Peds career uncertainty

[Chemical X]

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I've been coming to this website (under a couple different names) since my premed years...haven't been on in awhile. I know in the past there were more pre-med/med students that frequented these boards than attendings, but I'm hoping there are some peds people here that can give me some insight. I apologize in advance for the lengthy post.

I guess I've come to a crossroads in my career, and I'm not sure which way to go (or even how to decide). I finished residency almost 2 years ago. I haven't loved medicine since I started my clinical years, to be honest, and residency was often a struggle- I just started to feel increasingly disillusioned with the reality of a medical career and the idea that I was really "helping" anybody, and resentful of the huge debt and time commitments (which also made it difficult to pursue anything else). I actually really do enjoy many aspects of patient care and medicine, particularly education of patients and public health/prevention. That is why I went into pediatrics in the first place. I just feel like the actual practice of medicine often sucks the joy out of these interactions through paperwork, bureaucracy, long hours, ridiculous expectations, compensation not proportionate to the work we do...etc.

I managed to get through residency (I actually did quite well, although I was miserable at least 75% of the time), and got a job back in my home city doing primarily outpatient work, which I much prefer to inpatient. I signed a 2 year contract with a practice, with the expectation that at the end of it I would join as a partner. Along the way, I got married and recently had a child. I felt relieved to find a job with a good practice in my home city, where my husband and I want to settle down. I started at 4 days a week, but cut down to 3 (plus call) after the birth of my child.

In many ways, I feel very lucky to have a job that is mostly what I was looking for (outpatient, "part time" although of course in medicine 3 days/wk still = >40 hrs/wk), and in the place I want to be. The practice I've joined is a good one, but even when I started I had doubts about partnership. It is a huge financial and career commitment, and although I have a decent working relationship with the other pediatricians in the group I do not feel that I really fit in with them. They are all much older and at a different place in their lives and careers, and although I'm not treated badly I am not given the same respect or autonomy they afford each other and am not optimistic this will change as a partner. My pay would switch to straight productivity as a partner, and it has become clear that due to the financial structure of the group it will be hard to make what I do as a salaried employee if I stay 3 days/wk (I don't want to increase my hours until my child is much older, and we may have another). I also really dislike the business side of running a practice, which of course I would need to be much more involved in as a partner.

At a deeper level, I'm also not sure I am satisfied being a PCP- my passion, as much as I have any left in medicine, is really for adolescent and in particular reproductive health. I did not pursue fellowship because a. 3 more years and b. aforementioned student debt and c. 3 more years?! However, I find myself considering this option more as I face the prospect of partnership and thinking about what I really care about. Unfortunately, I would have to move out of state to pursue fellowship, uprooting my family. I am also not sure what I would ultimately do when I finish fellowship (assuming I get in- I would only apply to one program in the state nearest to me, so I could be within driving distance of family). I do not really like the academic hospital environment. I guess my dream job would be in some type of public health setting, ideally an adolescent health center, school health clinic, or similar where I could practice clinical work primarily but have some involvement in educational and/or public health programs also. I feel like adolescent fellowship would make me a better candidate for that type of job, but it's not like those open up all that often anyway. So I would be taking a huge pay cut, moving my family hundreds of miles, and forcing my spouse to leave their job, all for a totally uncertain future.

I've been searching job listings, hoping something that is at least a better fit (maybe a public health clinic job?) will open up in my city so I can find more career satisfaction without such a dramatic step, but no luck so far. Another part of me feels I should just suck it up and be grateful for a stable job, and join as a partner at the end of the year. I don't hate my job, and it allows me some level of work-life balance. I also worry about the ramifications for my career if I turn down partnership- I'm not sure how this will be viewed. I feel deeply conflicted, and did not expect to have this level of uncertainty after finishing residency. I hoped things would just fall into place and I would love my practice, but that clearly hasn't happened. It's obviously better than residency, but I'm still not happy and I'm not sure if I should just accept that and go with the stable choice (partnership) or turn it down, either for fellowship or the hope of something better for me that hasn't come along yet.

 

[Perrotfish]

I've been coming to this website (under a couple different names) since my premed years...haven't been on in awhile. I know in the past there were more pre-med/med students that frequented these boards than attendings, but I'm hoping there are some peds people here that can give me some insight. I apologize in advance for the lengthy post.

