Finding The Right Family Medicine Job for You

Finding a ‘perfect’ physician job can be daunting. The process of finding employment consistently ranks high on the life stressor index. Whether you are a newly minted physician finding your first job or a seasoned family doc looking to relocate, there are many considerations and priorities to review. No matter where you are in your career, these tips can help you streamline your search priorities and help you to consider the ‘intangibles’ to find the position that’s best for you.

The Big Picture

Most job searches start with the salary required, preferred location and practice type. While salary considerations are often the biggest factor and can narrow down the search, it can also box you in. Many urban areas which command higher salaries are saturated and often come with undesirable intangibles. If you limit yourself, you may miss better opportunities in outlying communities, such as better work- life balance or a more supportive work culture. Additionally, if loan repayment is a concern, underserved communities often offer loan payback packages.

Most docs know before graduating residency if they are planning on outpatient or hospital/urgent care medicine. While both have their pros and cons, consistency of patients, call and shift hours are often cited as why physicians choose one over the other. Outpatient clinical settings allow for growth opportunities, patient consistency, lower acuity and ownership/autonomy opportunities, but may come with more call and unpredictable schedule changes. Hospital and urgent care medicine allows for consistent shift work and the ability to check out at the end of the shift, but often at the expense of autonomy. If you are one who likes to leave work at work, the latter might be a good fit for you. Know your priorities to get the right fit.

Geography may also be a factor, especially in two wage earner households. A rookie mistake is to limit the geography to too small a region, in essence limiting opportunities. If geography is a concern, be sure to cast a big net to optimize your options.

Preferred Schedule and Patient Population

Do you prefer locums, part-time or full-time work? Do you like large clinical settings or small one to two doc offices? Do you want to include specific populations in your practice such as obstetrics, geriatrics or pediatrics? Do you have special skills, such as being bilingual, that would make a Federally Qualified Health Clinic or specific area attractive? When considering your options, questions like this help to guide you to the best match for you.

If you enjoy teaching, you might seek a position affiliated with a residency program or near a medical school. While teaching may slow down your practice, mentorship of students and residents can provide lasting relationships that can lead to practice partners.

Vacation hours, schedule and days off are also important in lifestyle balance. In many bigger clinics, having days off consecutively is a privilege earned, so newbies may get a random day off in the middle of the week. It can be a negotiated factor if you are aware of the clinic policies. Many doctors want to be able to control when and how much they work. That can be challenging in specific circumstances. If that is important, discuss it up front. Vacation may be doled out in a lump or earned based on hours worked. Understanding ‘paid time off’ can help you know how soon you might be sipping Mai Tai’s on the beach in Hawaii.

Practice Compensation Structure

In medicine there are many different types of fee structures to consider. Here are a few to think about:

Fee for Service (FFS) - A model that bills the patient per service or procedure. This type of payment structure can lead to more procedures and visits and comes with an increased office administrative burden. Staffing needs are higher as each service is billed individually, creating a higher volume of billings.

Capitation (CAP) - A model that pays the physician a pre-arranged set amount per member per month (PMPM) for an agreed upon number of patients assigned to that practice. These plans are meant to control costs and unnecessary procedures which may be seen in FFS models. CAP benefits are a healthy patient population and more focus on preventive care, as well as a more predictable payment structure. CAP can be challenging if there are many difficult, aged, or severely ill patients in your CAP panel.

Value Based Payment Systems (VBPS) - Value based payment systems tie the payment amounts to the outcomes and to patient satisfaction. The goals of VBPS are to provide the best patient experience, to advance health equity, to improve patients’ health outcomes, and to deliver health care services at a reasonable cost. This model also focuses on the well-being of the health care workforce. Disadvantages to this fee structure are seen when there are patient complications, unhappy patients or a physician consistently delivers ‘below satisfactory’ work.

Bundled or Episode Based Payments (BEBP) - This model bundles a fixed payment for a specific diagnosis or procedure together. The benefit is a more collaborative, efficient, and team-oriented care, and more predictable costs and payments for providers and patients. Disadvantages are seen when healing times are prolonged, as in a knee surgery patient with a complicated recovery.

Concierge - A membership-based model in which patients pay a monthly fee to have more convenient and personalized access to their physician, including same day appointments. It is not meant to replace insurance but to supplement it. The patient agrees to pay the physician directly, and insurance is not billed for the services provided. Benefits include a streamlined practice with fewer employees and an improved physician work-life balance. Disadvantages include exacerbating the shortage of primary care physicians in the workforce. Patients as customers also changes the physician/patient dynamic.

Understanding these payor systems and the average number of patients visits per day can guide you to the right fit for you.

The Intangibles

While salary and location are often cited as reasons docs take a job, the intangibles are often the reason for leaving. Intangibles are often difficult to assess from an employer’s website, but include factors like the work culture, administrative burden, company values, electronic medical records training and growth opportunities. For the ‘non-digital native’, the burden of charting is often far more taxing than the practice of medicine. If you fall in the ‘non-digital native’ category, positions that support AI charting software or scribes may reduce the burden.

If you like consistency in your practice, you may not be happy with a ‘shared medical assistant’, which many clinics have adopted to save money. In this scenario, the MA is shared in a medical ‘pod’ that works with more than one physician’s patients. If you have a busy practice and the MA is needed by another doc, this can lead to schedule delays and unhappy patients. Find out up front if you have a designated MA to save headaches later.

Another intangible to consider is your level of autonomy in the practice. While an employed position allows for security, it often come at the expense of autonomy. A new physician may welcome oversight, while a seasoned physician may find it a burden. Keep this in mind when applying for positions. A good resource to find out more about intangibles is to talk with current employees if possible.

Getting Ready to Interview

Whether it is for your first or fifth job, interviewing is a honed skill. Showing up in professional attire on time makes an impact on employers. Have a copy of your up-to-date CV handy for your interviewer to review. If you need help with formatting and polishing your CV, sites such as Upwork and Freelancer have consultants for hire. Additionally, make sure your CME hours are well documented and accurate, as some employers ask for these. Don’t be afraid to ask questions to clarify the particulars of the situation or practice. Having a list of questions ready to ask during your interview is always a good idea.

Final Thoughts

One of the biggest mistakes physicians can make during the job hunt is accepting the first job that comes their way without investigating the intangibles, work culture and satisfaction of the current employees. Give yourself time to evaluate the position fully; you will thank yourself later.