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Tuesday Nov 24, 2015

Moving On: Finding the Right Job Worth the Effort

Starting over is scary.

After surviving college, medical school and residency -- and the many moves and transitions that come with those stages of our training -- the last thing we want is more upheaval. We finally have some stability, more income and something resembling a routine. We make connections with colleagues and build a patient panel.

So when things aren't ideal and payers and others are making life difficult, physicians often stick it out. We feel obligations to our communities, our practices and our patients.

But sometimes, we have to go. We have to do what is best for our careers and our families.

And sometimes you have to follow your heart.

In August, I moved from Reno, Nev., to the Seattle area, leaving behind the community where I had completed medical school, residency and then practiced for four years. I delivered babies in residency and had those families follow me into private practice. I developed relationships not only with my patients but also the medical community in my city and state. I built a reputation in the community. I knew the payers, the specialists and the layout of the community hospitals. I had a safety net and a village of medical support at my fingertips should I experience a difficult case.

In Seattle, I knew my new husband and … hardly anyone else. I knew nothing of the medical community or culture in this area. I had no local colleagues to vouch for my abilities as a physician. I now had to re-establish myself and my practice and go through the process of figuring out what type of practice would suit me.

So how do you find not only a job but the right job? I knew the change was coming, so when I attended AAFP events -- such as the Congress of Delegates or the National Conference of Constituency Leaders -- I sought out the Washington delegates, told them about the move I was pondering and asked about potential employers I should look at it. I also reached out to a few old med school and residency friends who had relocated here for advice on local groups they worked with.

That meant my job search was based on networking and informed opinions rather than random Internet searches and the biased opinions of recruiters. I visited many clinics, spoke to many employees of all ranks within those teams, and in the end I found a place that fits how I practice and has a better flow, organizational goal and payer mix than the practice I left.

Keeping an open mind helps, too. At my old practice, I had a dedicated medical assistant (MA). We had a traditional system where patients checked in at the front desk and then had a seat in the waiting room. In my new practice, the MAs rotate among the physicians, and patients are checked in directly to rooms. There were other changes to adapt to, including how we handle referrals and phone triage. But ultimately, patient flow is improved and everyone on our staff works to the highest level of their training. That's a refreshing change that allows me to spend more of my time with patients.

Starting over, of course, brings new challenges. I'm building a new patient panel and starting new relationships. I'm learning a new set of subspecialists for when my patients need care that I can't provide. I rely more on my colleagues to ensure I am performing tasks in the right flow for this clinic. I’m learning a new electronic health record (EHR) system while still having to perform meaningful use measures.

There also were numerous hoops to jump through. I had to find my transcripts from medical school and the U.S. Medical Licensing Examination to go through the Washington state medical boards to obtain my new license. I needed signatures from the residency and hospitals where I had privileges in Nevada. I needed to go through orientation again and EHR training.

There were numerous tedious steps to get through in the credentialing process, and I have to prove myself again in the privileging process.

I learned through this process that moving in general is a stressful time, but finding and establishing a new practice has its own set of stressors. Many of them are logistical -- licensing and finding a good fit for what you want in a practice. I found that using a spreadsheet to compare each practice helped me visualize what each clinic offered in terms of payers, practice type, EHR, etc. Although it was tiring at times, I was able to obtain a great amount of knowledge on the culture and relationships of each practice by approaching and talking with all members of the teams.

I also realized that I was not a physician fresh out of residency and therefore was able to negotiate compensation differently than I did four years ago.

Moving across state lines can be challenging for physicians, but it can be done. And you might just find a better life on the other side.

Helen Gray, M.D., is an employed family physician in Kirkland, Wash., working in a regional medical center.

Posted at 03:02PM Nov 24, 2015 by Helen Gray, M.D.

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