Important Factors for Picking Your Practice
Sidney Christiansen, MD
Over the course of your career, you will face several important choices that define your career trajectory. Whether it is your choice of specialty or your geographical practice location, these decisions can have a big impact on your day-to-day practice. One of these decisions that does not get as much attention, yet can be equally impactful, is the type of practice you choose.
From a general perspective, practice type can be categorized as private practice, health system, etc. However, you need to account for the more specific factors that exist within these categories. If you keep these considerations in mind, you will be well prepared to take on your first job search.
Volume
How many patients are you expected to see daily? Weekly? Annually? The volume of patients you encounter has a direct effect on your compensation and quality of life. If you are eager to start earning and paying down your student loans, then a higher volume of patients may be right for you. Of course, this is only if your compensation plan is contingent on the number of patients you see and the type of procedures you perform.
The general rule of thumb is try to keep your patient volume to at most three to four patients per hour. Anything above that could contribute to diminishing quality of care and put you on the path to burnout. While you cannot always control patient volume, you can set your expectations during employment contract proceedings.
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Hours of Operation
If you are paid an annual salary, then understanding office time requirements is key to making sure you are not being overworked relative to your compensation. Many practices have posted hours of operation, such as the typical 8 am to 5 pm, but can pressure you with informal expectations to work beyond these hours. Especially if patients have run late and your schedule has been shifted.
The burden rests on you to make sure that seeing one or two patients after hours does not spiral into an extra 30 patients a week or 10-12 extra hours of work. You have a choice in how much you work when you establish your employment agreement, so do not be taken advantage of by your employer.
Of course, you can still go above and beyond for your patients, but you should be recognized for those efforts, financially or otherwise.
Call
In similar fashion to hours of operation, there needs to be a defined limit on the amount of call you take. Signing up to take a lot of call is not an issue, but being required to take call that you are not contractually obligated to take – or paid for is a problem.
Also important to consider, is who will be assigning call, how you will be paid for call, and how holidays are assigned for call. These are all things you can negotiate. If you find that call requirements do not match up with the way you want to practice, then you always have the option to look for employment elsewhere.
Practice Sites
If you are employed as part of a health system, it is very possible that you will be expected to cover more than one of their practice locations. In areas with higher population disbursement, the distance between these sites can be several miles. Clearly this can have effects on both your professional and personal life.
The two main factors to consider in this scenario are your ability to manage your time and where you will choose to live. Also, consider that you may be serving an entirely different patient population from site to site.
Working at separate locations is a common, yet glossed-over, detail of employment contracts. If you are going through the hiring process alone, make sure to keep it in mind.
Turnover
Turnover is a revealing metric when it comes to the health of the practice and how they treat their physician employees. A high turnover rate is a signal that you may not want to sign on with a potential employer, even if the offer sounds good.
Unfortunately, practices that are under poor management or have other issues try to conceal this and sell the practice to a physician. Avoid practices with high turnover, even if you are eager to start practicing. You can find out about turnover by asking in-depth questions during the hiring process or reaching out to former physicians.
Your Choice
Practice type has a significant influence on your career. The good news is that you get to choose. While the factors you need to consider may seem overwhelming, being diligent throughout your practice search will prove valuable to you over the course of your career.