During my tenure in health care, I have observed physicians who have delivered treatment to patients who had lost hope of ever improving their quality of life. And though medicine has never claimed to be a perfected science, practitioners’ deciding where to practice and making decisions about a course of treatment are universally founded on the evolution of discovery and technology creating recognized practice protocols.

As a provider, your diagnostic and treatment strategies are guided by knowledge, experience, best practices, protocol standards, gut instinct and logic.

Most interesting to me is that, during their search for a new position, some incredibly intelligent and accomplished practitioners voluntarily paralyze themselves by casting such wide nets that they are faced with an unmanageable number of options.

Based on my experiences, I have come to conclude that this approach is derived from a need to tempt the unlikely, daunting curiosity about possibilities, a fear of missing out on the “perfect job” or an anxiety of making the wrong practice choice. And though some have taken an adventurous leap into an unexpected practice in a “now or never” location, the majority of job seekers lack the time or engery to stray from their recognized reality.

What’s your reality?

Last spring, I was assisting a Pediatric PGY3 who sought a position near her parents in North Carolina. Following our conversation about an opportunity near Raleigh, she expressed a sincere interest resulting in a site interview. Upon her return, we visited about her trip. She was highly enthusiastic about her prospective colleagues, the hospital and lovely community. Despite the practice’s interest to move forward with a formal offer, she shared that she was not ready to make a final decision. Throughout the next several months, the pediatrician interviewed with another practice in North Carolina, as well as opportunities in Washington, New York, Wisconsin, Ohio and Florida. More than six months post-interview, the group near her family in Raleigh and I received an email from her announcing her decision to move forward with their opportunity.

But as a result of her unresponsiveness to our calls and emails following her visit, she was unaware that the group had interpreted her silence to mean that she had no interest, and they signed another physician.

As a rule, practice searches are rarely a “one and done” proposition. For this pediatrician, her reality was that she was always going to choose a position in North Carolina. Her interviews in Washington, New York and Florida were an excerise in exploring possibilities. The Ohio interview was the outcome of falling prey to a persuasive recruiter who made unattainable promises. Wisconsin beckoned because of the potential of living near a friend from college.
Six months later, jet lagged, stressed, exhausted from juggling site interviews and difficult rotations, she discovered that in the end, her core practice decision had not changed since she began the process. Her final decision was to relocate to a practice near her parents in North Carolina. And though she did accept a position in North Carolina, to her dismay, it was not the job she most wanted.

As someone who has stood on the sidelines of hundreds (and at the risk of aging myself) even thousands of physicians’ practice searches, I have come to conclude that for most people, the reality of practicality and responsibility takes precedence over dreams of possibility.

For those inclined to heed the path less traveled, explore away. However, and at the risk of being a buzz kill, be aware that while you are on your expedition, the interview process halts for no one, and a desired position may close by the time you circle back.

Physicians searching for new positions should follow a similar structure as those they use in the practice of medicine. Diagnosis and treatment follows a structured process. Initially, information is obtained and the situation assessed. A plan is devised and strategies executed seeking a desired objective. This organized approach used in everyday practice is an optimal format when searching for a new practice opportunity. It will also help you streamline your search, have the support of a well-thought-out plan, and ease the stress that comes with making a major decision for you and your family.

Your job-search plan
As we embark on the initial step of your search, I suggest  creating categories vital to your search. Most commonly, that includes geographic location, practice preferences and community offerings. Next, revisit your thoughts about what you envisioned your career and life to be as you pushed through your academic training and residency. Oftentimes, this core truth will serve as the root of your final decision.

Talk it out
The next step is critical to your success: Devise a “needs vs. wants” list under each category. Make a list of both needs and wants that you will later merge with your significant other’s preferences. To that point, before applying for your first position, make sure you have had a face-to-face conversation with your spouse or significant other about their needs and wants. Stop. Read this again. Talk. Do not presume to know what is important to your significant other. Misunderstandings about “must have” versus “would be nice” items, whether yours or a loved one’s, serve as the greatest deal breakers.
Start the conversation with yourself and your loved ones with a common understanding that items listed as needs are essential for survival and wants would be nice but aren’t necessary. Rest assured that needs and wants have been known to migrate back and forth. When you have narrowed your practice choices to a final three, you can allow more flexibility in redefining the needs and wants on your list.

Start with your needs

A fundamental principle in physician recruitment states that physicians’ preferred geographic location almost always relates to some sort of personal tie to the region or state. Oftentimes, the location is within driving distance to family or friends. Additional considerations might include climate preferences or recreational offerings.

Practice considerations should include items such as practice environment (academia, private sector, government, public health service, federally qualified, underserved, hospital, university and/or clinical based); schedule (full time, part time, workdays per week, block scheduling, hours per day/shift); leadership opportunities; financial and benefit package offerings.

Your quality of life
When it comes to devising lists about community, tread cautiously. Your quality of life and overall happiness lie in the hands of the community in which you set roots for your family.

In my experience, one of the top reasons for practicing physicians to relocate is a result of a family member not being happy with where they are currently living. For the sake of conversation, this also applies to picking up roots and relocating to another city or state.

Selling a home, uprooting teenagers or moving away from an established life without the full support of all parties involved many times is a non-starter for a practice search. As a compromise, many physicians successfully secure a new position within 30 to 45 minutes of their home base. Should relocation be in your plan, make sure to include additional items like the proximity to places of worship, shopping, cultural venues and schools.

The interview

As you entered the interview stage, prepare to incorporate your needs list into the conversation in the form of questions. Also during your evaluation of an opportunity, feel free to explore items on your want list with the recruiter—but make sure to position them as such, to avoid misunderstandings about your priorities.

Decision time

After vetting a comfortable number of opportunities, I recommend narrowing down your choices to a final three. As a fan of HGTV, I like to refer to this as the House Hunter Decision phase. At the end of each show, the buyers discuss the pros and cons of each of their three options. They then exclude one, leaving two. For our purposes, this is the point in the process when items on your want list come in handy. Ask if one of the opportunities offers all your needs and more of your wants than the other. Or perhaps there are more wants and fewer needs for one compared to the other.

Whatever you decide, one thing is definite—your deliberate approach resulted in your well-deserved happy ending. Congratulations!

Patrice Streicher (patrice.streicher@vistastaff.com) has 26 years of experience in physician recruitment and patient care delivery systems. She is Associate Director at VISTA and has served on the National Association of Physician Recruiters (NAPR) Board of Directors since 1996.