Job search while in residency?

[[DPD]]

Hello SDN!

I recently had a Transitioning to Practice lecture discussing the steps we need to be taking as residents to prepare for life post-residency (all four years of residents took part in the lecture). An attending leading the lecture shared a story of a resident in our program who was able to negotiate and commit to a job during his first year of residency. The hospital then paid him a monthly stipend throughout his four years in training until he graduated.

I was wondering how common this is, and if it would be worthwhile to start reaching out to potential hospitals to see if this would be a possibility. I'm only a first year resident, so I know there is plenty of time for this, but I figured it wouldn't hurt to get some opinions on the topic. Thanks very in advance for your input!

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[FlowRate]

I feel like it's less common these days, but people have negotiated returning to specific locations in exchange for stipend/tuition payment, etc. in the past. (Supposedly my dad knew of physicians ~his age who had such a deal.) Usually it's a small/rural area with serious service needs.

 

[masterofmonkeys]

Still happens quite a bit. Just remember it's all taxable and it starts looking tremendously less sexy.

 

[hamstergang]

If they're willing to pay you for years before you actually do any work for them instead of paying someone to do work for them now, how terrible must that job be?

 

[st2205]

Some places will but as residency goes on your preferences on what you want to do or where you want to be may change. If you're pretty set on where you want to be, though, no harm in reaching out and getting an idea of the field. I signed on with a place earlier this summer (a year out).

Still happens quite a bit. Just remember it's all taxable and it starts looking tremendously less sexy.

It is but it depends on how it's written. I'd imagine most are structured like a forgivable loan so you pay taxes when it's forgiven rather than when it's dispersed. Often the money may be more valuable as a resident and not paying tax on it then may be more advantageous than later when you're making more and may need it less. However, you'll obviously be taxed at a higher rate when it's forgiven than you would if it was when it was dispersed.

If they're willing to pay you for years before you actually do any work for them instead of paying someone to do work for them now, how terrible must that job be?

Certainly possible. Though I only signed a year out, they were willing to do it up to two years out and up to three for C&A. I feel it's a strong gig (the strongest in the area), only 4 days per week, lots of benefits, pretty high pay and as long as I'm hitting minimum RVU threshold (<300/mo), you can decide how much time you spend with patients and take off as much time as you want so long as you aren't abandoning your patients or inconveniencing other doctors.

 

[masterofmonkeys]

It is but it depends on how it's written. I'd imagine most are structured like a forgivable loan so you pay taxes when it's forgiven rather than when it's dispersed. Often the money may be more valuable as a resident and not paying tax on it then may be more advantageous than later when you're making more and may need it less. However, you'll obviously be taxed at a higher rate when it's forgiven than you would if it was when it was dispersed.

Given that part of the package is also the high salary associated with working at whatever place you end up, that makes the actual salary tremendously less sexy. Speaking realistically, the people who will truly financially benefit from the above scenario are people in really rough circumstances. Like spouse and kid AND catastrophe. I've spent about 20k on healthcare costs this year as a fellow (as a single person in a low cost place FWIW) and that offer STILL isn't attractive.

 

[st2205]

Given that part of the package is also the high salary associated with working at whatever place you end up, that makes the actual salary tremendously less sexy. Speaking realistically, the people who will truly financially benefit from the above scenario are people in really rough circumstances. Like spouse and kid AND catastrophe. I've spent about 20k on healthcare costs this year as a fellow (as a single person in a low cost place FWIW) and that offer STILL isn't attractive.

Which offer are we talking about? What I'm talking about is a stipend and when it's taxed. The difference is whether you want it taxed at 25% now or 33% later. In my case, it's a swing of about $1,500.

In any case, it's all taxable income. Getting a bonus doesn't cease to be a bonus because there are associated taxes. You just have to realize there are taxes and you won't pocket the whole thing, just like any other income.

 

[masterofmonkeys]

Sorry, maybe wasn't super clear with that. What I was trying to say is that you have to be in pretty dire financial straits before defering taxation until you're in a higher tax bracket (and thus losing net income) becomes attractive.

Also, in some ways it's a lot easier to do good tax deductions when you're a resident/fellow than when you're an attending.