I guess I've come to a crossroads in my career, and I'm not sure which way to go (or even how to decide). I finished residency almost 2 years ago. I haven't loved medicine since I started my clinical years, to be honest, and residency was often a struggle- I just started to feel increasingly disillusioned with the reality of a medical career and the idea that I was really "helping" anybody, and resentful of the huge debt and time commitments (which also made it difficult to pursue anything else). I actually really do enjoy many aspects of patient care and medicine, particularly education of patients and public health/prevention. That is why I went into pediatrics in the first place. I just feel like the actual practice of medicine often sucks the joy out of these interactions through paperwork, bureaucracy, long hours, ridiculous expectations, compensation not proportionate to the work we do...etc.

I managed to get through residency (I actually did quite well, although I was miserable at least 75% of the time), and got a job back in my home city doing primarily outpatient work, which I much prefer to inpatient. I signed a 2 year contract with a practice, with the expectation that at the end of it I would join as a partner. Along the way, I got married and recently had a child. I felt relieved to find a job with a good practice in my home city, where my husband and I want to settle down. I started at 4 days a week, but cut down to 3 (plus call) after the birth of my child.

In many ways, I feel very lucky to have a job that is mostly what I was looking for (outpatient, "part time" although of course in medicine 3 days/wk still = >40 hrs/wk), and in the place I want to be. The practice I've joined is a good one, but even when I started I had doubts about partnership. It is a huge financial and career commitment, and although I have a decent working relationship with the other pediatricians in the group I do not feel that I really fit in with them. They are all much older and at a different place in their lives and careers, and although I'm not treated badly I am not given the same respect or autonomy they afford each other and am not optimistic this will change as a partner. My pay would switch to straight productivity as a partner, and it has become clear that due to the financial structure of the group it will be hard to make what I do as a salaried employee if I stay 3 days/wk (I don't want to increase my hours until my child is much older, and we may have another). I also really dislike the business side of running a practice, which of course I would need to be much more involved in as a partner.

At a deeper level, I'm also not sure I am satisfied being a PCP- my passion, as much as I have any left in medicine, is really for adolescent and in particular reproductive health. I did not pursue fellowship because a. 3 more years and b. aforementioned student debt and c. 3 more years?! However, I find myself considering this option more as I face the prospect of partnership and thinking about what I really care about. Unfortunately, I would have to move out of state to pursue fellowship, uprooting my family. I am also not sure what I would ultimately do when I finish fellowship (assuming I get in- I would only apply to one program in the state nearest to me, so I could be within driving distance of family). I do not really like the academic hospital environment. I guess my dream job would be in some type of public health setting, ideally an adolescent health center, school health clinic, or similar where I could practice clinical work primarily but have some involvement in educational and/or public health programs also. I feel like adolescent fellowship would make me a better candidate for that type of job, but it's not like those open up all that often anyway. So I would be taking a huge pay cut, moving my family hundreds of miles, and forcing my spouse to leave their job, all for a totally uncertain future.

I've been searching job listings, hoping something that is at least a better fit (maybe a public health clinic job?) will open up in my city so I can find more career satisfaction without such a dramatic step, but no luck so far. Another part of me feels I should just suck it up and be grateful for a stable job, and join as a partner at the end of the year. I don't hate my job, and it allows me some level of work-life balance. I also worry about the ramifications for my career if I turn down partnership- I'm not sure how this will be viewed. I feel deeply conflicted, and did not expect to have this level of uncertainty after finishing residency. I hoped things would just fall into place and I would love my practice, but that clearly hasn't happened. It's obviously better than residency, but I'm still not happy and I'm not sure if I should just accept that and go with the stable choice (partnership) or turn it down, either for fellowship or the hope of something better for me that hasn't come along yet.

I really don't understand this partnership offer based on your description. They want you to work more clinical hours and add administrative duties... for the same pay? What incentive do you have to join? Is it really just stability? Is there a number of hours that you could work where you actually would make more than a contract employee?

You also mentioned that they are all much older, as in every single one. Are you the only junior physician on a partnership track? Do they seem to have any sort of stable development plan for their business? How big is this practice? Do they own their own physical plant or do they rent? What makes you think you're signing on for a group that will be there for you in 30 years?

You say you're working 40+ hours/week for 3 days/week of clinic, how is that? Are they 12 hour clinics? What EMR are they using? Are you doing a lot of clerical work? Administrative work? Or do you just feel pressured to study as a junior attending? If you're working 8 hour clinics three days a week and your practical work week is expanding to 40+ hours due to administrative/charting crap this group might be costing you more than you realize by not investing in proper administrative support (not to mention costing you a lot of happiness).

