What Options are Available in Life After Residency?
Rachel Johnson, MD (University of Cincinnati)
Finding a job after residency is a stressful yet rewarding process. Four years of medical school and four years of residency culminate into one final decision: where am I going to practice? There are many factors to consider, many of which I felt like I had limited knowledge of when I started residency. Through talking to my peers, mentors and attendings I have learned a lot and wanted to pass along a few tips. I by no means know everything, not even close, but maybe enough to help a few people navigating the early stages of residency and life thereafter.
One of the most important decisions to make is choosing which type of practice setting best fits your wants and needs. In today’s market, the options largely include an academic system, a hospital based system, private practice and private equity. I will refrain from labeling things as “pro” vs “con” as this really differs from person to person.
Academic System: This is likely what most residents are familiar with and exposed to as they go through residency. These positions occur at teaching hospitals affiliated with a university or medical school. Your responsibilities are split between teaching, research and time in the clinic. This is a salaried position often with a productivity bonus. Overhead is handled by the teaching institution and there may be some loss of autonomy and sometimes efficiency when compared to private practice.
Hospital Based System: These are practices affiliated with hospital systems that are distinct from teaching hospitals. You are a salaried physician often with a productivity incentive. There is a variable loss of autonomy as policies are set by the hospital system. You are not responsible for overhead and often have a good referral base immediately as well as other sub-specialists accessible within the same health system.
Private Practice: This can range from a solo practice to a larger physician owned practice that may allow you to buy in and become a partner after a number of years. In this setting you have the most autonomy and compensation matches your productivity. Seeing more patients increases your income while taking time off results in lost revenue. As an owner you are in charge of the overhead (human resources, billing and collecting, rent, associate salaries and benefits, etc).
Private Equity: This is an emerging trend in medicine, and in particular Dermatology, in which private practices are being acquired by large financial investors. They help provide business input and financial backing with variable influences on the practice of medicine. Your focus is on seeing patients with a productivity based compensation similar to private practice.
Choosing the practice setting you will best thrive in is just the first step. Beyond that there are many additional factors to consider before making your final decision. This involves several objective measures that may include: hours per week, salary or percentage of collections, signing bonus, CME money, vacation days, student loan forgiveness, moving expenses, available EMR, restrictive covenant, supervising responsibilities, etc. Other influential factors that are more subjective and equally important include practice environment, collegiality among associates, administrative support and billing support. This is just the beginning of the discussion as each resident embarks on their own journey to finding life after residency. Medical school and residency are a huge investment on many fronts, so I encourage you to explore all your options and hope everyone finds the practice they have been looking for!