By Alyssa Molina, MD
When it comes to residents transitioning into practice, there are a few things I would stress. Know where you would like to be on the job continuum between autonomy and security. You could have a completely autonomous position. You own your own practice, you decide when you’re opened, when you are closed, and what you do. While you’ll have complete autonomy, you won’t have security. If you are sick and you don’t come to work, you don’t get paid. At the other end of the spectrum, you have the security of being employed by a practice. In that practice, they decide how many patients you see, how many vacation days you get, and so on. There’s very little autonomy, but you have job security. You always get a paycheck, and it doesn’t matter how many patients you see. Most jobs are somewhere in the middle so, it’s important that you figure out for yourself, and your family, where you are comfortable on the spectrum.
Where I’m currently employed, I have a lot of autonomy. If I choose to take off, I just make sure I’m not on call and that someone’s covering the clinic. I’m paid based on my productivity so there isn’t a certain number of days I have off each year. If I’m willing to take a smaller paycheck, I could take off more days and still have a job when I get back. Where I am on the continuum provides me with a base. They do all the billing for me, so I don’t have to worry about that.
Figure out where you’re comfortable on the security and autonomy scale, because being in the wrong place on that scale can affect your happiness. People who need to be independent probably don’t want to work in a place where they have no say in who gets hired and what gets done. People who thrive with that kind of autonomy might be miserable in that type of practice. If you need the security of knowing how much money you’re making every month, that you have good benefits, and that you have to see a certain number of patients, then you’d likely be drawn to a practice that provides more security. It’s incredibly important to know yourself when picking a practice.
Keep in mind, you’ll probably see the people you work with more than you see anybody else. Make sure you like the people you work with. It’s important to find a practice where your personality fits in with the culture. If you are miserable at work, it’s very hard to be happy outside of work. Get a feel for the people who work there. Make sure you can spend time talking to the people already working there, and if you can, try to have lunch or dinner with them. Interacting with them before you accept the position will help you figure out if you’ll get along with them and if they have helpful natures.
When you first get out of residency, you’re going to have a lot of questions and you’re going to feel like you’re flailing. During this transitional period, it’s very helpful to have an officemate you can ask questions to who isn’t annoyed by your presence. Consider asking yourself these questions about the position you are thinking of taking: Will you have to compete for patients? Is the practice busy enough to handle another physician? Do they seem excited to have you there?
I have a colleague who accepted a job at a hospital. The hospital wanted her there, but her officemate didn’t. She also had to compete for patients with her officemate and it made her miserable. She ended up getting out of her contract early because of it. You need to know these things before you sign on.
It may seem obvious, but be sure to read your contract. Make sure you understand every piece of it. At the end of the day, it doesn’t matter what was said, the only things that matter are what’s written. If you’re not comfortable with — or you don’t understand — your contract, hire a contract attorney to make sure your interests are taken care of. If things hit the fan, your contract is the only thing that matters.
Now once you get into practice, know your limitations but be willing to stretch them a little. Be willing to ask for help, and make sure you put a system in place to ask for help. I’m really blessed to work with Russell Thomas, Jr., DO, MPH, and Ray Cantu, MD. Both of them are very knowledgeable, kind, and wise physicians. When I have questions, I ask them. They give me good advice on how to manage patients, where to look something up, and which specialists to trust. Knowing when to ask and figuring out whom to ask for help early is important because you’re going to need help at first, and that’s okay. You’re supposed to need help at first.