Job options after residency

[Fission Chips]

I will be starting my internship this summer in a large mid-west city. My wife is ~2 years behind me in training, and will be pursuing her (long) PhD. Assuming I have 2 years after I graduate and would like to stay in the same city (or nearby), what options do I have for contract negotiations? She will be looking at post-doc positions after she graduates, which will likely have us re-locate after the 2 years... which I am fine with because she has given up quite a lot for me to pursue my passion and I feel like it is time to repay her. I could care less where we finally end up, and I am very flexible with location. Unfortunately, it sounds like she won’t know where her post-doc will be until her final year.

A few questions I have right now:

1. Is anywhere going to hire me if they know I may be (likely) moving away in 2 years? Along those lines, I feel like it would be disingenuous to not tell them up front, but I also need a job after residency to pay back loans (320k today)

2. Should I look into hospital employed? Locums around the city? I feel like PP is out of the question up front.

3. I could be interested in pursuing a fellowship, but it isn’t a must. I love general Urology just as much as recon and onc (both offered at my program). Do programs ever take their own residents for fellowship? Is this program dependent?

4. Knowing I would like to stay in the same city for a couple years, when should I start thinking about talking to potential employers?

5. Is there any benefit or downside (in terms of future contract negotiations) to being employed by a hospital (or locums) for a couple years before applying to jobs in another city? I'm not set on private/group practice, but I would like to keep my options open. I would think those years would let me get my workflow optimized and get a sense of what sort of RVUs/year I generate, which may be desirable for future groups. Am I thinking about that correctly, or are there downsides I am not considering?

Any recommendations on how and when to navigate this would be appreciated.

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[cpants]

A little early to start worrying about it, but good to think ahead.

So if I understand the situation, you know that you will need to be in the large-midwest city where you are now for at least 2 years after residency, but will most likely move after 2 years.

PP is probably out of the question if you are on a 2 year timeframe. Most often PP means you will take a low salary for the first 2-3 years before becoming partner. Hospital employed is likely the best option for your first job for this reason. Luckily, there will be many options in a large midwest city and surroundings who would be thrilled to get a young general urologist. You will learn the lay of the land with regard to local hospitals and practices during residency just by being around. This will be your list of people to talk to when the time comes.

I would not go into it telling them any more than necessary about your plan to leave in 2 years. This weakens your negotiating position significantly in 2 ways. First, they know you are stuck in this city for 2 years and might accept a lowball offer. Second, they know you are a temporary solution for them making other candidates more attractive. My messaging would be vague--that you really enjoyed training in the area and you are looking elsewhere in state and region but you are really interested in their practice because of x, y, z factors. If they ask about your wife, just says she will be looking for postdoc positions locally in 2 years. They probably aren't going to dig into this much at all. Urology attending interviews are more like you interviewing them about why you should consider their job. I know that's hard to understand just coming out of the residency interview meatgrinder.

Locums also a potentially good option, but I would try to go somewhere stable for a few years. First years of attendinghood are still learning years and you don't want to spend them flying all over the country to less desirable locations and seeing whatever crap they dump on you. Locums tend to get dumped on in my experience.

I wouldn't worry about talking to anyone until end of PGY3 at the earliest. Goal would be to be signing at end of PGY 4/beginning of 5, hopefully with a fat signing bonus to throw at the loans.

Hope this helps.

 

[DoctwoB]

Agree with most of above. Hospital employed will probably be your best bet and I would NOT tell them your plans to potentially move on in two years. I acknowledge and respect the inclination to be up front and truthful, but keep in mind that they typically employ you at will, meaning with adequate (eg 90 days) Notice they can fire you for any reason, as some are sadly finding out now in the midst of COVID. Likewise you are free to do the same with adequate notice, though make sure you look through any contract carefully (have a lawyer review it) to make sure there are no repayments of signing bonus or anything like that.

I will disagree somewhat in that private practice isn’t totally off the table. Here I would be more up front, since you’re not angling for a partnership, and as such would want to structure your compensation to get more up front and not pay for equity in the practice. And when you do leave town if you’re not up front you wouldn’t be walking out on a Giant hospital corporation but your peers/future partners. Now most PPs looking to expand would rather have someone permenant, but maybe the market is tight enough that they’d rather have you for two years then not at all. Or maybe there are uncertainties ahead and they like the idea of having another urologist who is not a partner (for example if they’re considering selling the practice).

The good news is as a general urologist you are very much in demand. If you are looking anywhere outside of a very few saturated areas I forsee very few issues in landing the job you want.

 

[cpants]

Locums should be off the table because you won't be able to get board certified. ABU requires that you practice within one community for 16 months consecutively to apply for board certification. Certification is definitely something you want to achieve during the first 2 years.

 

[Fission Chips]

Thank you for the advice, I really appreciate it.