything as an attending upon graduation, I'd never do some of those things. I chose my employer mostly based on scope of practice opportunities."

Loney/Oller: "We currently have a full-spectrum practice. It was important for us to be able to do the things we were trained to do in residency. There are some limitations, however. Our residency had high-risk obstetrics and an open ICU. Currently, we practice in a 18-bed critical access hospital, 26 miles from a busy obstetrics practice and ICU. We treat patients of all ages, cover the ER, round on our own patients in the hospital, deliver babies, do C-sections, and Mike does colonoscopies. We do many in-office procedures as well, such as colposcopies, IUD insertion, laceration repair, skin biopsies, and joint injections."

What has been the biggest surprise you've encountered now that you're in your current practice?

Grivois-Shah: "The volume of outpatient visits is so much more when you're in practice as an attending than in residency. I'm seeing so many more patients in a week. As a result, there are so many more 'positives' that come up with screenings and rule-outs which keep things interesting!"

Loney/Oller: "How challenging running a private practice is on the business side. Keeping up with meaningful use, being involved in several quality-improvement programs and keeping up with standard bookkeeping have proven to be difficult, but doable challenges."

What advantages or disadvantages are unique to your specific practice choice?

Grivois-Shah: "The urban setting has a lot of challenges. Low-income patient populations often have limited access to fresh fruits and vegetables, for example, or don't have safe streets to walk and get some exercise. This makes lifestyle modifications very difficult! But there are a large number of community and public health groups and organizations that help provide resources to my practice, and my patients and their families. This helps mitigate some of the challenges."

Loney/Oller: "After practicing in an urban environment with specialists readily available, it has been a change to have the closest specialists 45 minutes away. This really challenges you to know what you are comfortable with handling, and when the patient will be better served by a referral. You also have to be ready to handle whatever comes in the ER door, and be capable of stabilizing the patient and making the quick decision on whether or not the patient needs a higher level of care. In a small community, you see your patients everywhere -- the grocery store, taking a walk around town, eating lunch. This can be a challenge at times, but it is also rewarding to truly be part of a community. You get to know your patients, to know the struggles they are having outside of your office, and to see how these struggles impact their lives and their health. We have the chance to take part in community activities and show our commitment to it and to our patients."