Are you unhappy with your current job and thinking about making a change? Or are you about to begin looking for your first job? Does the thought of a job hunt fill you with dread? Job changes provoke anxiety, regardless of whether you have been practicing for decades or have just completed your residency. There are many factors to consider and many decisions to make. But if it’s done right, the process can be systematic, and the result will be a happier you. In this article, I’ll discuss what makes physicians want to leave a practice, how to identify your key issues, how to find practice opportunities and how to evaluate whether a practice is right for you.

Why do physicians leave?

A variety of complex issues play into a physician’s decision to leave a practice; however, four factors seem to affect physician job satisfaction the most:

1. Patients, cases and career choices. There are, of course, many differences among family physicians. Some prefer treating patients in particular socioeconomic groups or ethnicities; others prefer focusing on patients of certain ages or with particular health conditions; and still others prefer performing obstetrical and surgical procedures. In addition, some family physicians prefer to include teaching as part of their career, some wish for added administrative or supervisory responsibilities, and some prefer to leave those tasks to others.

2. Culture and colleagues. Researchers have found that administrative issues and professional conflicts are two of the biggest reasons physicians leave a practice. The preferred practice culture would be one that provides physicians with clinical autonomy and control over their work environment.¹

3. Location and lifestyle. While some physicians are willing and able to relocate just about anywhere, many physicians (and their families) have strong feelings about location. Being too far away from (or too close to) family and friends may be a source of dissatisfaction. In addition, different communities offer different lifestyles. For example, practicing in a rural setting might be a shock to a city slicker, or vice versa.

4. Compensation. While compensation is not the most important factor attracting physicians to a practice, low compensation can be the reason they leave. One researcher found that physicians with lower incomes were more likely to become less satisfied, although those with increased incomes did not become more satisfied over time.² National surveys estimate family physician compensation at around $140,000 per year, but that may mask local conditions. Compensation varies both within and among local markets, depending on physician supply and demand, socioeconomics, cost of living and other factors.

Identifying your key issues

The main objective of any job search should be to find a practice that lets you achieve balance in both your professional and personal lives. The three pencil-and-paper exercises in “Identifying your key job issues” will help you identify your key issues for finding the right practice.

After completing these three exercises, review your responses. Identify the key issues that would make a practice a good or bad fit for you. What must the practice and community offer? What do you want to avoid? Most physicians come up with five to 10 key issues. Keep referring to your key issues as you evaluate prospective opportunities.

Finding practice opportunities

With your key issues in mind, it’s time to identify practices that match well with your preferences. I’ve identified five steps you should take to find the right practice for you.

1. Do your homework. Whether you plan a major or minor job move, learning about different types of practices will reduce your risk of an unhappy experience. Talk with physicians who work in a variety of practice settings, and ask them what they like and don’t like. If possible, visit a practice and shadow one of the physicians during a typical day. Ask plenty of questions, and keep your eyes and ears open.

2. Polish your curriculum vitae (CV). Your CV should not simply provide a long list of your achievements; it should begin with a few sentences summarizing your professional abilities and experiences, your career goals, and the type of opportunity you seek. This will help the person reading your CV quickly decide whether you might be a good candidate for the position. Customizing your CV for specific practice opportunities can help you get noticed, too.

Organize the rest of your information with section headings in a slightly larger, bolder font to make it easy to scan visually. Common section headings include education, credentials, skills, experience, publications, committees and presentations. Within each section, list your information in reverse chronological order.

You can include information about your interests outside of medicine, too. Although not essential, such information can be an effective conversation starter.

Your curriculum vitae should not resemble a PhD dissertation in terms of length or format. A one- or two-page CV is usually sufficient, but if you have worked in many practices or have published extensively, you might need another page or two.

3. Take charge. Keep these three C’s of job hunting in mind as you identify and evaluate practice opportunities:

• Control: The people recruiting you have an agenda. To avoid being pushed into a bad career move, assert some control over the process by sticking to your key issues, which you identified earlier.

• Courtesy: Although the process can be frustrating at times, being courteous to everyone you interact with opens doors. Rudeness locks them. You never know who individuals know or when your paths might cross again.

• Common sense: Don’t ignore your instincts. If a deal sounds too good to be true, it probably is.

4. Don’t believe everything recruiters tell you. Many employers do their own recruiting, often using in-house recruiters. Others retain independent physician recruiting firms to refer candidates for vacant positions. The quality of in-house and independent recruiters varies greatly. Some carefully match physicians with practice opportunities, while others are not as conscientious.

Independent physician recruiting firms typically charge employers fees of $20,000 or more per position. The possibility of a hefty commission can be a strong incentive to work aggressively to close the deal with a physician candidate. Don’t rely on a recruiter’s representation of the perfect job. Evaluate each opportunity independently, and measure it against your key issues.

