Picking the first job after fellowship

[Slowpoke]

I'm personally looking into options in the realm of academic medicine and have applied broadly with interviews across the nation. I've called upon SDN at most major milestones during the career in medicine, so I wanted to do the same for this big transition. Were there factors that were important to you coming out of fellowship that you realized wasn't actually important and what factors ended up being more important than you realized? I'm trying to weigh picking a cush job with primarily bread and butter in a great location vs a busier practice, with more advanced procedures, in suboptimal locations, but potentially higher income.

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[lobelsteve]

Make you happy first with location and perceived style of practice.
No one ever has anyone on high dose opiates.
No one ever does suspicious/marginal procedures.
Don't buy a house until 18 months in.
Don't go on the internet for advice.

 

[drrosenrosen]

Advice I heard but didn't follow and wished I had: Continue living like a resident, stash all the extra money into a fund that allows you to pick up and relocate if you need to. Don't buy a house until 18 months in - everything can seem great at first until it doesn't.

Agree w/ Steve on practice style - you have to be comfortable with everything your partners/employers are doing.

 

[paindoc007]

Good advice above. To add, looking back, I think the medication piece is really important. What’s the philosophy of the group you’re joining? Make sure that aligns to some degree with you. Don’t be the 100% interventional guy, thinking when you’re joining a hospital/group where all the other pain docs are opioid writers, and assume that’s going to go smooth. Patients, referring pcps, are going to get pissed off real quick.

 

[Agast]

I'm personally looking into options in the realm of academic medicine and have applied broadly with interviews across the nation. ………

I'm trying to weigh picking a cush job with primarily bread and butter in a great location vs a busier practice, with more advanced procedures, in suboptimal locations, but potentially higher income.

These are both academic opportunities or are you talking about private practice as well? If strictly academia I would pick bread and butter in a great location. Bureaucracy is death by a thousand paper cuts so you might as well enjoy the lifestyle outside of work.

 

[specepic]

Make you happy first with location and perceived style of practice.
No one ever has anyone on high dose opiates.
No one ever does suspicious/marginal procedures.
Don't buy a house until 18 months in.
Don't go on the internet for advice.

This

 

[deleted875186]

Advice I heard but didn't follow and wished I had: Continue living like a resident, stash all the extra money into a fund that allows you to pick up and relocate if you need to. Don't buy a house until 18 months in - everything can seem great at first until it doesn't.

Agree w/ Steve on practice style - you have to be comfortable with everything your partners/employers are doing.

This x 1000.

Even if you don’t think your going to be treating your partners patients often, it will happen. Have to know how they practice.

Recommend renting, at least for the first year. Don’t sign a non compete if attached to the area. Save an emergency and relocation fund.

 

[Ronin1]

Bread and butter pays the bills. Pick the style of practice that meets your personality type.

 

[oreosandsake]

Almost for everyone, your first job won’t be your last job.

Every step along the way is a learning experience. Choose work mentors wisely. PI and work comp only practice might pay you well but you might not be happy with what you’re doing.
Money isn’t everything.

Geography and proximity to desired lifestyle always trumps money in the long term. If you do buy a house, don’t tell your employer, co workers etc

 

[RoloTomassi]

Might be hard to do this as a fellow but try to make a list of factors that play into your happiness (money, autonomy, hours, time off, commute, quality of partners, quality of staff, location, office culture, procedures you like, patient demographics, payer mix, growth potential, partnership opportunities, research opportunities, etc.). Rank those items, then see which job hits the most high priority boxes.

 

[RoloTomassi]

Also, your first job you will learn a ton--how the real world works, billing/coding, networking, you'll make mistakes, you'll make changes to your technique. It's nice to be in a place that isn't too high volume, high pressure to do advanced procedures, and you're not the only pain doc, to bounce ideas, talk shop about technique, complications.

 

[drrosenrosen]

Also, your first job you will learn a ton--how the real world works, billing/coding, networking, you'll make mistakes, you'll make changes to your technique. It's nice to be in a place that isn't too high volume, high pressure to do advanced procedures, and you're not the only pain doc, to bounce ideas, talk shop about technique, complications.

