Part job search, part negotiation, part vision quest—choosing a practice is no easy feat, so here’s some advice to help you find your way
Ever since you were a wide-eyed pre-med mulling over which med school to attend, you’ve been faced with one momentous, life-changing decision after another. Well, guess what?—they’re still coming! And picking a practice is a pretty big one. Choosing where you’ll work is a defining moment in your career as a physician. So, no pressure or anything.
In the same way you’d assess a patient, you should gather as much evidence as possible and make a well-informed diagnosis. Just remember that making the right choice will be based just as much on your own personal values as it is on any empirical data. So, here are some questions you might want to ask yourself as you’re contemplating the next big step of your professional career.
Location, location, location
Believe it or not, the one aspect of a practice or position that seemingly has nothing to do with medicine might be the most important one to consider as you’re making the big decision. But the location you choose – and the lifestyle that location affords you – will be vital to your success. You’ll be joining a new neighbourhood or community, and you’ll be settling down there for a while. So…what are housing prices like? Can you afford a property that meets your family’s needs? If you have children, are there good schools nearby? Depending on your religious practices, it’ll be important to know if there’s a church, mosque, synagogue, or other facility in the area. If you’re married, your spouse is most likely going to need a job somewhere in the vicinity (trust us, you’re going to want both of those household incomes for the first little while). The point is, if you and your family aren’t happy with where you’re living, it’s not going to matter where you’re practicing.
Maintain the balance.
If you’ve survived med school and residency, that probably means you’ve figured out a healthy way to keep your work/life balance in check. And that’s something you’ll want to continue doing as you begin your professional career. So, think carefully about the aspects of a potential practice that will affect your day-to-day: specifically, the office hours (which can vary widely from practice to practice) and everything that happens outside of office hours. What obligations are you undertaking by joining a practice? Will you be on-call for hospitals or nursing homes, or required to teach or train? And are all these obligations shared equally between all the physicians (because sometimes they’re not)? How will you and the other physicians cover for each other on weekends, holidays and after-hours?
What kind of practice is this practice?
This might seem like a silly question to ask, but joining a practice is a big commitment, and you want to make sure that you know everything there is to know about how it operates—especially the nitty-gritty details. Like buying a car, knowing what’s going on under the hood will save you from ending up with a lemon. So, what kind of practice is it? Does it have a clientele with special needs? Does it offer obstetrics or minor surgical procedures? What kind of equipment do they have? Is it up-to-date, modern? Is the space in which it operates owned, leased, or sublet by the physicians? What kind of vibes does the space give you? (Seriously—you’re going to be spending a lot of time there and feeling comfortable in the space will play a bigger role in your satisfaction than you might think.) What kind of vibes do the staff give you, for that matter? Don’t be afraid to ask some of the most obvious questions—becomes sometimes the answers aren’t as obvious as you might think.
How you do your job.
And then, of course, there’s the small matter of how you actually practice medicine every day. During your time in residency, you’ve hopefully observed and absorbed all sorts of different ways of doing things—and have also developed some ideas about what worked for you (and what didn’t). When exploring your practice options, use the instincts you’ve honed over the course of your medical training to ask the right questions. Whether it’s the way they approach and organize their medical records, or if they follow current guidelines and evidence-based medicine, or what their policies are for things like missed appointments, sick-leave notes, and prescribing antibiotics and narcotics—you’ll want to get a clear sense of what the practice’s perspective is on the things that matter most to you.
You’ll also want to get a sense of how many patients you’ll be able (or be expected) to see in a single day, how much time you’ll have to spend with each of them, and whether or not you have any flexibility to customize your schedule. Some practices reserve time-slots throughout the day for specific types of appointments, like check-ups, counselling, or same-day calls. In addition to that, how much (and what kind of) support can you expect to get from the staff? Can you lean on them for help with clinical and administrative tasks—or will you have to be a lone wolf (which you actually might prefer)? All of these considerations will have an impact on your workday.
Don’t forget the boring stuff (aka. the important stuff).
Whether you’re joining a practice, becoming an employee, or locum'ing in some remote and beautiful locale, you’ll be undertaking the requisite legal and financial responsibilities. Which is why it’s important to do your due diligence before teaming up. Before signing an association or partnership agreement, it’s essential that you have reviewed it from top to bottom with your lawyer and accountant. Why? Because that agreement will cover all sorts of important aspects of your partnership, like how you get paid (salary vs. fee-for-service), what benefits are available (health, dental, etc.), and how businesses expenses will be shared between partners. You’ll also want to get as much clarity as possible on the practice’s financial policies – like who submits and reconciles the billings and how fees are collected – and whether or not all group members have the necessary liability insurance, office insurance, disability insurance (basically, all the insurances) so that your shared interests are adequately protected.
You should get a head start on making this decision by reaching out to the people you’ve met throughout your residency. Ask them questions. Then ask them more questions. And then surprise them with several more questions. Learn as much as you can about what their personal and professional lives are like. What did they do right? What would they have done differently? Use their experiences to guide yours. It’s important for them to know what you’re looking for, too: the reality of the situation is, many of the best opportunities won’t be publicly advertised, and will only be open to you through recommendations from people who know you.
The wider world will also influence your decision. Medical and political issues can have a big influence on where, how, and with whom you choose to work, so do your best to stay up-to-date with what’s happening in the industry.
You can also do some studying (because you’re probably not sick of studying yet). Reading and reviewing office policy documents and procedure manuals can give you a sense of how different practices operate, and which of those policies and procedures you’d like to adopt.
What should I do next?
If you have any questions about how to manage your transition from residency to practice – like, say, how to develop a solid financial plan that will help you cover the costs of setting up a business, or how to get through those first few months when income is scarce – our team of advisors is always available to help.