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Wednesday Oct 29, 2014

Moving On: Why My First Job Won't Be My Last

I never imagined that my first job after residency wouldn't work out.

As a medical student, my focus was to get through medical school and match with a good residency. During residency, I focused on learning the practice of medicine and honing my skills. It seemed a given that I would finish residency, find a private practice and live happily ever after. It didn't work out that way.

I felt that I conducted a thorough job search and did due diligence on the offer I eventually accepted. But here I am, preparing to change jobs.

Although I feel now as though I failed, in retrospect, it seems silly that I did not consider this possibility. Many physicians do not stay in their first position out of residency. In fact, job turnover among physicians in general was at a seven-year high of 6.8 percent in 2012.

There are many reasons physicians may change jobs, including compensation, moving closer to (or further away from) family, poor job fit, and even changing careers entirely. For me, it was a combination of factors that included compensation, location, issues related to raising my family and the changing health care landscape.

Compensation among family physicians is always a sticking point because no one wants to pay us what we're worth. For the past few years, average incomes for family physicians have been on the rise, according to Medical Group Management Association data. But in an individual practice, this means little. Many residents are poorly equipped to evaluate a practice's financial statements to determine their degree of solvency. Having a salary guarantee is nice, but it pays to try to look down the road to what will happen when the guarantee runs out.

Choosing a location, especially one where you have not lived before, also can be challenging. My wife and I thought we knew what we were getting into when we moved back to our home state. However, we moved to an area neither of us had lived in before. There were many complications, such as lack of available housing and a poor real estate market, along with lack of local services and goods that we frequently required. For instance, my wife makes and sells crafts online, and with no fabric shops in town, she frequently had to drive several hours to get supplies.

We also ran into problems when considering long-term plans for our children. The schools in the area had poor ratings, raising concerns for us about the education our children would receive. About a year after we moved to the area, a bond issue on the ballot to raise money for local schools failed miserably. This raised another red flag for us that the community was not vested in improving education in the area.

Finally, it seems I have fallen victim to the tumultuous health care landscape. In short, I could not make a living as a physician under current circumstances. Although I routinely saw 20 or more patients a day, I made less money in practice than I had in fellowship. This feeds back into evaluating a practice carefully beforehand, including closely examining overhead, practice management and collection rates, as well as the practice's vision for the future and adaptability.

So looking back, what did I learn from this experience? It taught me a lot about the business of medicine -- even if I learned most of it by doing things the wrong way.

It also brings to mind my high-school Latin -- temet nosce, or "know thyself." It quickly became apparent that I had not prioritized aspects of the move appropriately. Even if the job had worked out well, I do not think we would have stayed given that we felt our children's education would suffer. Had I dug a little deeper, I would have found that the last four physicians in my position also stayed only a short time.

The fact remains that we cannot have all the information before making a decision. As a mentor once told me, there is no perfect job." We must decide what aspects of our lives, both professional and personal, are most important and be flexible with the rest. Even through a bad decision, I have learned and grown professionally, and I hope to translate that experience to a better fit for me and my family in our next adventure.

If you find yourself in a similar situation, the AAFP has online resources related to helping family physicians plan their careers and succeed in landing the right jobs.

Peter Rippey, M.D., is working locums while transitioning from private practice to a hospital-employed position.

Posted at 10:01AM Oct 29, 2014 by Peter Rippey, M.D.

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