I'm not sure how to weight the option of fellowship against a good partnership offer or what you should do with regards to your debt. How much debt, BTW? does your husband work? Could you kill of this debt in a year or three? In any event, however, if the partnership offer isn't good the choice certainly gets a lot easier.

 

[Chemical X]

I really don't understand this partnership offer based on your description. They want you to work more clinical hours and add administrative duties... for the same pay? What incentive do you have to join? Is it really just stability? Is there a number of hours that you could work where you actually would make more than a contract employee?

You also mentioned that they are all much older, as in every single one. Are you the only junior physician on a partnership track? Do they seem to have any sort of stable development plan for their business? How big is this practice? Do they own their own physical plant or do they rent? What makes you think you're signing on for a group that will be there for you in 30 years?

You say you're working 40+ hours/week for 3 days/week of clinic, how is that? Are they 12 hour clinics? What EMR are they using? Are you doing a lot of clerical work? Administrative work? Or do you just feel pressured to study as a junior attending? If you're working 8 hour clinics three days a week and your practical work week is expanding to 40+ hours due to administrative/charting crap this group might be costing you more than you realize by not investing in proper administrative support (not to mention costing you a lot of happiness).

I'm not sure how to weight the option of fellowship against a good partnership offer or what you should do with regards to your debt. How much debt, BTW? does your husband work? Could you kill of this debt in a year or three? In any event, however, if the partnership offer isn't good the choice certainly gets a lot easier.

Thanks for your reply...I wouldn't be required to work more hours as a partner, but I would be expected to participate in more administrative duties (join committees/go to more meetings/etc) which would definitely take up more of my time. However, the financial structure seems heavily weighted towards those who work full time- the administrative and site fees we all share are essentially the same for all partners regardless of how many hours you work, so if you work 3 days instead of 4 or 5 your margin of profit after meeting those expenses is a lot lower. Obviously this is a choice, but with an infant at home and possibly another in the coming 2-3 years I don't foresee increasing my hours much if at all for some time. It does not seem fair to me that the fees are not proportionally less to match your hours if you work less, even though you use less staffing, supplies, etc; but that is how the partnership is and I don't know if it will change in the near future. I also have to factor in the partnership buy in cost, which is usually spread over several years and deducted from your draw of the profits during that time.

The practice has several other clinics, and the other locations all have at least a couple other younger physicians (partner track or new partners)- the site I'm at is the only one where I'm by far the youngest. Our site is also the least busy of the group, which I think is mainly due to our geographic location, lack of public transport options, and lack of proximity to a hospital that delivers babies. So for the group as a whole, it is probably sustainable, but at my site I feel somewhat isolated and challenged in building a practice.

I do get along well with one of the newer partners at my site, she is >10 years out of residency but that still makes her the closest to me in age/experience at this clinic, and she has younger children at home also. The others are all 20 years into their careers with children out of the house or in high school. They have established patient panels and seem relatively unconcerned about the challenges of building up a practice at this location, which (again, unlike the other clinics in the group) is not located near a hospital supplying newborns or close to public transportation. These are things I didn't even know to consider coming out of residency. They seem to consider it my job to "market myself" to bring in patients, which is fair to some extent but I don't think will completely overcome the other issues. They are also far removed from the challenges of balancing young children with work, and I get the overall impression that at least the male partners see it as something of an indulgence to work part time (despite the fact that they have wives that stayed at home to raise their kids and did not work at all).

As for the hours, I am scheduled for generally 8.5-9 hrs a day of clinic, plus newborn rounds before clinic 2 days a week (again, at a hospital that is pretty removed from our location, so I don't get many ongoing patients out of it), call about once a week (mostly home, call although with occasional delivery attendance), and q8-10 weekend call which includes working weekend clinics. Charting easily takes another 1-2 hrs a day, plus the usual returning phone calls to families, following up labs and referrals, etc. So my workdays, with rounds, clinic, charting, and other tasks generally are 10-12 hrs. Maybe I am inefficient, but this seems comparable to most of the other physicians at my clinic. I do feel that there is generally decent administrative support, but many things seem like they can't be outsourced (discussing abnormal test results with families, for example, or reviewing labs/medical records/consult notes). Finally I would estimate I spend another 5-10 hrs/month attending meetings outside of my scheduled hrs, either for our clinic, the group, or the hospitals we round at. Putting all of that together, I easily average >40 hrs/wk.

