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 Three Keys to Practice Selection - Continued

What to Consider Before you Start Your Job Search

Practice setting: Surveys indicate that many new physicians would prefer an employment setting with a hospital, group practice or other employer. However, few newly trained physicians today are seeking a solo practice, though some are still attracted to the autonomy and entrepreneurial benefits of a partnership setting. Fortunately, now, like no other time in the past, there are creative employment options to explore that allow physicians to enjoy economic security while benefiting from other perks such as favorable schedules and relatively quick paths to partnership. These practice settings are described in more detail in "Practice Settings: What's Available?" There are a number of questions new physicians should ask themselves in order to determine which setting is best for them. Do you want to do in-patient medicine, what hours do you prefer, how much after-hours work you can cope with, what type of procedures would you like to do, how much input do you need to have in group governance, are you comfortable with managed care, medical home or Accountable Care Organization (ACO) treatment protocols, do you need extensive specialty support, do you interact well with other physicians, do you need to run your own show?

Entrepreneurial physicians may feel more comfortable associating with a private-practice physician or, in increasingly rare cases, starting their own practice. Physicians who need a more controlled lifestyle may seek a group or hospital setting. It is a question of balance. If you enjoy autonomy but can't face the idea of doing paperwork and supervising a clerical/support staff, you may wish to forgo some independence by becoming a hospital or group employee. If you want to be "where the action is," you may opt for a hospital-based practice. In addition to examining yourself, you should talk to older physicians who have experienced a variety of practice settings. Being part of a staff model HMO may not appeal to all doctors, but those who desire a set schedule and freedom from the strains of building and maintaining a practice may find it satisfies their needs. While practice setting is an important factor, it is often the people who you will interact with more than the setting itself that will determine how well you fit. That is why it is critical to ensure as best you can that your personality, expectations and goals will mesh with your employers and co-workers (again, see "How to Interview").

Quality of life/Geographic location: Quality of life means something different to everyone. To determine the quality of life attributes you need, ask yourself several questions, including: What are the must-have absolutes that I simply cannot dispense with? What will I be doing with my free time and how will I spend my discretionary income? Do recreational options have to be within 30 minutes or three hours by plane or car? Do I have children, or am I thinking of starting a family, and how will this affect what I need in a community? The key is not to focus on a particular community—i.e., "I must live in Aspen, Colorado." The key is to consider what you need in a location and a community and to find a place that meets most of your needs. Number one is, you need a community where your skills are needed, where you will have a viable practice for the long-term. You may also need good public schools, because your educational debt may preclude sending your children to private schools. If water sports are essential to your wellbeing, you will need water. If finances dictate that you must have reasonably priced real estate, you may have to rule San Francisco out as an option. If museums, cafes, art galleries and the opera are what you need to be happy, you will need at least reasonable proximity to a major city. New physicians often select a location based on the fact that they trained in the community, that they are from a particular community or that their spouse is from the community—regardless of whether or not the community meets their personal or professional needs. That is one reason many new physicians end up relocating after one or two years. An analogy can be made to finding the right suit or dress. If you insist on buying a particular designer brand, you may not find the right fit. If you are more open to other options, you are more likely to find something that fits.

Once you have examined these three areas, you will be in a better position to find what you need. You will be able to seek and ask for the type of finances you want, you will know which type of setting to look for and you will have an idea of what kind of community you would like to live in. You will find that "shopping for a practice" is much like shopping for other items—it helps to know what you want and the price you will pay before you enter the market.

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