The Important Considerations for Starting a Career in Medicine

Last Updated on March 20, 2019 by

You’ve finally finished all those years of training and now it’s time to make a decision second only to choosing a spouse—what you will do for the rest of your life. You’re probably thinking about salary and getting rid of debt, but those are secondary issues. First of all, your employment choice should fit with your long-term vision and plan for you and your family. Second, you should fit into the culture of your future practice or organization.
Long-term plan, what long-term plan? I’ve just been trying to make it through all these years of residency. Probably so, but now it’s crucial to think down the road at least ten years. Make sure that what you do next year gets you to your desired future. What do you want to be doing in ten years? Private practice? Hospital employee? Academics? Where? Does the proposed location meet the needs of your spouse and family?
Private practice offers the most freedom and concurrently, the most responsibility. For most urban areas, this will mean a group practice which will allow you to concentrate on building patient volume without having to deal with the administrative aspects of a new practice. Many groups have been acquired by hospital systems or insurance companies, and this means you are a corporate employee, a choice for perhaps 50% of those leaving training. Here you can expect, either soon or over time, an administrator monitoring your schedule and work habits, telling you how much vacation you can take, etc.
Academic medicine offers the satisfaction of teaching and research, but you will be expected to fund most of your income from your practice, so you will be working hard in these three areas. You will be stretched and stressed in several different directions.
What appeals to you? You should do your diligence by serious discussions with physicians in your field who are in all these different practice situations. If possible, follow each one around for a few weeks. Project yourself out a few years to see if this practice setting suits you.
Where? The community you choose for you and your family will make a big difference to your future happiness. Your spouse should have a strong vote here. Many doctors end up leaving their first job because of spousal unhappiness with the first location.
Once you have made the initial first cut of these decisions, you are likely to be looking at some sort of a group to join. Here your fit with the culture of that group becomes key. The first book assigned to my MBA class involved the culture of organizations and with good reason. Group culture rules. One study showed that more doctors leave their first practice because of poor cultural fit than any other reason. So what is it? The way we do things. How we treat patients. Our approach to ethics, to decisions about treatment or surgery. Some groups are aggressive or frankly unethical. Others observe the proper ethical principles but pay no attention to basic business practices with resultant high overhead. Perhaps the younger doctors are not valued and are expected to shoulder a bigger load than the older physicians. The community at large comes to ostracize some groups and adore others, largely because of culture.
Here again, your job is to determine the culture of a prospective group by observation and investigation. Ask questions and observe. Spend time in that setting if possible. Then decide if you fit. If you don’t, keep looking. It is very hard and expensive to leave a group and far better to take the time to make a good decision initially.
These few words just hit the surface of the huge task involved with finding your optimal career choice. My book, The Business Side of Medicine… What Medical Schools Don’t Teach Youcovers this topic in more detail as well as other areas.