You will learn at least as much in your first year out as you did in fellowship. I strongly recommend working somewhere that you can have partners to learn from/bounce things off of. It becomes much easier to work independently as you grow, but somewhere you can develop mentor relationships is invaluable

 

[SpineandWine]

You'll most likely leave your first job (I recently just left my first job) - nothing to do with job, nothing to do with anything other than you find out what parts of your first job make you happy and look for higher percentage of that in the second job -- whether it's interventions, surgeon referrals rather than PCPs, admin time, etc.

 

[agolden1]

Man I could write a book on this one at only four months in. I'll try and keep it brief though.

-Ask about opioid prescribing practices. Ask about attitudes towards concurrent opioid and benzo, opioid and MJ, and high dose opioids. Is there one partner close to retirement who didn't care about these combos and all of his patients are going to come to you as he leaves? What is your personal line in the sand regarding these combinations.

-Does the practice heavily rely on mid-levels? See if you can talk to a few of them. What's the overall mood. How long have they been at the practice? What happens to your schedule if a few if the midlevels quit? That cushy "no med management" job where all the med management goes to the midlevels suddenly gets a lot less cushy is 2-3 of them quit about the same time and you are left cleaning up their messes.

-Similarly, are the other interventional docs seeing their own followups or punting to PA/NP? If they're not seeing their own ad the PA/NP schedule is full, guess who is seeing those followups?

-See procedural flow AND clinic flow. Does the practice have enough MAs/rad techs? Do the staff endorse they have enough folks to load patients for them on a regular basis? Are there any days where PA/NP/physicians are loading their own patients and turning over their own rooms?

-Satellite clinics - Make mental note of where they are. Even if you are told one thing as far as locations you will be practicing at, if someone quits at a satellite location or volume isn't as high as expected at the primary location you were assigned, guess who the low person on the totem pole is who is going to spend a boatload more time commuting?

-Location - If there's a place you absolutely dream of being and you can't find just the right opportunity, there's nothing wrong with going on the outskirts for a while and keeping your eyes open for the right opportunity. Right now you are looking for "a job." In a year or two you can find "THE JOB."

 

[Slowpoke]

Man I could write a book on this one at only four months in. I'll try and keep it brief though.

-Ask about opioid prescribing practices. Ask about attitudes towards concurrent opioid and benzo, opioid and MJ, and high dose opioids. Is there one partner close to retirement who didn't care about these combos and all of his patients are going to come to you as he leaves? What is your personal line in the sand regarding these combinations.

-Does the practice heavily rely on mid-levels? See if you can talk to a few of them. What's the overall mood. How long have they been at the practice? What happens to your schedule if a few if the midlevels quit? That cushy "no med management" job where all the med management goes to the midlevels suddenly gets a lot less cushy is 2-3 of them quit about the same time and you are left cleaning up their messes.

-Similarly, are the other interventional docs seeing their own followups or punting to PA/NP? If they're not seeing their own ad the PA/NP schedule is full, guess who is seeing those followups?

-See procedural flow AND clinic flow. Does the practice have enough MAs/rad techs? Do the staff endorse they have enough folks to load patients for them on a regular basis? Are there any days where PA/NP/physicians are loading their own patients and turning over their own rooms?

-Satellite clinics - Make mental note of where they are. Even if you are told one thing as far as locations you will be practicing at, if someone quits at a satellite location or volume isn't as high as expected at the primary location you were assigned, guess who the low person on the totem pole is who is going to spend a boatload more time commuting?

-Location - If there's a place you absolutely dream of being and you can't find just the right opportunity, there's nothing wrong with going on the outskirts for a while and keeping your eyes open for the right opportunity. Right now you are looking for "a job." In a year or two you can find "THE JOB."

Thank you so much for all everyone’s response! FYI, I would buy your book if you sold one 🤣

 

[drrosenrosen]

Another point on satellite clinics - if there's certain locations that are just deal breakers for you, you can always try negotiating that point. My current practice has a couple of satellite locations, but since I'm on one side of town, one of the locations is like 2 hours away from me. They told me that I wouldn't be going there, but I had it written in my contract that I would not work there.