5. Uncover your own opportunities. The most reliable way of finding a practice opportunity is through word of mouth. Don’t be shy about contacting current and former colleagues and acquaintances for leads. A few minutes on the phone can be very productive. Even if the person you are speaking with cannot help, ask whether he or she can refer you to someone who might have useful information about practice opportunities.

You can also contact potential employers directly to learn about their open positions. Some post vacancies on their Web sites. Many professional journals, as well as dozens of Web sites, carry classified advertisements that recruit physicians. When visiting Web sites, remember that any information you enter may be shared with physician recruiters and others. When attending professional conferences, check out the jobs book or jobs board.

The AAFP has a placement service to match physicians with practice opportunities. Although recruiters place many listings, physicians can review them quickly and anonymously. You can learn more online at http://www.aafpcareerlink.org/.

Evaluating a practice

Be ready to talk to potential employers before your phone starts ringing. Both your initial discussions and your site visit (if those discussions go well) play an important role in your evaluation of a practice.

Holding initial discussions. When you hear from a practice’s representative, arrange a mutually convenient time to learn more by telephone or, if nearby, in person. Open with, “Tell me about your practice,” and listen carefully to the response. What does the practice’s representative talk about first? What does he or she emphasize? What does he or she mention in passing, if at all? Keep in mind that the representative is probably presenting the practice in the best light.

As your discussion progresses, ask questions about the type of work you might be doing, the practice’s history and why it is recruiting. Learn about the community. Most important, ask about the key issues (identified earlier) that might make the opportunity a good or bad fit for you.

Compensation is a delicate issue. There’s no point agreeing to travel for an interview only to learn that the position pays significantly less than you are willing to accept. Ideally, the practice’s representative will volunteer compensation information. If not, you can bring it up by saying, “Tell me about this position’s compensation package.” Don’t fall for the trick question, “How much you would like to earn?” The practice’s representative is probably trying to get you to quote a figure lower than the amount the practice is willing to pay. Respond that you would like to be paid fairly for the work you will be doing, considering your experience and local market conditions.

Visiting the practice. Work with your host on an itinerary that enables you to gather the information you will need to make a sound decision. Refer to your key issues outline. Try to visit for at least two days, or plan to come back for a second look. If you are married or in a committed relationship, bring your spouse or partner along. Hearing other perspectives can be valuable, and his or her satisfaction with your potential new job and community is important.

Meet the physicians you will be working with in the practice, as well as key practice staff. While being wined and dined is enjoyable, you will learn much more if you also observe practice operations. Try to spend time with the physicians individually. Imagine them as your colleagues. Ask if you can shadow a physician to see what the work is like.

If possible, talk privately with physicians in positions similar to the one you are considering. Alternatively, exchange phone numbers and e-mail addresses. How do they like working there? How long have they been with the practice? Why have other physicians left? A high rate of physician turnover suggests an inhospitable practice.

Your visit should also include a tour of the hospital and other locations where the physicians practice. Talk to as many people as you can, including prospective referral sources, family physicians and physicians in other specialties. Do you sense a welcoming, collegial atmosphere, or are you getting a chilly reception? Mention the practice opportunity to everyone you meet. Do they respond positively, or are they circumspect, possibly indicating that the practice’s reputation is less than stellar?

As your discussions progress, learn what your duties and schedule would be. Understand how the practice’s compensation system works and how much you might earn. Ask how you will build your practice, especially if your productivity will affect your compensation.

If you’re considering a position with a private practice, ask about future partnership or shareholder status. While neither you nor the practice’s owners will promise this, you should have an idea of what such a deal might look like. When would you be eligible to buy into the practice? What would you be buying? How much might it cost? How would you pay for it?

Be aware that hospitals and health systems frequently offer physicians financial incentives to join an existing independent practice or to start a new practice. Although typically presented as an income or collections guarantee, incentives are really a loan guaranteed by the physician. Each month during the one- or two-year guarantee period when the physician earns or collects less than the guarantee amount, the hospital writes a check to make up the difference. At the end of the guarantee period, the physician repays the loan or, to have it forgiven, continues practicing in the area. Among other things, federal Stark II laws state that the practice may not enforce a restrictive covenant during the repayment period. While such incentives can be beneficial, don’t rely on them to hold together a bad deal.

Your final decision

After you’ve made your site visits, it’s time to reflect and make your decision. Compare what you have learned about the practice opportunity with your key issues outline. Too many inconsistencies increase the risk of a bad fit.

It may help to imagine yourself in the practice. Can you see yourself doing the work alongside your colleagues and within the practice’s culture? Can you envision your career path? Can you see yourself living in the community? Will you be fairly compensated?

Take the time to think things over and decide whether you would like to pursue the practice opportunity or whether you should walk away. Neither decision is easy, but you should pick the one that, above all else, makes you happy.