I really have no basis for comparison- is all of this excessive? This is a big part of why I wanted to cut back the number of days I worked after having a child- I hardly see my son the days that I work. When I talk to my friends at other practices, they seem to have similar workloads. I haven't met many physicians in any setting who actually work an 8 hr day, although it would be great. But I really don't know exactly what's "normal" or what I should expect.

Regardless of the reasons why the demands and financial aspects of partnership are challenging at this particular clinic, your point is well taken though that my choice is made simpler by the reality that I would likely not earn more as a partner despite taking on more responsibility. I do lean towards not joining...I just feel unsure of what to do instead, and afraid of turning down an offer for a stable job with a respected practice in my city just because it's not a good fit for me. Am I being petty?

 

[Perrotfish]

Regardless of the reasons why the demands and financial aspects of partnership are challenging at this particular clinic, your point is well taken though that my choice is made simpler by the reality that I would likely not earn more as a partner despite taking on more responsibility. I do lean towards not joining...I just feel unsure of what to do instead, and afraid of turning down an offer for a stable job with a respected practice in my city just because it's not a good fit for me. Am I being petty?

Being petty means being hung up on what you objectively know is a small part of a deal but which you are subjectively having a lot of problems getting past. Having doubts about a partnership because you really don't like the fact that everyone shares on office is, arguably, petty. Having doubts about a partnership offer because they have no mechanism to help you build your practice, pay you less than a contractors market rate for the hours you work, and require a lifestyle you don't want to commit to is not petty. Its a business negotiation and those are the core components of a business negotiation. There is definitely no sense in signing a partnership contract which would cut your pay not just now, but for the foreseeable future if you continue to practice the way you want to practice.

I would be really curious to know how much you earned during the last two years. It sounds like the core problem with your working life is that you want to be working part time (3 days/week) but accepted a partnership track position that adds an enormous amount of extra call, nursery coverage, weekend coverage, and meetings (5 hours is a LOT of meeting time for a contract worker). Are you really being paid for those days or are those basically sacrifices that they're foisting on you because you're moving towards partnership? Do the senior partners cover a comparable amount of call or is it all given to the new guys? There are ED and urgent care coverage jobs that actually pay by the hour without ancillary duties, it may be that all you really is urgent care work where you can work 3 days a week for 30 hours rather than 40+, it might be that you are putting yourself in a situation that's harder than it needs to be.

The larger question of what to do with your life, of course, depends on several other factors. Does your husband work, and if so can his job move? How committed are you to living in your home city? How bad is your debt? Is it the total number of hours a week that bothers you or is it more the length of the day? Do you see yourself feeling good about working 50-60 hours a week once you have all the kids you're going to have in school? How many children do you ultimately want? What do you think about ED work? Adolescent inpatient work? What do you think about the other more outpatient subspecialties like pulm, GI, or development?

 

[didja]

I think you should just apply for the kind of jobs you want now as a pediatrician with interest in public health and adolescent health, don't bother with the adolescent medicine fellowship.

 

[BigRedBeta]

I think your current practice setup is a nightmare, and joining at the partner level is only going to further entwine you and prolong your misery. You have a chance to get out.While I can't say for certain, I don't think turning down a partnership offer for a position that is not working in your favor will be looked upon poorly. People change practices not infrequently, and you can honestly say that it ended up not being a situation that worked out the way you hoped (even citing the fact that you entered the contract before you had a child and you didn't realize how that was going to alter your perspective on things).

I agree with you wholeheartedly that the Ado med fellowship is ridiculous at 3 years. Your interest in treating adolescents is your selling point though and that's where you have a chance to fulfill your passion. Truthfully, not many pediatricians get excited about taking care of teenagers, and the fact that this is what you readily identify as your sole remaining "passion" represents an incredible opportunity. But there is no way, unless you were completely adamant about obtaining an academic position, I would ever recommend you pursue fellowship training. It's just not needed at this point in current practice.


I have friends from residency who similarly loved working with the teenagers, and when searching for jobs, they were advised by faculty mentors to actively "sell" that trait to practices they were looking at joining - there are opportunities within large practice groups to become that adolescent "specialist" who the other docs will transition care to as the patients get older. My one friend who most successfully made this position work is not 100% teens on his patient panel yet, and he does end up getting a lot of sick visits for younger kids thrown into his schedule because he's still building his panel and his schedule is more open, but he views it as a way that is building familiarity with kids and families for when they do eventually transition to him in the coming years. He is also building relationships with internists in the area to facilitate transition to adult care for the more complex patients in his group, and working with the athletic trainers at the high schools in the area doing outreach for concussions and advocating for pre-participation neurocognitive testing more directly.

