8 steps physicians can take when deciding where to practice

The foundation for a joyful career in medicine is practicing in a positive and supportive environment. However, the wrong fit can lead to physician burnout and disruptive job changes. Resident and fellow physicians close to completing their training may feel overwhelmed when evaluating potential job prospects. Knowing how to identify and evaluate job opportunities can empower physicians to find jobs that match their priorities. 

“There are things that we can as individuals control that contribute to burnout, but the job search allows you to do your best to find a place that's going to support you as a professional and as a physician and as a human being who wants to be satisfied and happy,” said AMA member Alexandra Ristow, MD, the lead primary care physician at Patina, an in-home and virtual care primary care practice for seniors in Pennsylvania. “You're going to spend most of your week at the job, and making sure it's at a place that matches your values and allows you to thrive is important.”

Physicians can learn how to identify and evaluate potential job opportunities through an AMA STEPS Forward^® toolkit that provides a list of key steps to help physicians find jobs that match their priorities. 

Before beginning the search, physicians should take a step back to think about their priorities, such as location, schedule, practice size, compensation and patient population.

“New physicians may have a little bit of a disadvantage because you’re used to this mentality of ‘somebody let me into med school please, I need to match,’” said Dr. Ristow, who is the author of this toolkit. “The key is really to stop and think about the different realms you might have control over.” 

This is particularly important as more doctors opt for hospital employment over private practice. Hospitals’ employment contracts can often determine whether doctors feel they have fulfilled the dreams that drove them to the profession, said Elizabeth A. Snelson, president of Legal Counsel for the Medical Staff PLLC, which specializes in working with medical staffs, medical societies and medical staff professionals.

Snelson is the author of the AMA Physicians’ Guide to Hospital Employment Contracts (PDF), free for AMA members, which provides expert guidance to physicians contemplating, entering into or working under employment contracts with hospitals or related entities.

“Hospital employment is a very different animal because hospitals can have doctors do things differently,” she said. “This is a new age in the practice of medicine.”

Most physicians complete their training in a landscape dominated by large medical organizations and fee-for-service models. However, there are other options out there, which is why it is important for doctors to explore practice options. 

“Coming from residency, I was in a big multi-specialty academic center and that’s really all I had known,” said Dr. Ristow. “I knew a few words that I could use to identify how you would describe different practice settings, but I didn’t really understand what it would mean for the physician and the day-to-day life to work in these different practice settings.”

Dive deeper:

• Physician employee, partner or owner? 3 paths for young doctors
• Young doctors should know pros, cons of these 4 practice settings
• To succeed in your physician job search, first learn the process
• Employer’s vision can make or break your first physician job

With top priorities in hand and a preferred practice environment chosen, physicians can begin their search for specific positions.

“The main thing is to try not to let yourself get overwhelmed,” said Dr. Ristow, adding that it is important not to “have too many leads going all at once where it becomes overwhelming to evaluate and narrow it down.”

The AMA offers a number of tools and resources that can help you map your future as a physician, including offering insight on employment contracts and a list of positions from employers around the United States and beyond. Your peers and attending physicians can also provide some insight as you begin to plan your career path.

As physicians begin to narrow down their job opportunities, it is important to have in-depth conversations with practice managers and medical directors about support and quality of life.

“There’s a wide range of how practices work, how they view physicians or how the physicians within the practice function,” said Dr. Ristow. “Trying to get an understanding of what thought has been put into the support around the physician can be tricky.”

“It’s probably one of the most important pieces as far as evaluating what your day-to-day life is,” she said.

Get tips on your transition to practice

Make your transition from resident to attending physician seamless with expert advice.

Subscribe Now

An important aspect of a physician’s work-life balance is the role of the electronic health record (EHR). Physicians should discuss EHR usability and satisfaction with employees during the interview.

“Make sure that there is support around the electronic health record—support for you to be trained effectively and ideally support for some of your documentation,” said Dr. Ristow. 

The AMA offers career planning resources about evaluating a prospective employer, including technology use.

It can be difficult to evaluate a workplace’s culture, but it will play a pivotal role in a physician’s daily interactions. 

“As opposed to saying, ‘What is the culture around decision making in your clinic?’ you can say, ‘Can you give me an example of a new policy that was recently implemented and how that decision was made?’” said Dr. Ristow. “You’re asking for something very specific that will give you some insight into the culture.”

An important part of any job is the compensation. However, one number may not tell the whole story. For example, a position with a higher salary may pay less per hour after factoring in long practice hours, poor support and a clunky EHR. 

“It’s important to look deep into the details and make sure the bonuses or the production requirements are based on something reasonable,” said Dr. Ristow.

Dive deeper:

• It matters how your practice is paid. A primer for young doctors.
• Finding the right physician job means finding the right community
• What to ask when physician employers start talking compensation
• Red flags, must-haves for young doctors in contract negotiations

With an offer on the table, it is important for physicians to review and negotiate their employment contracts based on their priorities before making a final decision. Learn more about what to do before you sign.

But it’s just as important for every physician to hire a lawyer to scrutinize their employment contract—and not just any lawyer.

“Employment law is tricky, and representing physicians complicates it even further because physicians are so highly regulated for things that other employees are not,” Snelson said. “Your lawyer needs to be someone who does physician employment contracts.”

Retaining an attorney experienced in handling physician employment agreements can not only help you avoid land mines in individual contracts; it can also help you choose between competing offers.

For starters, an experienced attorney may know a great deal about the employer’s local health care market and your prospective employer. Depending on the size of the employer, the attorney may have previously reviewed and negotiated employment agreements for other physician clients involving the same employer.

In addition, the attorney may be able to give you insight into some of the questions you have regarding the employer and market. For example, your attorney may be able to give you a good sense of the employer’s reputation for quality in the community, competence, stability of its leadership and how it treats its physicians. This could prove invaluable to understanding whether the prospective employer would be a good fit for you.

“Never try to do this on your own,” Snelson said.