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Planning a Career Strategy

by Patrick C. Alguire, MD, FACP
Director, Education and Career Development, ACP


Most residency and fellowship programs do not offer guidance on finding employment after training. Nevertheless, to be successful in securing the best position, you need to complete a number of tasks in their proper sequence. Topping the task list is creating a career strategy, yet the most common mistake made by residents and fellows is beginning the job search without a clear and definite plan. Consider this: somewhere between 40% and 60% of newly graduated physicians change their job after just 5 years. In my own case, it was after 6 months!

A career strategy entails nothing more than making a choice based upon what is important to you. Some important factors to consider might include family priorities, location, financial requirements, and working conditions. To help organize your thoughts, write down the answers to the following 12 questions:

  1. How do you wish to practice medicine?
    1. as a hospital employee
    2. in a single specialty group
    3. in a multispecialty group
    4. within an HMO
    5. solo
    6. in another setting (urgent care, outpatient student health, public health department)
    7. no preference
  2. What kind of compensation would you most prefer for your first professional practice?
    1. income guarantee
    2. salary with a production bonus
    3. bank loan
  3. What level of compensation do you expect in your first practice?
    1. $75,000-$100,000
    2. $100,00-$125,000
    3. $125,000-$150,000
  4. How do you view working in a managed care environment?
    1. prefer
    2. do not prefer
    3. have no preference
  5. In what type of setting do you prefer to practice?
    1. urban
    2. suburban
    3. rural
  6. In what type of setting do you prefer to live?
    1. urban
    2. suburban
    3. rural
  7. What type of school system will be important to you?
    1. public schools
    2. private schools
    3. not an issue
  8. What is the most important consideration in selecting your first professional practice setting? The second most important consideration?
    1. geographic location
    2. financial compensation
    3. quality professional environment
  9. What type of patient mix do you prefer?
    1. all hospital
    2. all ambulatory
    3. mix of hospital and ambulatory (specify)
  10. How many hours per week do you wish to work (excluding call)?
    1. less than 35
    2. between 34 and 45
    3. more than 45
  11. How many days of call each month are you willing to take?
    1. 4 -5
    2. 6-7
    3. 8-10
    4. more than 10
  12. How important are job opportunities for your spouse/significant other?
    1. essential
    2. very important but not essential
    3. not important

You may wish to rank these 12 factors as most important, important, and least important. Use your ranked list when assessing the desirability of job opportunities, making the best match between the various opportunities and your needs. Meeting most or all of your career needs will not guarantee job satisfaction, but it does represent a rational approach to career planning.

The information in this paper was drawn in part from "Making the Right Practice Decisions in a Rapidly Changing Environment" published by ACP.

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