What I'm getting at here, is that there are more opportunities in front of you than what you've outlined. How attractive those individual options are depends on your situation: emotionally, financially, academically, and socially, including your family situation. The area in which you live may also be a limiting factor (if you're in a more rural area or not for example).

As an outsider who doesn't have to live with the decision being made, it's easy for me to say that you should take on the uncertainty of not renewing your contract and start utilizing your network to see if other practices would be interested in hiring you in a role that you define in terms of patient population. Just looking at open positions is probably not going to be enough to get you what you want and deserve. Working outside the typical paradigm and creating a niche means you're really going to have to negotiate with groups. This will require you to actively prioritize what aspects of joining a new practice you're willing to budge on (such as number of days of clinic, which may be a considerable sticking point) and what is set in stone - and with your current experience, you'll have much more insight into the aspects that go along with being in a practice and able to navigate that. It's possible that with less administrative work or lack of business meetings, an extra day of clinic might be more easily managed by you. Saying all of this though, only you know if your family can manage not having your income for a period, what the job market is truly like in your town, and all of the other variables that would go into this decision.

Good luck!

 

[didja]

^This

 

[BigRedBeta]

Just looking through your posts again...and realized that it sounded like you were actually within a fairly sizable group with multiple sites.

Assuming you find what my friend has done at all interesting or what you're looking for, is there any chance you could carve out an adolescent specialist role within the larger group practice as a whole (and not just your one branch location)? This might be the best of both worlds - security but also a change in focus towards your passion. You could/should bring up the need to move to a location that is best served by transit options so that the teenagers can actually make it the office on their own, and you could probably place your clinic hours primarily in the afternoons/evenings, with fewer clinic mornings that would allow you spend time with your own little ones in a more consistent manner (I hesitate to say "more time" because I think you're going to need to be flexible on something and scheduling is often the easiest thing to point to - I could easily see a schedule for you that involves 7 or 8 half day clinics (so 3.5-4 days a week total) that runs 2-7:30pm Monday through Friday, and then an AM clinic on Saturday morning and 1-2 other days of your choosing though those days will be pretty long days).

I think you should also reach out to the other physicians in the group who are younger - set up a happy hour or a barbeque or something to start building connections. As residency training has changed and the practices of pediatrics has gotten more and more specialized, that mindset has started in the training programs and grown from the bottom up, rather than top down. Your younger colleagues will probably be more inclined to see the utility in having focused patient panels and expertise in-house having "grown-up" in that training environment whereas in generations past, the ideal practice scenario was being able to see everything all the time.

The more I think about it, the more I think as a first step it's worth at least trying to have the conversation with the larger group and trying to negotiate a package that suits you within your current group. It can't hurt to ask and then from there it's all negotiations. You might try talking with the office managers first just to see what sort of volume of teens there are in the practice. And it never hurts to have nurses on your side, so possibly talking with a few of them who you think might be interested in getting away from the babies and toddlers.

If you do decide to try this, you've got to make sure you've done your research and be able to explain how this will benefit the practice as a whole, the plans you have for advancing care of adolescents (e.g. transitions to adult care, relationships with the school districts regarding athletes, public health initiatives), and how you'll build this patient panel, (which I think should be easy - a few direct mailers to all the parents with teenagers and kids older than 9, the office hours built around school/athletic/social commitments, etc). If you could get this all figured out soon, you could get everything set up in time for sports physical season in mid-summer, which would REALLY build your patient list!

 

[Chemical X]

Just looking through your posts again...and realized that it sounded like you were actually within a fairly sizable group with multiple sites.

Assuming you find what my friend has done at all interesting or what you're looking for, is there any chance you could carve out an adolescent specialist role within the larger group practice as a whole (and not just your one branch location)? This might be the best of both worlds - security but also a change in focus towards your passion. You could/should bring up the need to move to a location that is best served by transit options so that the teenagers can actually make it the office on their own, and you could probably place your clinic hours primarily in the afternoons/evenings, with fewer clinic mornings that would allow you spend time with your own little ones in a more consistent manner (I hesitate to say "more time" because I think you're going to need to be flexible on something and scheduling is often the easiest thing to point to - I could easily see a schedule for you that involves 7 or 8 half day clinics (so 3.5-4 days a week total) that runs 2-7:30pm Monday through Friday, and then an AM clinic on Saturday morning and 1-2 other days of your choosing though those days will be pretty long days).

I think you should also reach out to the other physicians in the group who are younger - set up a happy hour or a barbeque or something to start building connections. As residency training has changed and the practices of pediatrics has gotten more and more specialized, that mindset has started in the training programs and grown from the bottom up, rather than top down. Your younger colleagues will probably be more inclined to see the utility in having focused patient panels and expertise in-house having "grown-up" in that training environment whereas in generations past, the ideal practice scenario was being able to see everything all the time.

The more I think about it, the more I think as a first step it's worth at least trying to have the conversation with the larger group and trying to negotiate a package that suits you within your current group. It can't hurt to ask and then from there it's all negotiations. You might try talking with the office managers first just to see what sort of volume of teens there are in the practice. And it never hurts to have nurses on your side, so possibly talking with a few of them who you think might be interested in getting away from the babies and toddlers.

If you do decide to try this, you've got to make sure you've done your research and be able to explain how this will benefit the practice as a whole, the plans you have for advancing care of adolescents (e.g. transitions to adult care, relationships with the school districts regarding athletes, public health initiatives), and how you'll build this patient panel, (which I think should be easy - a few direct mailers to all the parents with teenagers and kids older than 9, the office hours built around school/athletic/social commitments, etc). If you could get this all figured out soon, you could get everything set up in time for sports physical season in mid-summer, which would REALLY build your patient list!

Thank you for the suggestions, BigRedBeta and Perrotfish. I have considered trying to expand my adolescent care role within the group I am with, and others outside the group that I have spoken with have suggested this as well. I may try to discuss it with them, but truthfully I am not optimistic. This seems to be an overall conservative group, and their focus with new patient recruiting is entirely on newborns since this is what they perceive will build longevity for the group. Adolescents who will only be seen once or twice a year for a few years before transitioning to adult medicine do not seem to be viewed in private practice as a "desirable" group to reach out to. Further, like many practices now we are moving towards a medical home model; while there are many benefits to this, it does mean an increased focus on the PCP relationship which means less "sharing" of patients between physicians as would occur if adolescent patients were routinely sent to me at a certain age or for certain services. They also seem to want to employ only physicians who will function as a PCP that is open to seeing all ages- there are really no other docs in the group who fill a "specialty" role. That being said, I have had a number of teen females sent to me (particularly by the male docs) for GYN/birth control needs as this is not something they are excited to deal with, but this is on the order of maybe 2-3 teens a month.

Even if I could do more with adolescents at my current job, it would not alleviate my concerns about the business aspects of partnership and whether this is a financially beneficial arrangement at the current hours and location I work. Further, a private practice setting in which I see teens who are brought in by their parents and often receiving services through their parent's insurance has not proved to be an ideal situation for providing care to adolescents (confidentiality is very difficult to maintain, so I find it to be very difficult to build trust or provide necessary services when there are concerns about parental involvement). So, as I said...not optimistic.

I have also considered trying to transfer to one of the other clinics, at least 2 of them would be the same distance in terms of my commute and I think might be a better fit in terms of personalities and also financial viability at 3 days a week. As I may have said previously, part of the issue is that the site I am at has both fewer physicians (so higher site expenses per physician) and is less busy for a few reasons, so it is more difficult to be profitable there; this would be alleviated to some extent at one of the other sites. I am not confident however that this will be an option, or how it would be viewed by the group. Currently I am not aware of any openings at the other sites, and I would leave my current clinic short in terms of staffing needs, so I am not sure how open they would be to this.

I have reached out tentatively to some contacts I have in the area about job options, including with the county health departments here. So far it is not looking great, while there is certainly a need there is limited funding so not a lot of hiring going on. I will need to make a decision about partnership in the fall, and am starting to feel like I'm running out of time to find other options. I don't think I should make this serious of a financial and career commitment given all the uncertainty I have just because I don't have something better, but I can't afford to not work and wait for the right thing to come along either. It may be possible to negotiate extending my contract rather than joining as a partner, but I am not aware of anyone else doing this and am not certain they will be willing to do this. Obviously I have some tough choices to make in the near future...

 

[didja]

Sorry to bump an old thread, and I'm not sure if the original poster is still around on SDN but any follow up?

 

[drkristy85]

yes I am curious too....how did it turn out?